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K.R. v. TD Insurance Company (16-004073)

  • July 25, 2017

The claimant sought attendant care benefits up to the 104 week mark. Adjudicator Treksler found that the claimant suffered injuries that entitled her to attendant care of $873.30 per month. The second issue was whether the claimant’s attendant care expenses were incurred. For a period of five months, the claimant used a professional service provider and those expenses were awarded. For a further period of 13 months, Adjudicator Treksler found that the claimant’s expenses were deemed incurred under section 3(8) of the SABS because the insurer had unreasonably withheld or delayed payment. She was critical of the insurer ceasing payment of attendant care benefits on its basis of its Form 1 alone without considering the records of the claimant’s treatment providers. Finally, Adjudicator Treksler held that no attendant care benefits were payable before the claimant’s Form 1 was submitted.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Incurred Expense
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