The claimant sought entitlement to an in-home assessment and a special award. The insurer had an occupational therapy IE to address the proposed assessment. The questions posed to the occupational therapist were suggestive of the answers the Fund wished to receive. The occupational therapist assessed the claimant’s abilities, but was unable to diagnose the cause of his impairments. The Fund then sought an orthopedic IE, which was then changed to a physiatry IE. The claimant did not attend the IE and argued that the insurer could not request the further IE, and should have made the request at the same time as the occupational therapy IE. Vice Chair McGee awarded the proposed in-home assessment, finding that the medical records from the claimant’s family physician made clear that the assessment was reasonable and necessary. She held that the Fund’s request for the physiatry IE was not reasonable. The Fund should have known from the outset that an occupational therapist could not diagnose the cause of the claimant’s impairments. She also held that the Fund had tried to have the occupational therapist opine on matters it knew were outside of her expertise. Vice Chair McGee granted a special award of 40 percent against the Fund. She found the Fund’s decision to maintain the denial of the assessment was unreasonable and that its dealings with the claimant and the requested IEs was blameworthy conduct. The claimant was an elderly man struck as a pedestrian, and more vulnerable than the average car accident victim, warranting a higher special award.
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