Category: Medical Benefits

The claimant sought entitlement to four medical benefits. Adjudicator Ferguson dismissed the claims. He held that the proposed assessments were not reasonable and necessary, and that the proposed treatment was not proven to be related to an accident-related impairment.

The claimant sought entitlement to various medical benefits. Adjudicator John awarded the all of the claimed assessments and treatment. She found that the claimant continued to suffer from chronic pain which affected her activities of daily living. She also suffered psychological injuries that required ongoing treatment. Adjudicator John was not persuaded by surveillance which showed the claimant engaging in certain normal activities. She also held that a partial release at FSCO did not prevent the claimant from disputing entitlement to the medical benefits that formed part of the LAT dispute.

The claimant sought entitlement to one medical benefits for physical therapy. Adjudicator Ferguson dismissed the claim. He held that the claimant failed to demonstrate that the claimed benefit was reasonable and necessary.

The claimant sought entitlement to a functional abilities evaluation/vocational assessment and a chronic pain assessment. Adjudicator Ferguson held that functional abilities evaluation/vocational assessment was payable up to the Professional Services Guideline limits, but denied entitlement to the chronic pain assessment. The FAE was awarded because the claimant was not able to do his pre-accident work and sought appropriate alternatives. The chronic pain assessment did not add anything to the claimant’s treatment as he was already diagnosed with chronic pain and given recommendations.

The claimant sought entitlement to payment of physical therapy. Adjudicator Mather concluded that the treatment was not reasonable and necessary because there was no evidence that such treatment was beneficial and that further treatment was required.