The claimant was involved in an accident on February 9, 2006 and disputed entitlement to a treatment plan for $25,659.25 proposing catastrophic assessments. The insurer argued that the claimant had sustained only minor, soft tissue injuries as a result of the subject accident and had not established that catastrophic assessments were either reasonable or necessary due to lack of objective medical evidence. Adjudicator Grant noted that, by their nature, assessments are speculative and are conducted to determine if a specific condition exists or threshold has been met, but accepted the insurer’s position that there must be “some” suggestion that a specific condition exists in order to conclude that further investigation is reasonable or necessary. An IE paper review acknowledged that the claimant sustained injuries from the initial accident and that the current complaints were the same as before the accident, but also considered that there was no medical evidence to support that the claimant’s current pain complaints were related to the accident. The IE assessor noted a six-year gap in medical records, along with no supporting medical records to substantiate the claimant’s subjective complaints. The claimant did not provide any records to contradict those findings. Adjudicator Grant dismissed the claimant’s application in its entirety.
