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M.G. v. Echelon General Insurance Company (18-002005)

  • October 27, 2020

The claimant sought entitlement to a neuropsychological assessment, physiotherapy, occupational therapy, attendant care assessment, and assistive devices, a special award. As a preliminary matter, the claimant sought to exclude surveillance evidence and bar the insurer from cross-examining her on an affidavit from an earlier proceeding. Adjudicator Neilson allowed the insurer to cross-examine the claimant on the affidavit, as it was evidence and was relevant to the issues in dispute. The surveillance was permitted to be entered into evidence despite the insurer not producing the full unedited video because the insurer had attempted to obtain same and did not have the video in its possession. Adjudicator Neilson awarded the attendant care assessment, occupational therapy, and physiotherapy. However, mileage fees, transportation costs, and documentation support activities from the attendant care assessment were not payable. The neuropsychological assessment was denied as it was duplicative of an approved neuropsychological assessment, which the claimant had split into two portions to avoid the $2,000 cap on assessments. Adjudicator Neilson also granted a special award of 35 percent on the attendant care assessment. It had been denied when the claimant was in the MIG, and the insurer did not reconsider the denial after the claimant was removed from the MIG.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, LAT Rules, Special Award
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