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T.H. v Allstate Insurance Company of Canada (19-004567)

  • May 14, 2020

The claimant disputed her entitlement to two denied treatment plans, one for optometric services and one for occupational therapy services. The insurer took the position that the claimant’s impairments for which she sought treatment were not sustained as a result of the accident. Adjudicator Paluch disagreed, finding that but for the accident, the claimant would not have suffered the impairments which are bases for her current claims for treatment. While he could not deny that the claimant’s pre-accident issues may have contributed to her current impairments, the post-accident evidence showed a substantial change from her noted pre-accident health issues. The claimant’s post-accident complaints were consistent and continuous and confirmed via diagnoses in the reports and clinical notes of her medical assessors and treatment providers. On that basis, Adjudicator Paluch also felt that both treatment plans were reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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