The claimant disputed his entitlement to denied dental services and the remaining balance of a partially approved psychological treatment plan. Adjudicator Lake found that the claimant was not entitled to the proposed dental services or to the unapproved portion of psychological treatment. With respect to the dental services, she concluded that the claimant had not proven, on a balance of probabilities, that his tooth issue arose as a result of the accident. The claimant’s treating dental surgeon did not opine on or conclude that the claimant’s tooth issue was caused by the accident. Rather, he only stated that this was what was reported to him by the claimant. The unapproved portion of the proposed psychological treatment related to the treating psychotherapist’s hourly rate. The treatment plan sought funding for psychological counseling sessions with a regulated psychotherapist at a rate of $149.61 per hour. The insurer advised that fees could be billed for treatment by a psychotherapist at $58.19 per hour, but agreed in good faith to fund treatment at a rate of $100.00 per hour. Adjudicator Lake found that the claimant was not entitled to the unapproved portion of the psychological treatment plan, as he led no evidence that the psychotherapist specialized in CBT, nor did the treatment plan propose to provide any CBT treatment.
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