Category: Attendant Care Benefits

The claimant sought entitlement to attendant care benefits in the amount of $3,079.00 per month. At issue in the hearing was whether the claimant: (a) had proven that she incurred expenses for attendant care, and (b) the service provider sustained an economic loss due to providing attendant care services. The claimant submitted that her partner sustained an economic loss of $778.00 per month while providing attendant care services, as the partner had reduced her work scheduled by one 8-hour shift per week to accommodate the claimant’s care needs. Upon review of the partner’s income and employment documentation, Vice Chair McGee found no marked difference her pre-accident and post-accident hours of work and earnings. Vice Chair McGee noted that while she was sensitive to the impact the accident had likely had on the claimant and her partner, the SABS reflected a clear intention on the part of the legislature to compensate non-professional attendant care providers only up to the amount of the economic loss. As the claimant had failed to establish that her partner had suffered monthly economic loss, she had not met her onus in proving that she incurred the claimed attendant care services, and the claim was dismissed.

The claimant sought entitlement to attendant care benefits in the amount of $3,079.00 per month. At issue in the hearing was whether the claimant: (a) had proven that she incurred expenses for attendant care, and (b) the service provider sustained an economic loss due to providing attendant care services. The claimant submitted that her partner sustained an economic loss of $778.00 per month while providing attendant care services, as the partner had reduced her work scheduled by one 8-hour shift per week to accommodate the claimant’s care needs. Upon review of the partner’s income and employment documentation, Vice Chair McGee found no marked difference her pre-accident and post-accident hours of work and earnings. Vice Chair McGee noted that while she was sensitive to the impact the accident had likely had on the claimant and her partner, the SABS reflected a clear intention on the part of the legislature to compensate non-professional attendant care providers only up to the amount of the economic loss. As the claimant had failed to establish that her partner had suffered monthly economic loss, she had not met her onus in proving that she incurred the claimed attendant care services, and the claim was dismissed.

The claimant applied to the LAT for entitlement to ACBs. Vice-Chair McGee found that the claimant failed to prove entitlement to ACBs for the relevant time period. It was undisputed that the claimant was entitled to attendant care directly following the accident. At issue before the Tribunal was whether the claimant submitted appropriate proof of the services he incurred, and whether he established that his wife, who had provided his care, had sustained economic loss as a result. The Tribunal found that it had no power to order the payment of expenses incurred before submission of Form 1, limiting the claimant’s overall entitlement. Further, the claimant failed to establish his wife’s economic loss. The tax returns submitted showed a decrease in her annual income but did not establish what that income would have been but for the attendant care services. The wife’s income for the two years prior to the accident showed fluctuations as well, and without more information it was not possible to make a final determination.

The claimant sought entitlement to attendant care benefits in the amount of $272.46 per month. Adjudicator Ferguson noted that to be payable, attendant care benefits must be incurred by the claimant, as defined by section 3(7) of the SABS, but the claimant submitted no evidence of same. The claimant relied on section 3(8) of the SABS, which allows the Tribunal to deem expenses incurred where an insurer has acted unreasonably, arguing that the insurer ignored the submitted Form 1. Adjudicator Ferguson felt that it would be inappropriate to deem the expenses incurred, given that the claimant had not taken any steps to obtain, source, or price any potential attendant care, as well as the lack evidence that any family member or other person would have incurred any economic loss in providing attendant care. There was no persuasive evidence that the claimant would have incurred this expense if not for the inaction of the insurer, and as such, the claim for attendant care benefits was dismissed.

The claimant sought entitlement to attendant care benefits in the amount of $272.46 per month. Adjudicator Ferguson noted that to be payable, attendant care benefits must be incurred by the claimant, as defined by section 3(7) of the SABS, but the claimant submitted no evidence of same. The claimant relied on section 3(8) of the SABS, which allows the Tribunal to deem expenses incurred where an insurer has acted unreasonably, arguing that the insurer ignored the submitted Form 1. Adjudicator Ferguson felt that it would be inappropriate to deem the expenses incurred, given that the claimant had not taken any steps to obtain, source, or price any potential attendant care, as well as the lack evidence that any family member or other person would have incurred any economic loss in providing attendant care. There was no persuasive evidence that the claimant would have incurred this expense if not for the inaction of the insurer, and as such, the claim for attendant care benefits was dismissed.

The claimant applied to the LAT seeking entitlement to ACBs and transportation expenses associated with a psychological assessment. The insurer accepted the claimant’s entitlement to ACBs prior to denying entitlement base on its own Form 1. Vice-Chair McGee found that ACBs were not payable as the claimant failed to establish that the expenses he claimed were “incurred” as defined in the SABS. Vice-Chair McGee also noted the insurer would not have been liable for amounts incurred prior to completion of the claimant’s Form 1. The claimant failed to tender the OCF-18 proposing the disputed transportation expenses and simply asserted the expense was reasonable. Vice-Chair McGee found that the claimant failed to establish that the claimed expenses satisfied the requirements of s. 15 of the SABS. The application was dismissed.