The claimant sought entitlement to medical benefits, a social work assessment, an OCF-3 expense, and interest. Adjudicator Boyce concluded that the claimant was entitled to the three medical benefits, but not the assessment or expense. The insurer agreed to fund these treatment plans subject to a ruling with respect to the amounts proposed in excess of the maximum hourly rate in Superintendent’s Guideline No. 03/14. The insurer sought a breakdown of the services to be rendered, at what frequency or at what rate. Adjudicator Boyce found that treatment plans should clearly articulate the service provided and identify the provider and the appropriate rate. Adjudicator Boyce looked to the signing provider for each treatment plan and assumed that the provider’s area of expertise was the dominant modality for each. The applicable rate for each signing provider was then used to calculate the fees for each OCF-18. With respect to the assessment, Adjudicator Boyce found no reason to interfere with the insurer’s denial and that the type of assessment did not appear to be consistent with the claimant’s diagnosis and that there was no compelling medical evidence to indicate that a social worker assessment was required as a result of injuries sustained in the subject accident. Finally, the claimant sought $200 for an OCF-3 Disability Certificate. Adjudicator Boyce agreed with the insurer that the claimant submitting six OCF-3s from the same clinic in a three-year span was excessive where the claimant had not pointed to any change in circumstance. Further, neither the claimant, nor the clinic provided particulars to support why it was necessary to provide an updated OCF-3. Accordingly, Adjudicator Boyce found that the claimant was not entitled to the expense because it was not reasonable or necessary.
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