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M.M. v. Aviva Insurance Canada (18-000467)

  • June 11, 2020

The claimant sought reconsideration of the Tribunal’s decision that a special award was not payable on a psychological assessment that was initially denied but approved just before the hearing. Adjudicator Punyarthi granted the reconsideration and ordered a special award of 45 percent be paid on the denied assessment. She explained that the Tribunal had made a material error of fact in reviewing and drawing conclusions from the evidence at the hearing. The adjuster had sufficient information available to determine that the proposed assessment was reasonable at the time it was requested. Once the clinical notes and records had been provided, only a paper review should have been requested or the assessment should have been approved based on the adjuster’s review of the records. The 45 percent award was based primarily on the delay of 19 months.

Full decision here

TGP Analysis

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  • FILED UNDER Special Award, Reconsideration
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