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White v. Travelers Insurance (19-010567)

  • January 8, 2021

The claimant disputed her entitlement to two treatment plans for vision-related services. The insurer denied the treatment plans on the basis that the claimant’s vision impairments were not caused by the accident, as the claimant had pre-existing issues with her vision and the neuro-optometry IE assessor found that the claimant’s visual impairments were natural history issues, unrelated to the accident, and should be improvable with a new eyeglasses prescription. Adjudicator Farlam rejected the insurer’s argument, and accepted that the claimant’s vision impairments were caused or exacerbated by the accident, preferring the records of the claimant’s treatment providers over the findings of the insurer’s IE assessor. On that basis, Adjudicator Farlam determined that the disputed treatment plans were reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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