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Applicant with quadriplegia and depression not entitled to increased attendant care maximum as care needs overlapped.
The applicant sustained a cervical spinal cord injury in a motor vehicle accident, resulting in quadriplegia.
He claimed entitlement to an increased maximum monthly attendant care benefit under section 47(6) of the Statutory Accident Benefits Schedule, arguing he also suffered a separate psychological injury (major depressive disorder) requiring additional care.
The arbitrator found that while the applicant did suffer a psychological injury as a result of the accident, the attendant care services required for this psychological impairment overlapped with the 24-hour care already required for his physical injuries.
Therefore, the applicant was not entitled to the higher maximum under section 47(6) and the insurer was obliged to pay the standard catastrophic maximum under section 47(5).
Applicant awarded caregiver and attendant care benefits; insurer's malingering allegations rejected despite substance abuse issues.
The applicant was injured in two motor vehicle accidents in 1996 and sought statutory accident benefits for caregiver, housekeeping, and attendant care expenses.
The insurer terminated caregiver benefits and denied attendant care, alleging the applicant was malingering and exaggerating her symptoms, pointing to a pre-existing slip-and-fall injury and substance abuse issues.
The arbitrator found that the applicant sustained psychological and physical injuries in the accidents, leading to disabling psychological and chronic pain conditions.
The arbitrator rejected the insurer's malingering argument, finding the applicant's substance abuse was a misguided effort to control pain.
The applicant was awarded caregiver benefits from February 4, 1997, and attendant care benefits for a limited period, but her claim for additional housekeeping benefits was denied.
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