B.H. v. Belair Direct Insurance (16-002779)

Shortly before the hearing, the insurer accepted that the claimant suffered a catastrophic impairment, and was entitled to IRBs. The only remaining issues were the claimant’s entitlement to attendant care benefits, and a special award. In terms of the attendant care claim, the insurer accepted that the claimant was medically entitled to assistance; the dispute was whether the service provider was a professional under the “incurred” definition. The service provider was not working as a PSW at the time of the accident, but had started working after the claimant’s accident, and had worked for three weeks providing services to other individuals. Adjudicators Treksler and Hines held that the wording “but for the accident” in the “incurred” definition did not require the professional service provider to have been working as a professional at the time of the accident. Instead the wording “but for the accident” required an inquiry as to whether the professional service provider was working in that role prior to the date of the provision of services. The professional service provider had worked for three week with other individual prior to working with the claimant, and the adjudicators therefore concluded that the “incurred” definition for a professional service provider was satisfied. The adjudicator also issued a special award of $3,693.60 in relation to IRBs, on the basis that the insurer had requested too much information and refused to pay IRBs despite sufficient information to calculate the claimant’s weekly entitlement.

E.K. v. Unifund Assurance Company (17-000897)

The parties were able to resolve the dispute during the Case Conference. The claimant sought costs and a special award. Adjudicator Makos denied both claims. He wrote that the insurer’s delay in payment of the disputed benefits was not unreasonable in light of the lack of medical information provided by the claimant prior to the Case Conference. However, he accepted that the Tribunal did have the jurisdiction to make a special award even if the insurer had paid a benefit shortly before a hearing.

R.M. v. Optimum Insurance Company (16-000344)

The claimant brought an application for interest and a special award on IRBs that had been miscalculated by the insurer. Adjudicator Bickley awarded interest on IRBs after they were recalculated at a higher amount. A special award was denied because the parties had proceeded on the shared assumption of the weekly IRB quantum for six years, until new records were obtained by the claimant.

J.T. v. Intact Insurance Company (16-000041)

Rule 19.1 provides that costs may be requested during a proceeding if a party, during a proceeding, acts unreasonably, frivolously, vexatiously and/or in bad faith. Correspondence which took place prior to the LAT application cannot be considered under Rule 19.1. A special award was not given because the insurer did not “withhold or delay” payment of accident benefits while it awaited updated medical records.