Here the court sets out 'attendent care' SABS benefit provisions:
(a) Claim for Attendant Care Benefits
The Statutory Scheme
[7] Mr Luluquisin was deemed catastrophically impaired by his insurer. Section 14 of the SABS provides:
Except as otherwise provided in this Regulation, an insurer is liable to pay the following benefits to or on behalf of an insured person who sustains an impairment as a result of an accident:
1. Medical and rehabilitation benefits under sections 15 to 17.
2. If the impairment is not a minor injury, attendant care benefits under section 19.
Mr Luluquisin’s impairment is not a “minor injury” – it is catastrophic. Therefore, the insurer is liable to pay attendant care benefits to Mr Luluquisin in accordance with section 19 of the SABS.
[8] Section 19(1)(a) of the SABS provides:
(1) Attendant care benefits shall pay for all reasonable and necessary expenses,
(a) that are incurred by or on behalf of the insured person as a result of the accident for services provided by an aide or attendant or by a long-term care facility, including a long-term care home under the Fixing Long-Term Care Act, 2021 or a chronic care hospital;
[9] There are two aspects to the test under s.19(1)(a) that are material to this appeal: (i) whether the claimed expenses are “reasonable and necessary”, and (ii) whether those expenses “are incurred by or on behalf of” Mr Luluquisin.
The author has waived all copyright and related or neighboring rights to this Isthatlegal.ca webpage.
