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R.D. v. Pafco Insurance Company (18-004113)

  • April 6, 2020

The claimant sought a catastrophic impairment determination, attendant care benefits, and housekeeping expenses. The insurer argued that the claim for HK expenses was barred by the limitation period. Adjudicator Hines concluded that the claimant suffered a catastrophic impairment as a result of Class 4 Marked impairments in each of daily living, social functioning, and adaptation. While the claimant had been involved in an earlier accident which caused serious physical injuries, the subject accident caused a severe decline in his emotional functioning which satisfied the catastrophic impairment definition. Adjudicator Hines held that the limitation period did not apply to the HK expenses claim based on the Court of Appeal’s reasons in Tomec v. Economical, and that the claimant was entitled to HK expenses of $100 per week, but only if incurred. There was no basis on which to find expenses deemed incurred. The claim for ACBs was denied. Adjudicator Hines held that entitlement only began in December 2018 when Form 1s were submitted, but that the Form 1 submitted did not reflect the claimant’s current need for assistance. The claim for both past and ongoing ACBs was dismissed.

Full decision here

TGP Analysis

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  • FILED UNDER Catastrophic Impairment
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