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N.A. v. RBC Insurance Company (17-005380)

  • May 23, 2018

The claimant sought payment for a TMJ assessments and oral orthotics. The insurer argued that the claimant’s dental impairments were not accident-related. The Adjudicator concluded that on either the “but for” test or the “material contribution” test the claimant’s dental impairments were not caused by the accident. In reaching her conclusion, the Adjudicator relied on the claimant’s clinical notes and records and the opinions of the IE assessors. These records revealed that the claimant’s pre-accident and post-accident TMJ symptoms were so similar that the Adjudicator was unable to conclude that the post-accident symptoms were caused by the accident. The Adjudicator dismissed the claimant’s application.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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