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T.B. v Aviva Insurance Canada (17-006162)

  • September 28, 2018

The claimant sought various medical benefits, the cost of a chronic pain assessment, and a special award. Adjudicator Johal held that the claimant was not entitled to any of the benefits in dispute. The claimant relied solely on her self-reporting of her injuries to IE assessors to argue that the treatment plans in dispute were reasonable and necessary. The adjudicator held that self-reporting of pain is not alone sufficient to show that the treatment is reasonable and necessary or that she suffered from chronic pain or chronic pain syndrome. Some form of medical documentation corroborating the claimant’s self-reporting is required. The adjudicator preferred the assessors’ opinions that the claimant had myofascial pain in relation to her usual ADLs and that the treatment plans were not reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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