Susannah Gray

The applicant sustained a severe brain injury in a motor vehicle accident and required long-term care in a nursing home.

She sought payment from her insurer for chronic care co-payments, ongoing and retroactive attendant care, rehabilitation services, and a special award.

The arbitrator held that the insurer was primarily responsible for paying the long-term care accommodation fees under the Statutory Accident Benefits Schedule, subject to deductions for the applicant's low-income subsidy.

The arbitrator awarded ongoing and retroactive funding for a community support worker to reduce the applicant's social isolation, as well as funding for a case manager and specific therapy assessments.

A special award of $10,000 was ordered against the insurer for unreasonably withholding the co-payments and misrepresenting its obligations under the Schedule.