Both the claimant and the insurer sought reconsideration of the Tribunal’s decision which found that the claimant was not entitled to an income replacement benefit but was entitled to an examination expense for an attendant care assessment. Adjudicator Gosio dismissed the claimant’s request for reconsideration, but granted the insurer’s request for reconsideration by ordering that the issue of the attendant care assessment be reheard. The adjudicator’s finding with respect to the attendant care assessment was based on an argument that was not raised by either of the parties in their submissions (the applicability of section 25(1)4 of the SABS), and Adjudicator Gosio agreed that the obligation is on the claimant to make their own case, rather than the insurer having to disprove the claim. However, he noted that the appropriate remedy in this case was not to vary the decision as requested by the insurer, but rather to invite both parties to make submissions on the applicability of section 25(1)4 of the SABS.
