Reconsideration granted; attendant care recalculated using mandatory hourly rates and 25% special award set aside.
The insurer requested a reconsideration of a Tribunal decision that awarded the insured up to $6,000 per month in attendant care benefits and a 25% special award under section 10 of O. Reg. 664.
The reconsideration adjudicator granted the request, finding that the first-instance Tribunal erred in law by failing to calculate the attendant care benefits using the mandatory hourly rates prescribed by the Guideline.
The adjudicator recalculated the incurred attendant care based on a ratio derived from the occupational therapist's recommendations.
Furthermore, the adjudicator set aside the 25% special award, concluding that the insurer's conduct in relying on its own experts' reports to partially approve benefits was not excessive, imprudent, or inflexible, and did not meet the threshold for an unreasonable withholding or delay of benefits.
OLATOntario Licence Appeal TribunalJun 25, 2020
