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Applicant v. CUMIS General Insurance (17-002592)

  • April 3, 2018

The claimant sustained serious injuries and required 24 hour care. She moved homes to receive care from her father. The claimant and insurer disputed how much money the claimant was entitled to for the cost of rent (as a rehabilitation benefit). The claimant argued that she was entitled to the full cost. The insurer argued that she was entitled to the current cost less the estimated cost of the housing she would have resided in but for the accident. Adjudicator Ferguson held that the claimant was entitled to the lesser amount for rent. He calculated the amount as the rent for the current house less the average monthly rent for a two bedroom apartment plus 50 percent of monthly utilities. He reasoned that the claimant’s pre-accident living situation should be recognized, and that to pay for the full rent would amount to a windfall.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits
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