Wednesday, January 23, 2008

Workers Comp Claimant gets his minivan!

In an unpublished case (decided Jan 17, 2008) the Colorado Court of Appeals affirmed a decision that required the insurer to have to pay for a claimants minivan. Back in 1996 a wheelchair accessible van was denied to a quadriplegic claimant as not covered under the allowable medical benefits. Yet in this case the van was allowed not just the cost to modify the van for a wheelchair. In this area it is very much a case by case analysis and up to the Judge to determine if there was a therapeutic value. Really it boils down to how strong the medical opinions are on your need for any medical apparatus (in this case a van). So if the insurer claims it is not going to pay because of caselaw be aware that the cases vary and sometimes the insurer is mistaken. My caveat to all claimants is to let the claimant beware. Never assume the insurer is correct no matter how confident they sound to you. In the present case the van cost over $24000 and to modify it another $28000 plus. The insurer agreed to the cost of modifying the van but not for the van itself. The decision required them to pay for the van. However do not assume in all cases a van or other item needed to help you out shall be covered. Insurers can make you prove your case and may even then appeal. But it all depends on how medically needed the item is but you should know sometimes the claimant wins!

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