Maximum attendant care and home modifications awarded; special award granted for insurer's unreasonable withholding of benefits.
The applicant was catastrophically impaired in a motor vehicle accident and sought statutory accident benefits, including attendant care and home modifications.
The respondent insurer partially denied the claims based on its own assessments.
The Licence Appeal Tribunal found that the applicant's functional limitations, including cognitive and physical impairments, necessitated the maximum attendant care benefit of $6,000 per month and home modifications totaling $344,864, which included an in-home elevator and therapy room.
The Tribunal also awarded the cost of a housing analysis assessment but denied the cost of a second attendant care assessment submitted prematurely.
Finally, the Tribunal ordered a special award under s. 10 of Regulation 664, finding the respondent unreasonably withheld benefits by failing to properly investigate the applicant's functional needs despite having access to medical evidence supporting the claims.
OLATOntario Licence Appeal TribunalJan 2, 2020
