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📁 MARK'S DOC
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Review_Division_Submission_3_of_3 — p.13
📄 Review Division Submission 3 of 3 | p.13
📄 Review Division Submission 3 of 3 | p.13
📝 Extracted Text (OCR)
6/14/26, 1:03 AM Pacific Blue Cross Go Back to your Member Profile Logout Claim Details Learn more about your claims. To view claim details, select your search criteria and then press the Apply button. To search by Claim ID, you must provide the Service Date Range for results. Totals for Amount Claimed and Amount Paid will be refreshed based on the search results. Individual Show Claims Within Service Date Range Mark Holand (DOB: Sey 24 Months CD i) Claim ID Apply All Health Dental Drugs Service Date ¥ Name Expense/Item Amount Claimed Amount Paid Statement Date ‘Aug 18, 2025 Mark Holand ‘TEVA-SUMATRIPTAN DF $133.21 $0.00 Aug 19, 2025 Details Jul 19, 2025 Mark Holand APO-BILASTINE TABLETS $55.40 $51.14 Jul 19, 2025 Details Jun 16, 2025 Mark Holand APO-BILASTINE TABLETS $55.40 $51.14 Jun 16, 2025 Details May 27, 2025 Mark Holand ‘TEVA-SUMATRIPTAN DF $133.21 $132.85 May 27, 2025 Details May 20, 2025 Mark Holand PANTOPRAZOLE MAGNESIUM $26.24 $22.81 May 20, 2025 Details May 14, 2025 Mark Holand ‘APO-BILASTINE TABLETS $55.40 $51.14 May 14, 2025 Details Mar 24, 2025 Mark Holand APO-BILASTINE TABLETS $55.40 $51.14 Mar 24, 2025 Details Feb 26, 2025 Mark Holand TEVA-SUMATRIPTAN DF $144.73 $132.85 Feb 26, 2025 Details Feb 25, 2025 Mark Holand ‘TEVA-SUMATRIPTAN DF $144.73 $0.00 Feb 26, 2025 Details Feb 12, 2025 Mark Holand ‘APO-BILASTINE TABLETS $55.40 $51.14 Feb 12, 2025 Details Jan 14, 2025 Mark Holand BLEXTEN $63.41 $56.81 Jan 14, 2025 Details Jan 14, 2025 Mark Holand BLEXTEN $63.41 $0.00 Jan 14, 2025 Details Nov 22, 2024 Mark Holand TEVA-SUMATRIPTAN DF $144.73 $144.33 Nov 22, 2024 Details ‘Aug 06, 2024 Mark Holand TEVA-SUMATRIPTAN DF $144.73 $144.33 Aug 06, 2024 Details Page 2 Total $1,275.40 $889.68 Grand Total $4,311.41 $2,004.16 « First | « Previous | Page 2 of 2 | Next » | Last » "ePacic Bue Cross isthe registered tradename of PBC Health Benefits Society (PBC), an independent licensee of the Canadian Association of Blue Cross Plans (CABCP). Pacific Blue Cross and the cross design are trademarks ofthe CABCP. ‘Biv Shield i a recistered trademark of Blue Cross Blue Shield Association. Insurance is sold through PacBiue Life Services Lid, dba Paci Blue Cross Agency licensed insurance agency and wholly owned subsidiary of PBC. Insurance is Lnderartten by various underwriters, For information on underwriters vist pac.bluecross.a/Dsclosure, Al rights reserved, Privacy Statement | Legal Complaints | Security | Browser Requirements Browser Capabilities Contact | CUPE 1816 | 7.7.594.4 - ACES https://service.pac. bluecross.ca/ACESWeb/Pages/Claims/Claims.aspx? MODULE=ALL 14 IV.D Other Pre-Existing Factors Were Mischaracterized The Opinion also references the worker's heightened sensory sensitivity as part of the “pre-existing and non-occupational” picture. The worker's heightened sensory sensitivity is consistent with an autistic neurological profile (formal assessment pending), which the