Category: Income Replacement Benefits

Applicant v. Old Republic Insurance Company (16-000179)

The insurer appealed a decision by an adjudicator that the claimant was entitled to IRBs up until a particular date in the future. The Executive Chair held that the adjudicator made an error of law by setting an end date for the reinstated IRBs. An insurer has an ongoing obligation to adjust a file, and by setting an end-date, the Order potentially fettered the insurer’s ability to adjust the claimant’s file.

Applicant v. Old Republic Insurance Company (16-000179)

The insurer appealed a decision by an adjudicator that the claimant was entitled to IRBs up until a particular date in the future. The Executive Chair held that the adjudicator made an error of law by setting an end date for the reinstated IRBs. An insurer has an ongoing obligation to adjust a file, and by setting an end-date, the Order potentially fettered the insurer’s ability to adjust the claimant’s file.

J.W. v. Echelon General Insurance Company (16-000082)

The claimant sought IRBs for both the first 104 weeks after the accident, and beyond the first 104 weeks after the accident. Adjudicator Flude accepted the that the claimant met the “complete inability” test as neither the claimant nor the insurer submitted evidence of employment for which the claimant might reasonably be suited by education, training, or experience.

A.P. v. Aviva Canada (16-000045)

The claimant sought further IRBs and medical benefits out of the MIG. Vice Chair Flude held that the claimant did not suffer from a pre-existing condition, was not suffering chronic pain syndrome, and could perform the essential tasks of her employment. IRBs were denied and the claimant was restricted to MIG level benefits.