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E.M. v. Aviva Insurance Company (18-004588)

  • July 17, 2019

The claimant sought entitlement to a chronic pain assessment. Adjudicator Grant concluded that the assessment was not reasonable and necessary. The claimant had already participated in a chronic pain assessment, and the proposed assessment was duplicative. The claimant’s treatment providers were suggesting treatment rather than assessments to focus on her recovery. Finally, the claimant had not undergone surgery, and there was no reason for a further assessment prior to the surgery being completed.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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