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Y.C.T-T. and Certas Home and Auto Insurance Company (16-000872)

  • June 8, 2017

The claimant was originally placed within the MIG. During that period, the insurer denied medical benefits as well as an assessment of attendant care needs. The insurer later removed the claimant from the MIG, but did not approve the previously denied treatment plans. The claimant sought entitlement to the previous plans. Adjudicator Leslie found the treatment and assessment plans payable. Adjudicator Leslie confirmed that insurers have an ongoing duty to assess and reassess files in the course of medically managing a claim. On review of the claimant’s injuries and medical documentation, Adjudicator Leslie concluded the treatment plans were reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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