Retroactive 24-hour attendant care denied, but 10% award granted for 20-year suspension of benefits.
The applicant suffered a catastrophic brain injury in a 1999 motor vehicle accident.
The respondent insurer initially paid attendant care benefits (ACB) but reduced and then suspended them in November 2000 without proper notice.
The applicant sought retroactive and ongoing ACB at 24-hour care levels.
The Tribunal found that 24-hour care was not medically necessary, as the applicant had achieved a level of independent living with family support.
The Tribunal upheld the $120.40 monthly rate but ordered a top-up for two six-month periods following changes in living arrangements.
The Tribunal also awarded a 10% penalty under section 10 of Regulation 664 due to the insurer's 20-year delay in reinstating the suspended benefits, along with 2% monthly interest under the 1996 Schedule.
OLATOntario Licence Appeal TribunalAug 2, 2022
