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Optimum Insurance Company (16-000760)

  • March 31, 2017

The claimant sought entitlement to an in-home assessment and assistive devices. After weighing the evidence, Adjudicator Pay found the treatment plans reasonable and necessary. Although the insurer raised objections to the Reply submissions of the claimant, Adjudicator Pay stated: “Because these submissions of the applicant were not relevant to the determination of the dispute, I did not consider them. The issues in dispute focused on whether or not the two treatment plans were reasonable and necessary. In determining these issues, I considered the medical evidence. I did not consider telephone records or emails by the assessors. I also disregarded the allegation regarding production issues and the accusation of errors, misinterpretation and misleading facts. As a result, I do not need to consider the request to strike these portions of the applicant’s submissions, or to provide an opportunity to respond.”

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, LAT Rules
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