Canadian Underwriter

FSCO denies claim for caregiver and housekeeping benefits

August 26, 2009   by Canadian Underwriter

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A Financial Services Commission of Ontario (FSCO) arbitrator has denied an insured’s claim for caregiver benefits and housekeeping/home maintenance benefits following a vehicle collision.
Mohammad Asghar was injured in a motor vehicle accident on Aug. 2, 2006. He applied for and received statutory accident benefits from State Farm Mutual Automobile Insurance Company.
Asghar’s dispute with State Farm is with regards to his entitlement to the continuing payment of weekly caregiver and housekeeping benefits.
Asghar sought $350 per week for caregiver benefits, as well as $100/week for housekeeping/home maintenance, up to Aug. 2, 2008.
At the time of the accident, he lived in a basement apartment with his nephew, his nephew’s wife and their three children. He claimed he took care of the children and took responsibility for housework at the time of the accident, but could no longer perform these duties as a result of the collision.
Invoices submitted for both childcare and housekeeping costs were inconsistent and were essentially unreliable evidence, wrote Fred Sampliner, FSCO arbitrator. As well, Asghar failed to show that he was the primary caregiver for the children.
As a result, FSCO dismissed his claims for the benefits.
“Mr. Asghar is not entitled to payment of caregiver benefits under Part IV of the Schedule,” Sampliner wrote. “Mr. Asghar is not entitled to payment of housekeeping expenses under section 22 of the Schedule.”

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