Christopher A. Obagi

The applicant sought attendant care and housekeeping benefits following a motor vehicle accident.

The parties agreed on the quantum of benefits owed for services provided by the applicant's daughters.

The Tribunal ordered the respondent to pay the agreed amounts, plus interest on any overdue payments.

The applicant's request for a special award was dismissed, as the Tribunal found no evidence that the respondent unreasonably withheld or delayed payment.

Jevco Insurance Company sought reconsideration of a Tribunal decision awarding C.W. retroactive Attendant Care Benefits with interest.

Jevco argued the Tribunal made errors of law and fact regarding the award of interest, the imposition of a fiduciary duty, findings on Jevco's coverage denial, and the application of the pay-first provisions under O. Reg. 283/95.

The Tribunal dismissed the reconsideration request, finding that Jevco's non-coverage position in the related tort proceeding justified C.W.'s delay in applying for benefits, and that the unique circumstances of the case meant the pay-first provisions did not apply.

The original decision was upheld.

The applicant was injured in a motor vehicle accident and sought the cost of various catastrophic impairment assessments.

The respondent insurer partially denied the treatment plan, arguing the assessments were not reasonable and necessary.

Following a written hearing, the adjudicator found that only the Functional Review Evaluation was reasonable and necessary to procure accurate digital measurements under the AMA Guides.

The remaining assessments, including the AMPS, collateral interview, file review, and consensus opinion, were deemed duplicative or not essential.

The applicant was awarded the cost of the Functional Review Evaluation plus interest.

The applicant, a pedestrian who sustained catastrophic injuries when struck by a vehicle, sought retroactive attendant care benefits from the date of the accident in 2007 until she formally applied in 2015.

The respondent insurer had denied coverage in a related tort action for years before finally admitting it insured the vehicle.

The Tribunal found that it was initially impossible, and later impractical, for the applicant to submit her application earlier due to the insurer's non-coverage position and failure to notify her of her rights.

The Tribunal awarded retroactive attendant care benefits of $6,000 per month with interest accruing from the date of her hospital discharge in 2007.