Hathaway-Warner v. TD General Insurance Company (20-002110)

The claimant, who had previously been deemed CAT pursuant to Criteria 8, sought entitlement to attendant care benefits up to the $6,000 monthly maximum. The respondent had approved entitlement to ACBs up to $2,642.91 per month. The claimant also sought modifications to her home (totaling $399,763) or, in the alternative, funding for the purchase of a new home to accommodate her disability (totaling $931,000). With respect to ACBs, Adjudicator Norris found that the claimant was entitled to ACBs up to $3,589.07 per month. While the Adjudicator preferred the claimant’s assessment over the respondent’s IE report, the calculation of quantum of ACBs had to be done in accordance with the Form 1 rates at the time of the accident in 2010. As such, the claimant’s maximum monthly entitlement to ACBs was $3,589.07. However, Adjudicator Norris went on to find that ACBS were not payable because there was no evidence of any incurred ACBs for the period in question. With respect to the proposed home modifications or alternative housing, Adjudicator Norris found that the claimant had not met her onus of demonstrating that the requested expenses were reasonable or necessary to eliminate the effects of her impairments as a result of the accident. The claimant’s limitations in daily living were primarily mental and behavioural. The overarching concern by the healthcare providers at the hearing was that the claimant’s home was disorganized and cluttered. The home modifications proposed were only a peripheral response to the disorganization and clutter compounding the claimant’s mental and behavioural challenges. Adjudicator Norris noted that the respondent had approved funding for a personal organizer, which was a more efficient way to reduce the main barriers faced by the claimant. Costs in the amount of $1,000 were ordered against the respondent for its conduct in not abiding by the page limits for submissions as ordered by the Tribunal and in obtaining a recording of the hearing without providing a timely copy to the claimant as required under the Rules.