Category: Interest

R.T. v. The Economical Group (17-008069)

The claimant was catastrophically impaired as a result of an accident and sought a determination that she was entitled to receive home modifications and home devices in the amount of $415,334.00. The insurer agree that home renovations were required but disputed the scope and quantum of the proposed benefits. Adjudicator Grieves found that the proposed benefits relating to a rear entrance, deck, intercom system, and security system were reasonable and necessary. Adjudicator Grieves found that the proposed installation of an elevator, bedroom addition with ensuite bathroom, and an addition for a therapy room were not reasonable and necessary. Adjudicator Grieves found that the claimant was only entitled to interest on the portions of the treatment plan for which costs had been incurred.

Applicant v Aviva Insurance Canada (17-006470)

The applicant sought medical benefits for a massage therapy chair and extended warranty. Adjudicator Ferguson held that the applicant was entitled to the benefit claimed as it was reasonable and necessary. The applicant was also entitled to interest on overdue payment of benefits due. The adjudicator preferred the applicant’s treatment plan from an occupational therapist and a physiatry report over Aviva’s evidence. Aviva relied on a letter from an occupational therapist who did not recommend the chair but provided no reason for his opinion. Additionally, Aviva’s submissions did not address pre- and post-levels of well-being or functionality, except for pain, whereas the applicant’s evidence found that a chair would increase the applicant’s physical activity and improve family interaction. Aviva further argued that the cost of the chair was unreasonable, but the adjudicator found that Aviva did not make a case that cheaper models were as effective and the applicant did not claim the most expensive model available.

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.

M.R.A. v. Intact Insurance Company (17-006106)

The insurer approved the disputed treatment plans before the hearing date. The claimant sought payment of interest. Adjudicator Sewrattan concluded that interest was payable because the payment for treatment was overdue.

Applicant v Coachman Insurance Company (17-004906)

The self-employed claimant and insurer disagreed about the quantum of IRBs; the claimant also sought interest on medical benefits approved shortly before the hearing, and a special award. Adjudicator Victor held that it was reasonable to base IRB calculations on the year prior’s gross business income as contemplated in s.4(3) of the SABS, and as such the claimant was entitled to IRBs based on the two income tax returns he provided within the stipulated timeframe. Adjudicator Victor held that requests for further and supporting information were excessive and that the claimant was only required to prove his self-employment income in accordance with the SABS. The claimant went further than required by providing an accounting report. There was a small period of non-compliance by the claimant for which the insurer was entitled to withhold IRB payments. Adjudicator Victor also held that an insurer being incorrect about the claimant not having proved the quantum of IRBs was not enough to grant a special award. Interest was awarded on the approved medical benefits.

V.S. v. Travelers Insurance Company of Canada (17-001670)

The claimant sought reconsideration that he was not entitled to treatment outside of the MIG. With the insurer having approved both treatment plans in dispute and removing the claimant from the MIG in advance of the reconsideration hearing, the single issue to be decided was whether the claimant was entitled to interest on the insurer’s payment of the outstanding benefits. Executive Chair Lamoureux held that it did. Pursuant to sections 51(1) and (2) of the SABS, an insurer is required to pay interest on any overdue payments of a benefit. The insurer had agreed that the amounts of the treatment were payable and therefore was required to pay interest in accordance with the SABS on any overdue payments.

J.G. v. Travelers Canada (17-001630)

Prior to the written hearing, the respondent agreed to remove the claimant from the MIG and pay any invoices for incurred treatment. The claimant decided to proceed with the hearing and sought entitlement to a special award, costs, and interest on overdue payments. Adjudicator Sharma held that the claimant was entitled to the claimed interest only.

M.S. v. Aviva Insurance Canada (17-002857)

A treatment plan for physiotherapy services was recommended for the claimant, but the respondent denied it. The respondent later advised the License Appeal Tribunal that it had decided to approve the claimant’s medical benefit. By the time this dispute was heard by the License Appeal Tribunal, it was not clear whether the respondent had paid the claimant’s medical benefit. Adjudicator Ferguson found that the respondent was liable to pay interest on the overdue payment of the medical benefit.

A.R. v. TD General Insurance Company (16-003487)

The claimant sought interest on re-instated IRBs and entitlement to an orthopaedic mattress. The insurer opposed paying interest, arguing that the claimant had not provided evidence earlier in her claim supporting IRB entitlement. Adjudicator Maedel held that once the insurer re-instated IRBs, the claimant was entitled to interest for the period IRBs had not been paid. He rejected the claim for a mattress because the claimant had not provided any explanation how the mattress related to her specific injuries, and had not provided the Tribunal with the treatment plan itself.

Applicant v. Aviva Insurance Company of Canada (16-001985)

The claimant sought and was successful in obtaining a Tribunal Order for a number of treatment plans. In making the determination, the Tribunal also ordered interest payable at 2 percent per month. On reconsideration, however, Executive Chair Lamoureux noted the Tribunal erred by using the interest provisions of the previous SABS; the correct provision is section 51 at a rate of 1 percent per month, compounded monthly.