The claimant sought entitlement to NEBs, a medical benefit for physiotherapy services, interest on overdue payment of benefits, and an award. The claimant argued that she had partially resumed some activities post-accident but not at all. The claimant also argued that even though she had returned partially to her personal care, she experienced pain when performing these activities. Adjudicator Farlam found that the claimant was not entitled to an NEB for a number of reasons. The first was that the claimant’s self-reporting of her post-accident capabilities in the OCF-12 did not establish a complete inability to carry on a normal life as a result of the accident. The claimant indicated that she could “partially” do all of her pre-accident activities except washing floors, sewing, dancing and dance instructing. The Disability Certificate was given little weight given the lack of detail and explanation that the disability was temporary. The rest of the records put forward did not establish that the claimant was completely unable to carry on a normal life and only showed minor injuries. With respect to the disputed treatment plan, the claimant submitted that the treatment plan was reasonable and necessary to deal with her pain, help regain strength and improve her range of motion. The insurer argued that the treatment plan was not reasonable and necessary because the claimant, by having already received rehabilitation treatment, had achieved the plan’s proposed goals. Adjudicator Farlam found that the disputed treatment plan was reasonable and necessary, in part. The claimant had experienced enough improvement as a result of this treatment that it was reasonable and necessary to allow her treatment to be continued and the overall costs of achieving her goals was reasonable. However, Adjudicator Farlam agreed that the insurer was not required to pay for the assessment and two treatment sessions that were incurred before the plan was submitted.
