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Fahritdinov v. Aviva General Insurance (19-009897)

  • October 5, 2021

The claimant sought entitlement to NEBs and ACBs. Adjudicator Norris concluded that the claimant was not entitled to the benefits claimed. The claimant sustained injuries to his neck, shoulder, back, and knee as a result of the accident and required surgical intervention. Adjudicator Norris found that while the claimant may have experienced some changes to his life, he failed to demonstrate that he suffered a complete inability to carry on a normal life as a result of accident-related impairments. Thus, the claimant was not entitled to NEBs. Similarly, the claimant required attendant care services immediately following the June 20, 2018 surgery on his right knee. However, Adjudicator Norris found that the claimant had recovered from the surgery and no longer needed the assistance claimed. There was nothing in the evidence to suggest that the benefit was incurred, or that it was not incurred due to the insurer unreasonably withholding payment. There was a difference between what the Form 1 said and what the claimant reported to his assessors regarding his personal care abilities. He reported that he showered and completed most of his housekeeping and home maintenance tasks independently and that he had no limitations with respect to personal care. The application was dismissed.

Full decision here

TGP Analysis

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  • FILED UNDER Non-Earner Benefits, Attendant Care Benefits, Incurred Expense
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