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Mirzaie v. Wawanesa Mutual Insurance Company (19-009605)

  • October 22, 2021

The claimant suffered a catastrophic impairment. He sought the purchase of a home for $1.277 million as a rehabilitation benefit. The insurer argued that the claimant failed to prove that a new home was reasonable and necessary, and that the claimant failed to consider the value of modifications to his existing home. Adjudicator Gosio agreed with the insurer and dismissed the claim. He found that the claimant’s expert failed to comment on possible existing modifications to the claimant’s current apartment and gave no consideration to alternatives, such as a ground floor apartment, as opposed to purchasing a new home. Adjudicator Gosio also wrote that the claimant’s remaining rehabilitation limits were only half the amount of the claimed home, and that it would be unreasonable for the claimant to receive half the value of a home and then be left with no rehabilitation benefits and no new home. Adjudicator Gosio also rejected some of the premises of the claimant’s arguments. In particular, he noted that an earlier LAT decision found that the claimant did not require 24 hour care, and yet the claimant’s housing expert assumed that 24 hour was required.

Full decision here

TGP Analysis

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  • FILED UNDER Home Modification
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