Category: Attendant Care Benefits

The preliminary issue in dispute was whether the claimant was barred, pursuant to s. 55(1)(3) of the SABS, from proceeding with the application as the claimant failed to provide information to the respondent in accordance with s. 46.2 and s. 46.3 of the Schedule. The respondent made multiple requests for the particulars pertaining to the invoices for attendant care as well as a statutory declaration from the applicant and the service provider. The respondent submitted the claimant willfully ignored more than five requests made by the respondent seeking particulars of invoices submitted pursuant to s. 46.3. Moreover, the claimant agreed to provide the particulars when the parties attended the case conference and failed to do so. The adjudicator said the invoices provided by the service provider did not provide a breakdown of the services or the amount of time that was spent. Nor was there information as to when these services were provided. The invoices indicated the amount that was charged and the month. The adjudicator found the invoices lacked details of what services were provided to the claimant. The claimant returned an incomplete statutory declaration as she did not provide any of the information requested by the respondent and did not provide an explanation as to why she did not fill out the statutory declaration. The adjudicator reviewed the weekly logs and found the logs did not provide any information that would assist in determining what services were provided and the duration. Based on the adjudicator’s review of the statutory declaration, the weekly logs and invoices provided, it was difficult to ascertain whether or not the applicant had received the amount of care from the service provider in accordance with the Form 1. Therefore, it was reasonable for the respondent to request this information. The adjudicator ordered that the claimant was barred from proceeding with this application before the Tribunal and the application was dismissed.

The claimant applied to the LAT seeking entitlement to attendant care benefits during two periods: April 2018 to May 11, 2022, and May 12, 2022, to date. In October 2018, the insurer had cancelled a s. 44 in-home assessment because the claimant’s counsel had advised the claimant no longer wanted to claim ACBs. In July 2020, the claimant requested payment for ACBs based on a 2018 Form 1 that had not been submitted via HCAI, and submitted an OCF-18 for a s. 25 in-home assessment. The insurer scheduled s. 44 assessments to address these benefits, but the claimant failed to attend. As a result of his failure to attend multiple assessments, the claimant’s entitlement to benefits was suspended in April 2021. In 2022, a second Form 1 was completed on behalf of the claimant, but this Form 1 was also not properly submitted via HCAI. Adjudicator Griffith found that the claimant was not entitled to ACBs because the Form 1s had not been properly submitted via HCAI, as required by the SABS and FSCO Guidelines, which meant there was no dispute between the parties and the LAT did not have jurisdiction to adjudicate the issue. In addition, Adjudicator Griffith found that the claimant would not otherwise be entitled to ACBs because he had not proven that he incurred ACB expenses. In this regard, the decision notes that the claimant’s wife testified that she was a retired PSW. At the time of the hearing, she had not received a paycheque for work as a PSW for 8 years, but she had volunteered as a PSW at a nursing home until the COVID-19 pandemic. The claimant’s wife testified that she had provided 24-hour AC services to the claimant since 2018. Adjudicator Griffith found that the claimant’s wife was not in the course of her employment, occupation, or profession in which she would ordinarily have been engaged but for the accident when she provided AC services to the claimant. In addition, Adjudicator Griffith found that the claimant failed to show that his wife sustained an economic loss as a result of providing AC services.

The claimant suffered from a non-catastrophic impairment and applied to the LAT for attendant care and medical benefits. The claimant sought repayment for both non-professional and professional attendant care services. To establish that expenses for non-professional attendant care were “incurred” under s. 3(7)(e) of the SABS, a claimant must prove that a non-professional service provider sustained an economic loss resulting from their provision of goods and services “while, and as a result of providing attendant care.” The claimant submitted that his brother, who he alleged quit his job in order to care for him, was a non-professional caretaker and sustained economic loss while providing care for him. The insurer argued that the claimant’s brother did not provide evidence indicating that he left his job to care for the claimant. Vice-Chair McGee found that the claimant failed to provide evidence showing that economic loss occurred, as the claimant’s brother quit his job prior to the accident and there was no evidence suggesting that he had otherwise foregone employment. In seeking repayment for professional attendant care, the claimant provided multiple invoices. Vice-Chair McGee held that it is impossible to determine whether professional attendant care services meet the definition of “incurred” under s. 19(3) of the SABS where a claimant fails to provide particulars regarding the nature of the professional services provided and/or the identification and occupations of the chosen service providers. Given that the claimant abstained from providing such evidence, Vice-Chair McGee rejected his claim for professional attendant care benefits. Vice-Chair McGee also concluded that the claimant failed to establish entitlement to medical benefits.