The claimant sought entitlement to a number of medical benefits, as well as attendant care benefits. The insurer denied the medical treatment asserting the claims were not reasonable and necessary. The insurer also denied the claimant’s attendant care claim and cited a lower attendant care rate commissioned by an IE assessor. Adjudicator Billeh Hamud reviewed the medical evidence and preferred the evidence of the insurer’s attendant care assessor, which was not rebutted. Accordingly, attendant care benefits were awarded at the rate of the insurer. Moreover, because only one of the attendant care providers was qualified, the award for attendant care was confined to the expenses of the one PSW. As it pertained to the medical benefits claimed, Adjudicator Hamud determined that fees attached to the submission of treatment plans were compliant with Superintendent Guideline No. 03/14 and therefore payable. The substantive treatment sought, with the exception of a progress report, was considered not reasonable and necessary on review of the medical evidence.
