The applicant sought the costs of a chronic pain assessment. Based on an IE physiatry paper review, Aviva argued that continuing with psychological treatment alone would suffice. Adjudicator Diplas held that the cost of examination for a chronic pain assessment was reasonable and necessary. The adjudicator relied on clinical notes and records from the applicant’s chiropractor who had been treating the applicant since a prior 2013 accident, and placed significant weight on the evidence as it related to the history and chronicity of physical pain. The adjudicator also relied on a chronic pain assessment report, which was the assessment in dispute for which the applicant incurred the costs. The adjudicator held that the report bolstered his findings that a chronic pain assessment was reasonable and necessary. The adjudicator gave little weight to the section 44 paper review because the physiatrist did not physically assess the applicant and focused on whether the applicant suffered a complete inability to return to previous activities. The adjudicator further held that Aviva waived the requirements for a signed OCF-18, by scheduling an section 44 examination in response to an unsigned OCF-18.
Menu