The insurer alleged that the claimant was not a passenger in the vehicle when the accident occurred and sought repayment of medical benefits paid on her behalf. Vice Chair Flude concluded that the insurer had the burden to prove that the claimant had made a wilful misrepresentation, and that the insurer failed to meet its burden. While the claimant’s evidence was extremely vague, there was medical evidence that the claimant had suffered from significant cognitive dysfunction for many years and was quite forgetful with decreased attention and concentration. Furthermore, an email from the attending police officer confirmed that he recalled the claimant being at the scene of the accident but had not written her name because she did not appear injured. The request for repayment was dismissed.
Menu