S.A. v. Aviva Insurance Canada (18-004334)

The claimant sought entitlement to IRBs in the amount of $195.81 per week, the cost of an IRB calculation report, interest and a special award. The claimant submitted that from March 9, 2016 to April 30, 2016, he suffered a substantial inability to perform the essential tasks of his pre-accident employment as a floor installer due to the physical and psychological impairments he sustained. The claimant was working approximately 10 hours per day as a floor installer and was also employed as a server. The claimant began to receive chiropractic treatment a few weeks post-accident. According to the OCF-3, the claimant was said to be unable to perform the essential tasks of his employment, but was able to return on modified duties and specifically, “the applicant reports returning to work despite medical advice to refrain from work”. The insurer received a second copy of the OCF-3, one day prior to the claimant’s return to work, but the OCF-3 was altered to remove the information that the claimant had returned to work post-accident and modified duties were no longer listed as being available. Adjudicator Gosio concluded that the claimant was not entitled to the IRB as the claimant only saw his family physician once for accident related issues, he had returned to his pre-accident employment with modifications, and the medical evidence suggested that he was dealing with primarily soft tissue injuries that were successfully managed through treatment modalities. There was no evidence or submissions which indicated that the claimant was suffering from anxiety. With regards to the IRB calculation report, Adjudicator Gosio found that the report was reasonable and necessary as the claimant was self employed, which could complicate the calculation and having a member of a designated body prepare the report was acceptable in the circumstances.

M.G. v. Intact Insurance Company (17-008078)

The claimant sought entitlement to the cost of an accounting report related to IRBs. Adjudicator Parish dismissed the dispute. She found that the delays which occurred with the file while the insurer was conducting an investigation regarding the accident did not establish that the accounting report was reasonable and necessary. Further, she found that the accounting report was commissioned prematurely at a time when there was no quantum dispute with respect to the IRB, and that the IRB calculation was straightforward based on two income sources and did not necessitate retaining an accountant.

M.G. v. Intact Insurance Company (17-008078)

The claimant sought entitlement to the cost of an accounting report related to IRBs. Adjudicator Parish dismissed the dispute. She found that the delays which occurred with the file while the insurer was conducting an investigation regarding the accident did not establish that the accounting report was reasonable and necessary. Further, she found that the accounting report was commissioned prematurely at a time when there was no quantum dispute with respect to the IRB, and that the IRB calculation was straightforward based on two income sources and did not necessitate retaining an accountant.

M.M. v. Aviva Insurance Canada (17-006475)

The claimant sought entitlement to IRBs, various medical benefits, educational expenses, and an accounting report. Adjudicator Boyce found that the claimant was not entitled to payment of IRBs as claimed as she did not demonstrate a substantial inability to perform the essential tasks of her pre-accident employment for the period in dispute. Adjudicator Boyce had noted inconsistencies in the claimant’s IRB claim about her ability to complete her essential pre-accident employment tasks and that the claimant was able to return to work. The surveillance evidence was found to show the claimant doing many routine work tasks that contradicted her claim she was unable to work. She also claimed the cost of the accounting report she completed to calculate her IRB quantum, which was determined to be not payable because it was not an identified issue in dispute. The claimant was found to be entitled to payment for physiotherapy treatment and dental expenses including interest as they were considered to be reasonable and necessary. Further, the claimant was not entitled to the education expenses claimed as there was no evidence to support that she was unable to complete her course as a result of the accident. No special award was granted as there was no indication that Aviva unreasonably withheld or delayed payment of benefits where there was also a genuine dispute over entitlement.

S.M. v. Aviva General Insurance Company (18-010116)

The claimant sought entitlement to the cost of an accounting report related to IRBs. Adjudicator Boyce dismissed the dispute. He held that it was not reasonable and necessary for the claimant to procure an accounting report. The claimant had a single source of income, and was not self-employed. The existence of short-term disability payments did not justify retaining an accountant. The insurer’s use of an accountant was completed in the scope of properly adjusting the claim, and to address the missing OCF-2 that the claimant’s accountant had not considered.

S.G. v. Wawanesa Mutual Insurance Company (18-001861)

The claimant sought reconsideration of the Tribunal’s denial of IRBs and the cost of an accounting report. Adjudicator Parish concluded that the Tribunal had not made a significant error or law or fact such that it likely would have reached a different conclusion. Most of the arguments made by the claimant were, in essence, an effort to re-argue the case.

P.M. v. Aviva Insurance Canada (17-005419)

The claimant sought entitlement to IRBs and medical benefits. She also sought entitlement to an accounting report. Adjudicator Watt denied the claim for IRBs, as the claimant had been paid IRBs up to the date she returned to work on a modified basis. He found the treatment plans not reasonable and necessary. Finally, he held that the cost of the accounting report was not payable because it was the claimant’s behaviour which resulted in difficulties calculating the IRB. She withheld information regarding disability benefits and her return to work. Furthermore, she was not a self-employed person.

B.H. v. Certas Home and Auto Insurance Company (17-006692)

The claimant sought entitlement to the cost of an accounting report and interest on IRBs. The insurer had paid IRBs at a lower rate and then increased the weekly IRB payment upon receipt of further information. Adjudicator Ferguson held that the insurer was not required to pay for the accounting report because the claimant was an employed individual and the IRB calculation was very simple. It was not reasonable to retain an accountant. In terms of interest, Adjudicator Ferguson ordered the insurer to pay interest on the increased IRBs even though the claimant was late in submitting documents.

Applicant v. The Co-operators (16-004674)

The claimant sought removal from the MIG, entitlement to various medical benefits, and entitlement to the cost of an accounting report. The insurer raised a preliminary issue regarding the claimant’s non-attendance at various insurer examinations. Adjudicator Treksler held that the claimant was suffering from chronic pain syndrome and psychological impairment. However, she awarded only some of the claimed medical benefits. Four treatment plans were denied due to the claimant’s failure to attend insurer examinations, and one was denied because it was incurred before a treatment plan was submitted. The cost of the accounting report was denied because the adjudicator concluded that the claimant’s entitlement to income replacement benefits was straightforward, and an accounting report was not reasonable and necessary.

P.B. v. RBC Insurance Company (16-000284)

The claimant submitted an accounting report in respect of an IRB quantum. The insurer paid $2,500.00 per section 7(5) of the SABS. The claimant sought a further amount for HST. Adjudicator Sewrattan dismissed the claim for outstanding HST. The adjudicator also dismissed the claim for costs made by the insurer, stating that cost awards are to maintain civility and order during proceedings, to deter conduct that threatens the orderly and civil resolution of an application, and to ensure that the Tribunal’s process and the other participants are respected. They are not to compensate parties for the cost of bringing or defending claims, or to punish.