The claimant sustained a significant impairment as a result of an accident on November 24, 2013. The insurer accepted that the claimant was catastrophically impaired on February 24, 2014. The insurer denied ACBs and HK expenses on May 23, 2014. The claimant disputed entitlement in a FSCO arbitration, and the benefits were settled via a “Partial Final Release” on July 1, 2016. Notably, the partial settlement governed entitlement to ACBs and HKs “only to June 28, 2016”. On October 30, 2019, the claimant submitted a OCF-18 in the amount of $1,459.16 for an in-home assessment, which was denied by the insurer, who argued that the issue was statute barred pursuant to s. 56 of the SABS as per their May 23, 2013 denial. Adjudicator Boyce ruled that the OCF-18 was payable, as the settlement of the issues specifically noted that it only covered ACBs and HK expenses “only to June 28, 2016”, and did not indicate that by signing the release that the claimant was abandoning any future claim for ACBs or that she was barred from seeking re-assessment for the same in the future. He also noted that the claimant had litigated the denial in the past with a FSCO dispute, showing clear intent to dispute the issue. Furthermore, the insurer did not provide the claimant with an SDN and even noted in an email dated June 29, 2016 that “Since this is a partial settlement, there will be no Settlement Disclosure Notice”, indicating to Adjudicator Boyce that, as a catastrophically impaired insured, the claimant would be free to pursue future entitlement to ACBs and HKBs in the future as her circumstances and condition changed.
