In a recent decision of the License Appeal Tribunal, Adjudicator Grant considered whether attendant care should be paid to someone who did not submit a Form 1. (A.A. v. Primmum Insurance, 2019 ONLAT 18-000727/AABS)
In this case, the Applicant was a chemotherapy patient who suffered a crush injury to the lower leg when he was pinned between two cars. This serious injury resulted in attendant care needs that were provided by the Applicant’s son.
Unfortunately the Applicant died before he could complete a Form 1.
Adjudicator Grant made it very clear – if the Form 1 is not completed – there is no attendant care payable pursuant to section 42(5) which states: “an insurer is not required to pay an expense for attendant care needs which is incurred prior to a Form 1 being submitted”.
Another barrier to claiming these benefits is that a Form 1 cannot be completed by an injured person. Only an Occupational Therapist or Registered Nurse can fill out the form and sign it. Although a person may be entitled to these benefits – if they cannot afford to arrange for someone to fill out this form, they cannot claim these benefits.
Lastly, there is a hard limit on the amount of money provided to persons requiring attendant care. For a non-catastrophically injured person that cap is $3,000 per month. No matter how much attendant care is needed – the insurer is only responsible for $3,000 worth of care. They will never provide more than this limit for a non-catastrophically injured person.
Therefore, it is clear there are many barriers to claiming attendant care benefits. Even in a situation where attendant care was provided – not completing a Form 1 is a total roadblock stopping an Applicant from receiving those benefits. A lawyer can help you navigate these many hurdles and claim the benefits in the proper way.