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Stewart v. Certas Home and Auto Insurance Company (20-004275)

  • September 15, 2021

The claimant applied to the LAT seeking entitlement to ACBs and housekeeping expenses. The insurer had determined that the claimant was catastrophically impaired as a result of the accident and that ACBs were reasonable and necessary. The dispute was over the extent of ACBs to be provided and whether housekeeping benefits were reasonable and necessary. Adjudicator Ferguson found that the claimant was physically capable of performing his housekeeping and self-care tasks, but he required queuing and encouragement to actually engage in those tasks, and that he had previously benefited from the support of an RSW and PSW. Adjudicator Ferguson found that the claimant was entitled to monthly ACBs in an amount that was between the amounts proposed in the Form 1s of the parties. The claimant was also found entitled to housekeeping benefits. The housekeeping services proposed in the claimant’s Form 1 were a duplication of the housekeeping expenses, and therefore not reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Housekeeping Expenses
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