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T.A.K. v. Aviva General Insurance Company (18-008232)

  • January 13, 2020

The claimant sought entitlement to IRBs, ACBs, and a special award. The claim for IRBs only concerned the weekly quantum. Adjudicator Neilson held that the insurer was entitled to deduct CPP Disability Benefits, and entitled to deduct income reported on the claimant’s tax returns which the claimant could not provide documentation for. She was critical of the claimant’s lack of disclosure of his income, particularly given that he had filed his taxes after the date of loss. After the claimant turned 65, even though an IRB was not actively being paid, the insurer was entitled to reduce the weekly IRB in accordance with the SABS. Adjudicator Neilson held that the formula applied whether an IRB was being paid, or was later found to be payable. She issued a special award of 35 percent based on the insurer’s improper deduction of 100 percent of post-accident income rather than 70 percent. Adjudicator Neilson dismissed the claims for ACBs, holding that many of the claimant’s reported care needs arose from conditions unrelated to the accident (such as a strokes and post-accident falls). She was critical of the claimant’s assessors and treatment providers for not addressing causation.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Attendant Care Benefits, Special Award
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