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Z.P. v. Certas Direct Insurance Company (19-003226)

  • June 10, 2020

The claimant suffered a catastrophic impairment and sought entitlement to three treatment plans for home modifications and assistive devices. With respect to a $9,025.30 home modification assessment, the insurer had already paid $2,000 and argued that it was the maximum payable under the SABS. Vice Chair McQuaid agreed that the maximum payable was limited to $2,000 and dismissed the remaining $7,025. With regard to assistive devices, Vice Chair McQuaid concluded that the treatment plan was reasonable and necessary for the claimant’s impairments. For the third treatment plan regarding architectural working drawings, Vice Chair McQuaid found that there was a question as to whether the claimant still wanted to pursue home modifications after the proposal of Adapt-Able was withdrawn. The architectural drawings were therefore not payable.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, Home Modification
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