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Caregiver and housekeeping benefits denied; insurer failed to warn of limitation but applicant failed on merits.
The applicant sought caregiver and housekeeping benefits following a motor vehicle accident.
The insurer denied the claims, arguing the applicant was permanently disentitled for failing to submit a Disability Certificate (OCF-3) in a timely manner.
The Arbitrator held that the applicant was disentitled to housekeeping benefits because she never submitted an OCF-3 for that claim.
However, the insurer could not rely on the late submission of the caregiver OCF-3 to deny benefits because it failed to clearly communicate the consequence of permanent disentitlement to the applicant.
On the merits, the Arbitrator dismissed the caregiver claim, finding the applicant's evidence regarding her pre-accident caregiving responsibilities and post-accident needs to be inconsistent and unreliable.
Motion for third-party production of academic records dismissed as not reasonably required for a fair hearing.
The insurer brought a motion for an order compelling the applicant's daughter, a third party, to produce her university academic schedule.
The insurer sought the records to challenge the amount of time the daughter claimed to have spent providing housekeeping and caregiving services to the applicant following a motor vehicle accident.
The arbitrator dismissed the motion, finding that the academic schedule was not reasonably required to ensure a just and fair hearing.
The records contained no information about the applicant's impairments, and the schedule would not prove whether the daughter actually attended classes.
