Insurer ordered to pay retroactive attendant care benefits and a special award for unreasonably withholding benefits.
The applicant sustained a catastrophic brain injury in a motor vehicle accident, requiring 24-hour attendant care.
The insurer, despite knowing the severity of the impairment, failed to inform the applicant of her entitlement to enhanced benefits, arbitrarily reduced her paid attendant care based on flawed occupational therapy assessments, and failed to arrange required designated assessment centre (DAC) evaluations.
The arbitrator found the insurer's conduct unreasonable and in breach of its statutory obligations.
The applicant was awarded $178,928.33 in retroactive attendant care benefits, interest on overdue payments, and a special award for the insurer's unreasonable withholding and delay of benefits.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesDec 13, 2005
