Neutral Citation: 2004 ONFSCDRS 113
FSCO A03-001062
FINANCIAL SERVICES COMMISSION OF ONTARIO
BETWEEN:
THOMAS GEORGE
Applicant
and
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY
Insurer
REASONS FOR DECISION
Before: William J. Renahan
Heard: June 14, 15, 16 and 17, 2004, at the offices of the Financial Services Commission of Ontario in Toronto.
Appearances: Ian Little, Barrister and Solicitor, for Mr. George Robert Franklin, Barrister and Solicitor, for State Farm Mutual Automobile Insurance Company
Issues:
The Applicant, Thomas George, was injured in a motor vehicle accident on November 30, 1999. He applied for and received statutory accident benefits from State Farm Mutual Automobile Insurance Company ("State Farm"), payable under the Schedule.1 State Farm continues to pay weekly income replacement benefits.
However, State Farm terminated attendant care benefits, pursuant to section 16 of the Schedule, and housekeeping benefits, pursuant to section 22 of the Schedule, in December 2001, 104 weeks after the accident. Under sections 18 and 22, the insurer is not required to pay attendant care benefits or housekeeping expenses beyond 104 weeks, unless the insured's impairment is "catastrophic" as defined in section 2(1.1) of the Schedule.
Mr. George's family doctor, Dr. Athey, completed an Application for a determination that Mr. George suffered a catastrophic impairment on the grounds that he suffered chronic leg pain and weakness and that he walked with a cane and that he suffered from ulnar nerve damage on the left arm and from post-traumatic stress disorder, anxiety and depression. State Farm requested an assessment at a Designated Assessment Centre ("DAC"). The DAC concluded that Mr. George did not suffer a catastrophic impairment. The parties were unable to resolve their disputes through mediation, and Mr. George applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.
The issues in this hearing are:
Did Mr. George suffer a "catastrophic impairment" within the meaning of sections 2(1.1)(f) or (g) of the Schedule?
If Mr. George suffered a catastrophic impairment, what is the amount of attendant care benefits he is entitled to receive pursuant to section 16 of the Schedule?
If Mr. George suffered a catastrophic impairment, what is the amount of housekeeping expenses he is entitled to receive pursuant to section 22 of the Schedule?
Is Mr. George entitled to reimbursement for auto repairs in the amount of $225.93 and $158.75 pursuant to section 15 of the Schedule?
Is either party entitled to expenses pursuant to section 282(11) of the [Insurance Act](https://www.canlii.org/en/on/laws/stat/rso-1990-c-i8/latest/rso-1990-c-i