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Zabarain v. Coseco Insurance Company (2026 ONSC 3712)

  • June 30, 2026

The claimant appealed the Tribunal’s decision that he was not entitled to IRBs, that he was required to repay an overpayment of IRBs, and that the insurer did not wrongfully pay a hospital account. The Tribunal found that the claimant had returned to work as a lawyer and did not meet the post-104 week IRB test, and that his receipt of IRBs after his return to work resulted in an overpayment of IRBs. The Tribunal also found that the insurer properly paid for a large hospital account that was invoiced to the claimant due to being a non-resident. The Court dismissed the appeal. The Court concluded that the insurer properly paid for the hospital account when it received the hospital invoice and that an OCF18 was not required. Furthermore, nothing in the SABS prohibited an insurer from paying for an incurred expense that was related to the accident. The Court accepted that the Tribunal mis-stated the law on wilful misrepresentation, but that the error did not affect the outcome because the claimant had withheld employment information that resulted that was detrimental to the IRB claim.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Repayment, Medical Benefits, Divisional Court
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