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V.D. v. United Assurance Canada (17-005656)

  • December 5, 2018

The claimant sought entitlement to medical benefits proposed in treatment plans for chronic pain treatment and assistive devices (a self-propelled lawnmower and snow blower). The claimant had a pre-existing health history that included two back surgeries, and causation was an issue when determining whether the proposed benefits were reasonable and necessary as a result of the accident. Adjudicator Griffith found that the accident exacerbated the claimant’s pre-existing conditions, but concluded the claimant was not to entitled to the proposed benefits. Adjudicator Griffith found that the proposed chronic pain program was not reasonable and necessary on the basis that previous chronic pain treatment made the benefit in dispute redundant or unnecessary, the claimant did not have a psychological component to her pain issues, and the claimant had reached maximal medical recovery. The self-propelled lawnmower and snow blower were found not to be reasonable and necessary as a result of the accident given the evidence that the claimant could not perform lawn or snow removal tasks at the time of the accident due to pre-existing conditions.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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