Claimant successfully challenges Lifetime Care Scheme & is Awarded an Increase in Attendant Care
Published 29 Jan 2013
The Claimant Mr L was a self employed delivery driver.
On 26 September 2008, he was in the process of making a delivery. He attempted to cross the road whilst pushing a trolley between two parked cars and was struck by a vehicle. As a result of the collision, he was thrown up into the air and landed on the opposite side of the road resulting in him being struck by another vehicle. As a result of the accident he sustained significant injuries including a traumatic brain injury. Police and Ambulance were called and he was conveyed to Liverpool Hospital where he was admitted and treated. The Hospital staff and Social Workers made an application on Mr L’s behalf in order for him to become a member of the Lifetime Care Scheme. This is a scheme that has been set up for people who suffer catastrophic injuries such as traumatic brain injuries, severe burns, amputations and the like. Mr L’s application was accepted and he became an interim member of the Lifetime Care Scheme for a period of two (2) years and then after being re-evaluated after the two (2) year period he was accepted as a permanent member of the Scheme.
During the course of the proceedings the Scheme arranged various Occupational Therapists to assess Mr L’s attendant Care needs. The Scheme’s Occupational Therapist determined that Mr L required 20.6 hours of attendant care per week. It became apparent when we discussed this matter with his family that Mr L’s family were providing him with a lot more care at home and they were under a lot of stress as they were not coping with the need to look after their father. A request was made in writing to the Scheme to reconsider its position in relation to the number of hours of attendant care that was being provided to Mr L however the Scheme issued the determinations stating that the 20.6 hours was a reasonable sum as determined by their Occupational Therapist.
Statements were obtained from the Mr L’s family including his daughter and wife and an application for review was lodged with the Lifetime Care Scheme who allocated the dispute to a review panel to determine.
The review panel consisted of a doctor who specialises in Rehabilitation Medicine and two (2) Independent Occupational Therapists. The panel considered the Statements of the family and overturned the original Occupational Therapist’s assessment. The panel held that 20.6 hours of care was not sufficient and that Mr L required 56 hours of attendant care per week.
It is clear that many members of the Lifetime Care Scheme are not aware of their legal rights to challenge and review the Lifetime Care Scheme’s decision in relation to attendant care, the need for treatment and rehabilitation and other such matters. A member of the Lifetime Care Scheme is not bound by an Assessment conducted by one of the Scheme’s doctors or Occupational Therapists. There are rights of Appeal and review available to Lifetime Care Scheme participants.
If you are a member of the Lifetime Care Scheme you may be also entitled to a claim for non economic loss, past and future economic loss and past gratuitous care. Despite liability in Mr L’s case, being extremely difficult we managed to resolve his matter for $170,000.00 which included an allowance for non-economic loss, past and future wage loss and past gratuitous care. Mr L’s treatment, attendant care and rehabilitation and equipment needs will continue to be paid by the Scheme in the future.
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