Cora Moncada

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care and rehabilitation benefits.

The Licence Appeal Tribunal denied attendant care benefits for the initial period because the expenses were not incurred by the applicant's daughters.

However, the Tribunal granted attendant care benefits for a subsequent period, finding them reasonable and necessary, and deemed the expenses incurred because the insurer unreasonably withheld payment by relying on an insurer's examination without explaining why it preferred that report over contemporaneous medical evidence.

The Tribunal also approved a treatment plan for life skills training.

Due to the insurer's lack of transparency and unreasonable conduct in denying the attendant care benefits, the Tribunal ordered a special award of 35% under s. 10 of O. Reg. 664, plus interest.