S.U. v. Wawanesa Mutual Insurance Company (16-003333)

The claimant sought entitlement to medical benefits; the insurer argued that the claimant had not complied with section 33 requests and that the claimed benefits were not reasonable and necessary. Regarding the section 33 argument, Adjudicator Ferguson held that the information requested by the insurer was not “reasonably necessary” to determine entitlement as the insurer had already rejected the claims prior to making the section 33 requests. Regarding the medical benefits claimed, Adjudicator Ferguson held that the medical evidence did not support that the treatment was reasonable or necessary.