G.S. v. Western Assurance Company (19-003626)

The claimant applied to the LAT seeking entitlement to occupational therapy services proposed in one treatment plan. Causation was an issue at the hearing. The insurer submitted that the claimant’s concussion symptoms were caused by documented pre- and/or post-accident incidents, and not caused by the subject accident. The claimant submitted that the pre-accident incident, the accident, and the post-accident incident combined to cause the concussion symptoms. Adjudicator Ferguson found that the claimant did not sustain a concussion until after the accident, and the proposed occupational therapy services were not reasonable and necessary because the claimant’s concussion symptoms were not causally linked to the accident.