A recent decision of the Licence Appeal Tribunal
("LAT") indicates that an insurer cannot simply rely on
the opinion of an assessor when determining a claimant's
needs.
The adjudicator said that the insurer should have considered all
relevant medical evidence and should have followed up with the
assessors for clarification of the claimant's needs. The
failure to do so resulted in a special award against the
insurer.
Background
In Malitskiy v. Unica Insurance,
18-010164/AABS, the claimant sought entitlement to attendant care
in the amount of $6,000 per month less the partially approved
amount of $1,199.10. He also sought entitlement to a rehabilitation
benefit of $344,864 for home modifications and entitlement to some
cost of examinations. The claimant also sought a special award for
unreasonably withheld or delayed payments.
