The claimant sought removal from the MIG and entitlement to three treatment plans for psychology services and chiropractic treatment. This case also raised the issue of whether an insurer can properly deny medical benefits for a psychological assessment and psychological treatment without requiring the claimant to attend an in-person IE for a psychological assessment. With respect to the MIG, the claimant did not provide the required evidence from his health care providers to support that he had pre-existing conditions that would prevent him from achieving maximum recovery. In addition, the treatment plans and psychological report lacked credibility and the claimant’s psychological complaints were not medically supported. The adjudicator ruled that the claimant did not sustain more than predominately minor injuries. For this reason, the treatment plans were not reasonable or necessary. In determining whether the insurer provided proper medical reasons for denying the disputed treatment plans, Adjudicator Mather was satisfied that the insurer had made it clear to the claimant what medical evidence it was looking for to substantiate the claim. Adjudicator Mather held that the insurer provided a valid medical reason for denying the benefits for the psychological assessment and psychological treatment.
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