Source: http://vealelaw.com/category/future-care/
Timestamp: 2019-04-26 04:15:17+00:00

Document:
In Warick v. Diwell, the Plaintiff was seriously injured in a head on collision in which other occupants of the vehicle were killed. The Plaintiff commenced legal proceedings, seeking compensation for numerous types of damages, all of which were settled with the exception of the cost of future care.
The Plaintiff suffered a variety of injuries, however the specific ones that the Court noted would have the greatest impact with respect to her care were the spinal cord injury which paralyzed her from the waist done; the numerous surgeries on her intestines and bladder ; and a hand and wrist fracture.
A variety of future cost of care items were in dispute, with the most significant one being the cost of home care of the Plaintiff, with the Court awarding over $3 Million as a present value of the ongoing cost. Other notable items included awards for medications, travel, housekeeping, and mobility aids.
In Sunner v Rana, the Plaintiff was injured in a motor vehicle accident, and consequently advanced an ICBC claim. At trial, the Plaintiff was awarded numerous heads of damages, including the costs of future care in the amount of $20,000.00. ICBC’S lawyer appealed, arguing that the trial judge failed to provide adequate reasons for how the amount of costs of future care was arrived at.
ICBC’S lawyer also made the argument that section 83 of the Insurance (Vehicle) Act highlights the importance of particularization of the future care component, as certain items may be deductible. The Court of Appeal noted that the trial judge was not asked to particularize the future care component in any way, nor were the relevant portions of the legislation brought to his attention, which they should have been.
The Court of Appeal ruled that it was not possible to ascertain just how the trial judge arrived at the amount of $20,000.00. In citing previous Court of Appeal decisions in Johal and Gignac, the Court would rule that the trial judge committed a legal error by not engaging in an item by item analysis of the future care component.
Rather than substitute an award of its’ own, or dismiss the future care component of the Plaintiff’s claim, the Court remitted the issue back to the trial court.
 The appellants contend that the trial judge’s reasons provide no indication of why he awarded the respondent $20,000 for the cost of future care. He claimed $36,000 which the judge described as “25% of the higher amount estimated by Mr. Teasley”.
 In Gregory, this Court reiterated at para. 39 that “there must be some evidentiary link drawn between the physician’s assessment of pain, disability, and recommended treatment and the care recommended by a qualified health care professional”. A physician need not testify to the medical need for each item of care that is claimed.
 The difficulty is that it is not possible to ascertain on what basis the judge arrived at $20,000 as an appropriate award for the costs of future care. This Court has made it clear that an item by item analysis is required. In my view, the judge erred by failing to do so.
A substantial component of an ICBC injury claim, particularly a more serious one, is that of the cost of future care. This can involve costs for various modalities of treatment, costs for specialized equipment, costs for medication, and costs for healthcare professionals.
The costs must be reasonable, and must be medically necessary. Quite often, Plaintiff’s counsel will rely on expert medical reports stating that future care will be required, and will rely on cost of care analysis reports of occupational therapists.
 The award is “based on what is reasonably necessary on the medical evidence to promote the mental and physical health of the plaintiff: (Milina v. Bartsch (1985), 49 B.C.L.R. (2d) 33 (B.C.S.C.) and adopted in Aberdeen v. Zanatta, 2008 BCCA 420 at para. 41.
In Tsalamandris v. McLeod, the Plaintiff was injured in two motor vehicle collisions, and brought ICBC claims for damages. At trial, the Plaintiff was successful. One of the awards was for $93,000 for the cost of future care for pilates. ICBC’S lawyer appealed, however for the most part was unsuccessful. The British Columbia Court of Appeal discussed the general test applied by the Court when awarding damages for the cost of future care.
 She also found that the use of the community centre, particularly the opportunity it gave to exercise in a therapeutic pool, was medically beneficial and that it was reasonable to include the respondent’s portion of a family membership as a cost of future treatment. The appellants do not contest the benefit of exercising in the community centre, but argue that the failure to consider any contingencies results in over-compensation.
In Engqvist v Doyle, the Plaintiff suffered from chronic pain, and sought damages for future care. The treatment that was sought was available through the health care system, but was also available privately. The private treatment, which was more expensive, could be obtained more quickly. The lawyer for ICBC argued that the private treatment costs were unnecessary. The Court granted some damages for the private treatment, however did express some concern with whether or not the Plaintiff would actually engage in such treatment.
 Instead, the fundamental issue is whether a particular future treatment modality is reasonably necessary to promote the plaintiff’s mental and physical health: Milina v. Bartsch 1985 CanLII 179 (BC SC), (1985), 49 B.C.L.R. (2d) 33 (S.C.). In the case of medial nerve blocks, the evidence at trial was clear that the plaintiff should undergo at least one set of medial nerve block injections. The evidence at trial was also clear that the plaintiff could access medial nerve block injections on a fee-for-service basis at a private health clinic pretty much at her convenience, while publicly funded medial nerve blocks require that the plaintiff go on a four- to six-month waiting list. Similar time frames apply to rhizotomy procedures if such are indicated by the nerve blocks.
 That said, this is future care that we are talking about here. Nothing about the future is certain; including whether the plaintiff will or will not actually undertake privately funded medial nerve blocks or rhizotomies. I have reservations about the plaintiff’s resolve in that regard. I have those reservations because, on the one hand, the plaintiff testified that she would like to undergo a rhizotomy and would do so at a private care facility if she had the resources to pay for it. On the other hand, the plaintiff knows that she should be called for Dr. McCann’s publicly funded medical referral for the medial nerve blocks, which are necessary diagnostic precursors to a rhizotomy, sometime in November or December 2011, yet the plaintiff has absented herself from the province for five months in order to go to her holiday home in Arizona. The plaintiff did not testify that she would travel back to B.C. to take advantage of publically funded medial nerve blocks if she is called in November or December. Neither did the plaintiff testify that she would travel back to B.C. to undergo that therapy at her own expense at a private clinic. The plaintiff did not adduce any evidence that such treatment is available or at what cost in Arizona. Public versus private medical care was a centerpiece of the parties’ lis in this case. The gap in the evidence concerning the plaintiff’s intentions is, therefore, a puzzle.
In Harrington v Sangha, the Court held that Pharmacare benefits are non-deductible from a cost of future care award.
 The defendants say the plaintiff should not recover any portion of the cost of medication she may require, as she is eligible to receive PharmaCare benefits. They say that to allow a capital sum as part of the award to fund expenses that will eventually be repaid by a government funded programme will result in double recovery. In support of that proposition they rely upon cases that establish that while the principal goal of the tort compensation system is to ensure that injured individuals are made whole, insofar as possible, by compensation, a secondary objective of the system is to avoid double recovery.
M.B. v. British Columbia, 2003 SCC 53 (CanLII), 2003 SCC 53; Krangle (Guardian ad litem of) v. Brisco, 2002 SCC 9 (CanLII), 2002 SCC 9; Boren v. Vancouver Resource Society et al., 2003 BCCA 388 (CanLII), 2003 BCCA 388.
In Gregory v ICBC, the British Columbia Court of Appeal weighed in on the issue of the type of expert evidence required to prove damages for future care. The trial judge had accorded very little weight to the evidence of an occupational therapist. The Plaintiff was successful, in part, on appeal.
 And, there was a consensus among the physicians that Ms. Gregory has difficulty lifting above shoulder height, difficulty with prolonged heavy or repetitive motion above shoulder level, and that in general she will continue to have persistent pain and weakness.
 The evidence of the physicians does therefore provide some evidentiary basis for the recommendations for assistance with heavy housework, and yard maintenance. In my view the trial judge fell into error by failing to consider these claims on the basis only that, “there are no recommendations from the medical practitioners for housekeeping assistance, or home and yard maintenance … ”.
 Rather than remit this question to the trial judge, I am of the view that it is appropriate for this Court to substitute an appropriate award under this head of damages.
 That part of Ms. Percy’s recommendations in which she estimated assistance for heavy home and yard maintenance is set out above. I would substitute an award of $30,000 over and above the amount already awarded under this head of damages. This represents a reasonable assessment of the present value of the cost of some modest assistance with the housework, and yard maintenance, that Ms. Gregory could not perform herself in a reasonable manner, as a consequence of the impairment in her shoulder.
 I do not accept the defendants’ submission that an award for the cost of future personal care must be reduced to take into account the role Mr. O’Connell plays in providing supervision and guidance to Ms. O’Connell. Ms. O’Connell is entitled to be compensated for the cost of care that is medically required. As Groves J. held in Cojocaru, the law does not permit the defendants to pass off their responsibility to provide appropriate future care by suggesting that Ms. O’Connell can and should rely on her husband to take care of her. A husband is not expected to care for his injured wife on a gratuitous basis: see Andrews at p. 243.
It is trite law that a wrongdoer cannot claim the benefit of services donated to the injured party. In the present case it amounts in my judgment to conscripting the mother and mother-in-law to the services of the appellant and his children for the benefit of the tortfeasor and any reduction of the award on this basis is and was an error in principle.
 Having said this, it is also my view that these principles do not require that Mr. O’Connell’s presence in the home should be entirely disregarded, as the plaintiff submitted. While I agree that it must be assumed that all of Ms. O’Connell’s medically required care is to be provided by paid caregivers, I do not agree that the court must assume that the plaintiff lives alone. I will come back to this when I review the recommendation for personal care services.

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