The claimant applied to the LAT seeking entitlement to housekeeping and home maintenance expenses, the cost of a chronic pain assessment, and the cost of two OCF-3s. Adjudicator Farlam dismissed the claimant’s dispute. The claimant had purchased optional HK expenses in her policy. The insurer paid HK expenses for February 11, 2017 to April 12, 2017. There is no evidence that expense forms were submitted by the claimant for April 13, 2017 to March 16, 2018. In this hearing the claimant sought HK expenses of $904.00 for March 16, 2018 to February 5, 2019, a period some 13 to 24 months post-accident. Adjudicator Farlam noted that she preferred the evidence of the insurer’s OT, who was the only assessor to observe the claimant in her house and who assessed the claimant several months after the accident, and who concluded that the claimant was able to perform housekeeping duties. Adjudicator Farlam also preferred the evidence of the IE physiatrist who noted that the claimant suffered soft tissue injuries and did not suffer a substantial inability to perform her pre-accident housekeeping tasks. With respect to the disputed chronic pain assessment, Adjudicator Farlam relied on the surveillance obtained by the insurer which showed the claimant driving in inclement weather, brushing snow off her car, walking through a parking lot, and retrieving bags from her truck. Adjudicator Farlam also noted that the claimant’s s. 25 chronic pain report did not enumerate or address the application of the criteria for chronic pain in the AMA Guides and was therefore not persuasive. The adjudicator dismissed the claims for the cost of the two disability certificates as the insurer did not request the updated OCF-3s and there was no medical evidence to suggest they were required.
