Maria Ayala v. Skampa Painting & Renovating Inc and CCMSI

In Maria Ayala v. Skampa Painting & Renovating Inc and CCMSI the Claimant is seeking an orthodontic night guard designed to produce her with some relief of jaw pain cause by her compensable injury. The E/C authorized an orthodontist and a night guard but didn’t actually provide the night guard because there was an issue requiring prepayment to the provider which the E/C refused to do. Claimant requested an alternate provider but E/C argued that they are not obligated to make an authorization with out a specific request for a one time change. The JCC found that E/C had not actually provided the benefit. The JCC found that the E/C need not only authorize the benefit but also “furnish” necessary medical care. Since the current authorized provider did not provide the night guard, the JCC GRANTED claimant’s request for an alternate specialist to provide the recommended night guard.

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