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S.M. v. Wawanesa Mutual Insurance Company (18-008474)

  • January 7, 2020

The claimant suffered a catastrophic impairment in a 2000 accident due to a GCS of 4. He sought entitlement to ACBs of over $5,000 per month, and sought retro-active ACBs back to 2015. Adjudicator Johal held that the claimant was not entitled to elevated retroactive ACBs because he provided no evidence why it was impossible or impractical to submit an updated Form 1 in 2015. In terms of ACBs from the date of the Form 1 submission onwards, the claimant was entitled to some assistance with intermittent care and financial affairs; he was not entitled to 24-hour care because he was sufficiently able to manage his routines and was able to respond to emergencies or changes in his routine. In terms of the incurred expense requirement, Adjudicator Johal concluded that the post-2010 definition applied to all ACBs claimed after 2010, and that the claimant could only seek entitlement to the amount of assistance actually incurred.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Incurred Expense
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