The applicant was involved in a July 29, 2021 accident and sought $3,000 per month in ACBs from September 9, 2021 onwards. The insurer did not dispute the initial entitlement to the maximum, non-catastrophic quantum of care. The adjudicator awarded her $942.19 per month in ACBs commencing December 9, 2022. She was not entitled to a special award. The applicant sought payment of invoices for AC services for the period August 16 to November 30, 2021. The invoices listed the hours of attendant care provided and the rates, which varied between $33.50 to $37.00 per hour. The invoices did not break down the level of care based on the Form 1. The insurer had attempted to apply the ratio method as set out in S.M. v. Unica Insurance, 2020 CanLII 61460 (ON LAT) and partially paid the care being claimed. The insurer had initially paid invoices dated August 31 and September 15, 2021, in full. The applicant argued that the insurer was estopped from changing its calculation method as it had reason to think the further invoices would be paid in full. Due to the insurer changing its payment to the ratio method, the insured had incurred a significant outstanding balance of attendant care. The insurer argued that it could not be estopped as it had not unequivocally waived a known right. In fact, in a letter dated October 29, 2021, it advised the applicant that it would be using the ratio method for paying further invoices. The adjudicator found that the facts did not warrant a finding that the insurer had estopped itself. No further amount of attendant care was awarded.
