J.P. v. Allstate Insurance Company (18-008027)

The claimant sought entitlement to IRBs and eight medical benefits. Adjudicator Boyce rejected the claims. He held that the claimant failed to adduce sufficient objective evidence of a substantial inability to engage in his pre-accident employment. All of his evidence was self-reported. Further, the claimant did not use any prescriptions to address his soft tissue injuries or pain. Adjudicator Boyce also rejected all of the claimed medical benefits. First, he noted that section 38(5) prevented the claimant from disputing entitlement to any OCF-18s while treatment remained under the MIG. With regard to two late denials, Adjudicator Boyce noted that any incurred treatment would be payable, but that the claimant failed to provide evidence that any treatment was incurred during the period of non-compliance.