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M.N. v. Aviva General Insurance (19-001788 and 19-007595)

  • September 16, 2021

The claimant sought entitlement to attendant care benefits in the amount of $272.46 per month. Adjudicator Ferguson noted that to be payable, attendant care benefits must be incurred by the claimant, as defined by section 3(7) of the SABS, but the claimant submitted no evidence of same. The claimant relied on section 3(8) of the SABS, which allows the Tribunal to deem expenses incurred where an insurer has acted unreasonably, arguing that the insurer ignored the submitted Form 1. Adjudicator Ferguson felt that it would be inappropriate to deem the expenses incurred, given that the claimant had not taken any steps to obtain, source, or price any potential attendant care, as well as the lack evidence that any family member or other person would have incurred any economic loss in providing attendant care. There was no persuasive evidence that the claimant would have incurred this expense if not for the inaction of the insurer, and as such, the claim for attendant care benefits was dismissed.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Incurred Expense
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