The claimant disputed entitlement to four treatment plans for physical treatments and a chronic pain assessment, an invoice for completion of an OCF-3, a MIG determination, interest and a special award. The claimant alleged that he suffered from chronic pain as a result of the accident. In support of his claims, the claimant submitted medical records from his family doctor showing a long history of complaints of back pain post-accident. The notes further indicated that treatments would give relief. The claimant also submitted a chronic pain report from a specialist. The insurer submitted its own independent reports, but never sent the claimant to independent assessments under section 44 of the SABS. The insurer raised concerns with the merits of the claimant’s report and the quality of the report itself. Adjudicator Norris agreed with the concerns, but held that the insurer did not provide a competing medical opinion to rule out chronic pain. The adjudicator ruled that the claimant was out of the MIG, that all disputed treatment plans were reasonable and necessary, that the claimant was not entitled to payment of the OCF-3 as he had returned to work post-accident and failed to prove it was reasonable and necessary, that interest was payable on all benefits, and granted a 40 percent special award for the insurer’s failure to recognize the claimant’s medical evidence, especially in light of the fact that the insurer had no competing medical opinion on which to continue to deny benefits and maintain a MIG position in light of the volume of evidence presented by the claimant.
