The claimant sought entitlement to 8 treatment plans, the cost of completion of two OCF-3s, and a special award. Adjudicator Lake found that the claimant was entitled to the majority of the treatment plans in dispute. She was not entitled to the cost of the two OCF-3s that were not requested by the insurer. She was entitled to the psychological portion only of a treatment plan for a multidisciplinary chronic pain program. Temporary pain reduction was found to be a legitimate goal for proposed acupuncture treatment. Adjudicator Lake denied entitlement to proposed treatment that was the same as treatment which had previously been approved by the insurer but not incurred by the claimant. A functional abilities assessment was found reasonable and necessary based on evidence the claimant was having difficulty with some personal care tasks. A special award of 25 percent of the disputed amount of three treatment plans was awarded to the claimant based on a finding that the insurer failed to consider all of the information available to it when making claims decisions.
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