The claimant sought entitlement to the costs of examination for an in-home assessment, attendant care benefits, and a special award. Adjudicator Norris held that the claimant was unsuccessful on all issues. The adjudicator held that the cost of an in-home assessment was not payable as it was incurred prior to submitting a treatment and assessment plan, as well as being incurring during a period in which the claimant was being treated under the MIG. The adjudicator held that the claimant was entitled to ACBs from the date the claimant’s Form 1 was submitted until the date the insurer produced a responding Form 1, but was not entitled to ACBs thereafter. The insurer produced its ACB IE report beyond the required 10 day period. However, the adjudicator did not award any ACBs and held that the insurer did not unreasonably delay or withhold payment of ACBs because: 1) the claimant took 3 months to submit a Form 1; 2) the claimant did not explain why services were not incurred; and 3) the claimant did not incur any services despite having entitlement to the benefit. The adjudicator declined to issue a special award based on Aviva’s delay in delivering its IE report because there was no delay or withheld payment of ACBs since they claimant did not incur any attendant care expenses. The adjudicator also declined to make a costs award under Rule 19.1 of the LAT Rules as neither party acted unreasonable, frivolous, vexatious, or in bad faith.
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