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Temple v. Economical Mutual Insurance Company (21-005510)

  • June 5, 2023

The preliminary issue in dispute was whether the claimant was barred, pursuant to s. 55(1)(3) of the SABS, from proceeding with the application as the claimant failed to provide information to the respondent in accordance with s. 46.2 and s. 46.3 of the Schedule. The respondent made multiple requests for the particulars pertaining to the invoices for attendant care as well as a statutory declaration from the applicant and the service provider. The respondent submitted the claimant willfully ignored more than five requests made by the respondent seeking particulars of invoices submitted pursuant to s. 46.3. Moreover, the claimant agreed to provide the particulars when the parties attended the case conference and failed to do so. The adjudicator said the invoices provided by the service provider did not provide a breakdown of the services or the amount of time that was spent. Nor was there information as to when these services were provided. The invoices indicated the amount that was charged and the month. The adjudicator found the invoices lacked details of what services were provided to the claimant. The claimant returned an incomplete statutory declaration as she did not provide any of the information requested by the respondent and did not provide an explanation as to why she did not fill out the statutory declaration. The adjudicator reviewed the weekly logs and found the logs did not provide any information that would assist in determining what services were provided and the duration. Based on the adjudicator’s review of the statutory declaration, the weekly logs and invoices provided, it was difficult to ascertain whether or not the applicant had received the amount of care from the service provider in accordance with the Form 1. Therefore, it was reasonable for the respondent to request this information. The adjudicator ordered that the claimant was barred from proceeding with this application before the Tribunal and the application was dismissed.

Full decision here

TGP Analysis

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  • FILED UNDER Attendant Care Benefits
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