Interim attendant care benefits granted; long-term care facility co-payment not deductible from attendant care.
The applicant, who sustained a catastrophic brain injury in a motor vehicle accident, sought interim attendant care benefits.
The insurer denied the benefits, arguing his needs were met by the long-term care facility where he resided.
The arbitrator found the applicant established a prima facie case for entitlement and demonstrated urgency and risk of irreparable harm due to the likelihood of another seizure and the facility's staff-to-patient ratio.
The arbitrator ordered the insurer to pay past and ongoing interim attendant care benefits, plus interest, and ruled that the facility's co-payment for accommodation and meals is a medical benefit, not deductible from attendant care benefits.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesMay 9, 2007
