As a result of injuries sustained in a motor vehicle accident Ms. A. required housekeeping assistance. The insurer denied Ms. A's claim, arguing that she failed to apply for these benefits within the first two years after the accident as required by law.
Ms. A. retained Ms. Kelley Campbell to fight for her rights. Kelly Campbell applied for mediation, and when mediation failed she applied for arbitration.
At a preliminary hearing on the issue of housekeeping benefits, the insurer argued that Ms. A’s application for benefits was incomplete as she had not submitted a disability certificate on time as required by the statute, and therefore her claim should be denied.
Kelly Campbell argued that while it was true that Ms. A had not submitted a disability certificate within two years, she had submitted medical evidence to the insurer of her ongoing disability and need for housekeeping assistance within the two years. Kelley Campbell also pointed out that the insurer had obtained its own independent assessment, during that time, which also concluded Ms. A. was not able to perform housekeeping. As such, the insurer was aware of the need for the benefits that were being claimed, and Ms. A should be able to proceed with her claim.
Finally, Kelley Campbell pointed out that the insurer itself had also failed to provide her with a copy of Ms. A’s file in a timely basis, and this had contributed to the lapsing of the two year period.
The Arbitrator agreed with Kelley Campbell that the insurer had enough information to form an opinion as to Ms. A’s need for housekeeping and allowed her to proceed to arbitrate her claim for benefits.