Accident Care Benefits and your Entitlements

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A highly debated and relevant issue is that of attendant care.

When you are seriously hurt, the success of your recovery is heavily dependent on the level of aftercare you receive. In many cases, you may not be able to accomplish simple tasks that would have been done effortlessly before. The pain and discomfort that follows is not something that should be handled alone.

Sometimes you have help from family, but it can interrupt their work and social lives. In several instances, outside help must be obtained in the form of nurses or aides.

Case example

Here, in Guo vs. State Farm, we look at a case that involves tourists, an accident, rehabilitation and monetary compensation.

In August of 2011, a family (husband, wife and their two daughters) came to Canada on vacation from China, and unfortunately the mother was injured in a vehicular accident.

She had purchased a ticket with the intention of leaving the following month, but stayed in the country to recover from her injuries. Her husband returned to China, while her two daughters stayed back to care for her physically.

Her daughters hadn't yet purchased a ticket to leave but their intention was to leave later in that same year. Through her insurance, she decided to apply for the accident benefits for which she felt that she was entitled.

The insurance company could not come to an amicable resolution because they did not believe that firstly, she got the care that she was claiming, and secondly that the services provided by her daughters warranted reimbursement for economic loss.

Through the arbitration process, certain disputable issues needed to be addressed. The first is whether or not the applicant (Mrs. Guo) received said care during the time period in question and whether or not they were covered under the Statutory Accident Benefits Schedule. The second was if the insurance company should be held liable for unreasonably delaying payments which would include the cost of litigation.

Her argument was that because of her accident her daughters were unable to travel back to China where jobs were waiting for them, and where no housing fees would have been incurred. Her daughters also had to forgo jobs in Canada due to her injuries and need for care. They were both here on student visas and could have legally sought employment, but had to instead rent an apartment and run an entire household to provide care for their mother. 

The insurance company did not agree that the daughters suffered any economic loss and argued that any financial loss was directly as a result of their father's neglect. He was a business man who was capable of supporting his family financially, but chose to do otherwise.

After assessing all the information, the Arbitrator found in favor of Mrs. Guo. He found the request reasonable as the applicant was able to provide evidence to support their claims. The issue at hand was not whether the economic loss incurred by the daughters could have been avoided through their father, it was whether they incurred the loss at all.

He also found that there was no intentional or malicious delay imposed by the insurance company, so no other penalties were imposed on either side.

In a case like this, it is very important to be represented by a licensed and experienced personal injury lawyer. In your time of injury, your focus should be on rehabilitation, not legal issues.

Read more about accident benefits or call us today to assess your case. Your initial consultation is free.


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