Attendant care benefits assessed at $2,987.47 monthly; $6,000 special award granted for unreasonably withheld benefits.
The applicant was struck by a car and claimed statutory accident benefits.
At the hearing, the insurer conceded the applicant suffered a catastrophic impairment due to a mental or behavioural disorder.
The parties disputed the quantum of attendant care benefits.
The applicant sought the maximum $6,000 per month based on an occupational therapy assessment recommending 24-hour care, while the insurer argued for approximately $2,000 per month based on surveillance footage showing greater independence.
The arbitrator awarded $2,987.47 per month, preferring the insurer's second expert regarding supervisory care but rejecting her reductions for personal hygiene.
The arbitrator also ordered a $6,000 special award against the insurer for unreasonably withholding the differential attendant care benefits for 15 months without seeking a professional review of its own expert's maximum-care recommendation.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJul 28, 2011
