The insurer denied the claimant’s entitlement to certain attendant care benefits. The claimant disputed the insurer’s denial and argued that the payments were unreasonably withheld or delayed. With respect to the period of time from when the first Form 1 was provided by the claimant to the time when the claimant started to incur attendant care services, Adjudicator Norris held that no attendant care benefit was payable because the claimant did not incur any attendant care expenses during that time. There was no delay in the insurer’s advice that it would pay any expenses incurred (subject to the limit outlined in the Form 1) from the time it received the Form 1. With respect to the period of time from when the claimant began to incur attendant care expenses to the two-year limit for non-catastrophic claims (during which time the insurer paid for all of the attendant care expenses incurred by the claimant), Adjudicator Norris found that the benefits paid accorded with the claimant’s needs and declined to deem any additional attendant care benefits incurred. Lastly, Adjudicator Norris found that the insurer unreasonably withheld payment of attendant care benefits for a period where it had agreed to pay attendant care benefits. The insurer did not deny there was a delay in payment and there was no apparent reason for its failure to pay the invoices in a timely manner. A special award of 25 percent was made.
Menu