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M.G. v. RBC Insurance Company (17-007098)

  • October 30, 2018

The claimant disputed his entitlement to NEBs and various medical/rehabilitation benefits. The dispute proceeded by way of a written hearing. Adjudicator Boyce held that while the claimant suffered from pain, the claimant managed his pain and it did not prevent the claimant from engaging in self-care and in his daily activities. Adjudicator Boyce noted that the claimant could dress himself independently, walk for periods of time, and sit and stand without assistance. The claimant also reported that he could drive and use public transportation with pacing. Adjudicator Boyce held that while the evidence submitted by the claimant demonstrated that he suffered from pain and psychological impairments, it was insufficient to meet the high threshold of entitlement to NEBs. With respect to the disputed medical benefits, Adjudicator Boyce found the cost of physical rehabilitation treatment and the cost of a chronic pain assessment reasonable and necessary given the claimant’s pain complaints. As the claimant did not advance sufficient evidence that he was not independent with his self-care, Adjudicator Boyce found that the proposed attendant care assessment was not reasonable or necessary.

Full decision here
Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Non-Earner Benefits
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