Applicant v. Wawanesa Mutual Insurance Company (16-001539)

The claimant sought entitlement to eight treatment plans for further assessments and treatment. Adjudicator Gosio rejected all of the claimed benefits, writing that the claimant had simply repeated the contents of the treatment plans as the justification as to why they were reasonable and necessary. On the other hand, the insurer had provided the opinions of four IE assessors, who each concluded that the proposed benefits were not reasonable and necessary.