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Carleton v. Unica Insurance Inc. (20-002008)

  • September 27, 2022

The claimant was injured in an accident and applied for an attendant care benefit but was denied on the basis that it was not reasonable or necessary. Vice Chair Johal found that the claimant was entitled to 315 minutes per week of attendant care that had been incurred for feeding and 45 minutes per week for attendant care for hygiene. Relying on the findings from the claimant’s occupational therapist, Vice Chair Johal found that the attendant care for feeding and hygiene was reasonable and necessary based on the claimant’s self-reported dizziness and decreased balance. Vice Chair Johal held that the claimant was not entitled to 1260 minutes per week (3 hours per day) of basic supervisory care. The basic supervisory care was not reasonable or necessary as the claimant testified that she was able to identify and respond to an emergency situation. Regarding whether the benefit was incurred or not, the claimant’s mother and husband provided attendant care. However, the claimant failed to produce any evidence of an economic loss of the claimant’s husband or mother, nor was there any evidence that either of them were providing attendant care assistance in the course of the employment, occupation or profession in which they would ordinarily have been engaged. As such, Vice Chair Johal found that the attendant care benefits were not incurred.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Incurred Expense
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