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R.K. v. Aviva Insurance Company (17-006651)

  • June 29, 2018

The claimant sought payment of attendant care benefits. The insurer did not dispute that services were reasonable and necessary, but argued that the claimant had not incurred such expenses. The claimant refused to provide answers to questions regarding the services during an examination under oath, and the invoices proving receipt of the services was vague and submitted well after services were allegedly incurred. Adjudicator Mather concluded that the claimant had received the services from a PSW, based on affidavits from the claimant and the PSW. She also concluded that the claimant was legally obligated to pay for the attendant care services. However, Adjudicator Mather decreases the total benefit payable based on the hourly rate in the Guidelines.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Incurred Expense
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