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M.F. v. Belair Insurance (18-003847)

  • November 29, 2019

The claimant sought entitlement to post-104 week IRBs and various medical benefits. In terms of post-104 IRBs, Adjudicator Grieves concluded that the claimant did not suffer a complete inability to engage in any employment for which he was reasonably suited. In doing so, the adjudicator noted that the claimant had only applied for IRBs a few days prior to the 104 week mark, and found that the claimant’s previous job as a delivery driver was still a viable occupation as he had worked in that capacity post-accident. Adjudicator Grieves also concluded that none of the disputed treatment plans were payable. The claimant was independent in self-care and had returned to work and school since the accident. As such, an in-home occupational therapy assessment and occupational therapy services were not reasonable and necessary. Adjudicator Grieves also noted that the proposed psychological assessment was not reasonable and necessary, given that the clinical notes and records submitted made no reference to any psychological complaints in the two years since the accident.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Medical Benefits
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