The claimant applied to the LAT for the balance of various partially approved medical benefits. The insurer’s denials were almost entirely based on the position that the claimant sought rates in excess of the rates authorized in the Professional Services Guideline. In addition, the insurer had approved 1-hour sessions for psychological therapy, rather than the 1.5 hour-sessions that had been proposed. Adjudicator Todd found that $200 was payable for completion of OCF-3s and OCF-18s. $80 per hour was found payable for osteopathic therapy, which was less than the $150 proposed and more than the $58.19 initially paid based on the Guideline rate for unregulated providers. Adjudicator Todd found that 1.5-hour therapy sessions were reasonable.
