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Reconsideration granted; Tribunal erred by awarding post-104 week attendant care without a catastrophic impairment designation.
The insurer filed a request for reconsideration of a Tribunal decision that awarded the insured post-104 week attendant care benefits and deemed those benefits incurred.
The adjudicator granted the request, finding that the Tribunal made two significant errors of law.
First, the Tribunal lacked jurisdiction to award attendant care benefits beyond 104 weeks because the insured had not been designated as catastrophically impaired, as required by s. 20(2)(a) of the Schedule.
Second, the Tribunal erred in deeming the expenses incurred under s. 3(8) without making any finding that the insurer unreasonably withheld or delayed payment.
The decision was amended to limit attendant care benefits to the 104-week period and to require the insured to prove the expenses were actually incurred.
Applicant removed from Minor Injury Guideline due to compelling evidence of pre-existing spinal conditions.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic and physical therapy.
The insurer denied the treatment plan, arguing the applicant's injuries fell within the $3,500 limit of the Minor Injury Guideline (MIG).
The arbitrator found that while the applicant's impairments were predominantly minor injuries, she had documented pre-existing conditions, including scoliosis and degenerative disc disease, that constituted compelling evidence she could not achieve maximal recovery within the MIG limits.
The arbitrator ordered the insurer to pay the $3,487.60 treatment plan plus interest.
