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Zhao v. Allstate Canada (20-000134)

  • January 28, 2021

The claimant filed a LAT application seeking entitlement to an attendant care assessment, various other treatment plans, and an award under Regulation 664. The claimant’s hearing submissions noted that the dispute over medical benefits other than the attendant care assessment were resolved prior to the hearing. While the case conference order referenced a claim for an award, the claimant did not address the claim for an award in the hearing submissions. The insurer requested that the claim for an award be dismissed as (1) the claimant had not provided particulars of the claim by the document disclosure deadline noted in the case conference order, (2) the claimant’s submissions were devoid of any claim for an award, (3) the claimant was barred from making further arguments relating to the award claim pursuant to Rule 9.4 of the Common Rules of Practice and Procedure, and (4) it would be breach of procedural fairness for the LAT to accept subsequent particulars from the claimant relating to the award. The claimant did not file Reply submissions. Adjudicator Parish dismissed the claim for an award because the particulars were not disclosed by the document production deadline and the claimant violated Rule 9.4. Adjudicator Parish found that it would be a breach of procedural fairness to the insurer to allow the applicant to proceed with the award without particulars being produced in advance of the hearing. Adjudicator Parish further found that the claimant was not entitled to the attendant care assessment. The insurer had previously approved attendant care based on an earlier assessment, and the claimant had not incurred any attendant care expenses. The OT in-home attendant care assessment report by Raymond Wong was not persuasive as it relied to a large extent on the claimant’s self reporting and limited objective testing. The assessment was found not to be reasonable and necessary.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, LAT Rules, Special Award
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