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Annual Accident Benefits Seminar for Health Care Professionals on September 25th

Smitiuch Injury Law is pleased to host its annual seminar, entitled "Accident Benefits: Practical Issues for Health Care Professionals."  It will be held on Wednesday, September 25, 2013 at the Brantford Golf and Country Club. The keynote topic at this year's seminar will be on "Living With and Caring for an ABI Survivor - A Mother's Perspective".  Bernie Perry, the mother of an acquired brain injury survivor, will identify the struggles and successes she has experienced in her daughter's recovery and rehabilitation.  Bernie will be accompanied by her case manager, Jody Abbot and Dr. Diana Velikonja, a clinical neuropsychologist at Storrie, Velikonja and Associates in Burlington. The afternoon will also provide an update on the latest news and case law in Ontario Accident Benefits, followed by an open forum with an expert panel to answer participant's questions.  The expert panel will be composed of Ms. Heather Driver (Financial Services Commission), Tamara Forbes (Forbes Health Management), Anna-Marie Musson (Miller Thomson) and Chris Jackson (Smitiuch Injury Law). The afternoon will begin with registration and lunch at 11:30 a.m. and will end with a cocktail reception and social at approximately 3:30 p.m. This event is 100% complimentary. If you wish to attend please RSVP no later than September 18, 2013 by calling 519-754-1558 or by email to [email protected]. A copy of the invitation can be accessed by clicking here.

The Attendant Care Needs Assessment (Form 1): It is what it is

In a recent Financial Services Commission of Ontario (FSCO) Arbitration ruling, Costel Sicoe and Jevco Insurance Company [FSCO A08-001173], Arbitrator Susan Sapin confirmed that the hourly rates indicated on the Attendant Care Needs Assessment (Form 1) are the rates which are to be used by insurers for paying the benefit. Mr. Sicoe was catastrophically injured in a motorcycle accident on June 15, 2006.  As a result of this accident he required round-the-clock attendant care.  Jevco paid the attendant care to the maximum of $6,000.00 per month. However, in February 2009 Mr. Sicoe moved to Romania.  Jevco reduced the monthly attendant care payments based on an argument that the basic supervisory care amount of $7.75 per hour is based on the minimum wage in Ontario at the time of the accident, but in Romania the minimum wage was $1.30 per hour.  Jevco paid $1.30 per hour for the basic supervisory services.  This resulted in Mr. Sicoe being paid less than the $6,000.00 per month that he was entitled to in accordance with the Form 1. Arbitrator Sapin confirmed the interpretation of an "incurred expense" from previous case law:

State Farm to pay $23,000.00 Special Award for Unreasonably Withholding IRB's

NOTE: This decision was overturned on appeal on October 1, 2012 In the decision Marcia Henry and State Farm Automobile Insurance Company [FSCO A09-000213] FSCO Arbitrator Denise Ashby ordered the insurer to pay a claimant's income replacement benefits (IRB) with interest. The insurer was also ordered to pay a special award of $23,000.00 for unreasonably withholding the benefit. Marcia Henry was a full-time emergency triage nurse in a hospital. The medical experts identified that she was only capable of engaging in sedentary work. Despite that, State Farm terminated her income replacement benefits prior to the 104-week mark, taking the position that she did not suffer a substantial inability to perform the essential tasks of her pre-accident work. The Arbitrator also considered Ms. Henry's entitlement to IRB's after the 104-week mark, when the eligibility criteria changes to having to suffer a complete inability to engage in any employment for which she is reasonably suited, based on education, training and experience. Although Ms. Henry took courses to upgrade her resume following the accident, it was determined that she still remained competitively unemployable when compared to her pre-accident job. The Arbitrator noted that, "It is unrealistic to believe that a woman of Ms. Henry's age, disability and expected level of income would be hired over similarly educated, healthy and younger candidates who would likely have lower salary expectations." The Arbitrator went on to state that,

Economical Insurance To Pay Special Award

A recent Arbitration ruling by the Financial Services Commission of Ontario (FSCO) has ordered Economical Insurance to pay a $6,000.00 special award for unreasonably withholding attendant care benefits from one of their policyholders.  In the matter of Mr. S. and Economical Mutual Insurance Company, the Arbitrator identified that the insurer relied on its own surveillance and not even their own medical experts when determining the amount of the attendant care benefit.

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