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Duval v. Aviva General Insurance (20-001990)

  • July 14, 2021

The claimant disputed entitlement to $1,030.84 in monthly attendant care benefits, treatments plans for cannabis and an orthopaedic mattress, interest, and a special award. Aviva initially accepted the Form 1 and paid attendant care invoices as they were submitted. Aviva then denied attendant care based on an orthopaedic assessment and Form 1. The claimant argued that she required attendant care due to pain and tingling in her arms, hands and fingers, as well as shoulder, back and neck pain caused by the accident. Aviva noted that the claimant continued to work as a law clerk post-accident, which required the use of her hands and arms; and continued to care for her children and remained active in the community, which was detailed in a surveillance report showing the claimant running various shopping errands without any difficulty. Adjudicator Chakravarti ruled in the claimant’s favour and found her entitled to attendant care, noting that the claimant consistently reported issues with functional impairments in her hands and arms to her medical practitioners. Furthermore, the insurer’s assessors admitted in their findings that functional limitations were present and that the claimant was limited by pain on examination. Adjudicator Chakravarti ruled that the claimant was entitled to attendant care at a reduced rate of $537.00 per month, which was appropriate based on what was actually incurred during the time Aviva paid the benefit. However, ongoing attendant care was not deemed to have been incurred as the claimant failed to prove that Aviva acted unreasonably or that she did not incur attendant care expenses because Aviva acted unreasonably. The claimant was not entitled to the remaining benefits as she failed to prove that they were reasonable and necessary as a result of the accident. No special award was granted.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Incurred Expense
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