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Caregiver and housekeeping benefits denied; insurer failed to warn of limitation but applicant failed on merits.
The applicant sought caregiver and housekeeping benefits following a motor vehicle accident.
The insurer denied the claims, arguing the applicant was permanently disentitled for failing to submit a Disability Certificate (OCF-3) in a timely manner.
The Arbitrator held that the applicant was disentitled to housekeeping benefits because she never submitted an OCF-3 for that claim.
However, the insurer could not rely on the late submission of the caregiver OCF-3 to deny benefits because it failed to clearly communicate the consequence of permanent disentitlement to the applicant.
On the merits, the Arbitrator dismissed the caregiver claim, finding the applicant's evidence regarding her pre-accident caregiving responsibilities and post-accident needs to be inconsistent and unreliable.
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