The claimant sought entitlement to a psychological assessment and chronic pain treatment. Adjudicator Victor held that the claimant was entitled to the medical benefits as they were reasonable and necessary. The claimant demonstrated consistent psychological symptoms throughout a pre-screening and two IEs. While the claimant only received a formal diagnosis from the second IE, the adjudicator held that a psychological diagnosis was not necessary. It was enough for the claimant to exhibit psychological symptoms related to the MVA that affected his life for a psychological assessment to be reasonable and necessary. While not in dispute at the hearing, the adjudicator noted that the insurer’s reasons for the denial met the requirements of the SABS and as the insurer stated that it had reviewed the MIG and the IE’s medical opinion and concluded that there was no compelling evidence that the impairment was not a predominantly minor injury. The adjudicator held that the chronic pain treatment was reasonable and necessary as the adjudicator preferred the evidence of the claimant’s expert over the IE assessor. The IE assessor’s paper review contradicted his earlier report in that it stated the claimant had returned to work and was fit, whereas the initial report stated that claimant had returned to work on modified hours and duties and continued to experience chronic pain and limitations.
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