2 total
Applicant established entitlement to housekeeping benefits but payment denied because expenses were not proven incurred.
The applicant sought housekeeping and home maintenance (HH) benefits and a special award following a catastrophic motor vehicle accident.
The Tribunal found that the applicant's traumatic brain injury and physical impairments resulted in a substantial inability to perform his pre-accident HH tasks, rejecting the insurer's reliance on surveillance footage and an Examination Under Oath.
However, the Tribunal denied payment of the HH benefits because the applicant failed to prove the expenses were incurred under section 3(7)(e) of the Schedule.
The claim for a section 10 award was dismissed as the insurer's conduct was not excessive or imprudent.
Insured not barred from proceeding with LAT application where insurer's notices for repetitive examinations were deficient.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits, which the respondent insurer denied.
The respondent raised a preliminary issue, arguing the applicant was barred from proceeding with his application before the Tribunal under section 55 of the Schedule for failing to fully participate in neuropsychological and psychological insurer's examinations under section 44.
The Tribunal found that the applicant had attended the examinations, though he did not complete all tasks.
Crucially, the Tribunal held that the respondent's notices for further psychological examinations were deficient because they failed to provide adequate medical or other reasons for the repetitive assessments.
Consequently, the respondent could not rely on section 55 to bar the application, and the applicant was permitted to proceed.
No co-appearing lawyers found.
No judges found.