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T.N. v. TD Insurance Company (19-005638)

  • March 11, 2020

The claimant sought entitlement to ACBs in excess of the total approved by the insurer. The insurer raised a preliminary issue that the Tribunal did not have jurisdiction to hear the matter because the claimant had not actually incurrent any attendant care expenses. Adjudicator Lester found that there was a dispute between the parties since the respondent only partially approved the request amount in Form 1, regardless of whether expenses had been incurred. Adjudicator Lester ultimately concluded that the claimant was entitled to ACBs in excess of the amount approved by the insurer, totalling 8 hours per day. With regard to cueing, Adjudicator Lester held that the time should be considered under the specific Form 1 activity, rather than as a supervisory function.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits, Incurred Expense, Jurisdiction
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