Insurer was Obligated to Pay for Insured’s Full-Time Care, not just for Care Provided During Regular Working Hours

02. October 2013 0

Insurer obligated to pay for insured’s full-time care under Ontario Statutory Accident Benefits Schedule—Effective September 1, 2010, and not just for care provided during the 40 hours per week when the insured’s mother would have been working but for the accident.

Henry v. Gore Mutual Insurance Co., [2013] O.J. No. 3792, July 16, 2013, Ontario Court of Appeal, J.M. Simmons, A. Hoy and G.R. Strathy JJ.A.

In this decision, the Ontario Court of Appeal addressed the amount payable by an insurer under the Statutory Accident Benefits Schedule—Effective September 1, 2010 in Ontario for attendant care.

The respondent was left paraplegic after a motor vehicle accident on September 28, 2010. His mother took an unpaid leave of absence from work to provide the full time care required. The respondent sought indemnity from the insurer for the full-time care he required. The insurer took the position that it was only obligated to pay for the time the respondent’s mother missed from work.

The application judge concluded that an insurer’s obligation to pay for attendant care benefits was not restricted to care provided during the 40 hours per week of paid work that was foregone by the respondent’s mother. The Court of Appeal agreed and dismissed the appeal.

This case was originally summarized by Cameron B. Elder and orginially edited by David W. Pilley of Harper Grey LLP.

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