Abadicio v. Economical Insurance Company (20-000099)

The claimant sought removal from the MIG and entitlement to three assessments. The insurer sought repayment of $7,120 in IRBs. Adjudicator Farlam held that the claimant failed to prove that she did not suffer a minor injury. She also concluded that the insurer was entitled to repayment of IRBs. The claimant had returned to work October 25, 2017 (one month after the accident) but did not notify the insurer until early 2018. There was no evidence that the claimant communicated the return to work at an earlier date, despite having a clear duty to advise the insurer. Adjudicator Farlam concluded that the claimant willfully misrepresented his work status while continuing to collect IRBs even though he no longer met the disability test. The insurer’s notice complied with section 52 even though the initial quantum of repayment increased later as more information became available. Additionally, the one year limitation on repayment did not apply, as the claimant made a willful misrepresentation regarding work status.

Security National Insurance Company v. Balgobin (20-003118)

The insurer requested repayment as a result of IRB payments made in error due to the claimant’s failure to notify the insurer that she had already returned to work. The claimant did not participate in the hearing. Vice Chair Boyce found that the insurer acted diligently upon receipt of information that the claimant was no longer entitled to IRBs and that the notices sent to the claimant requesting repayment met both the procedural and timeline requirements as set out in the SABS. As such, Vice Chair Boyce held that the insurer was entitled to IRB repayment in the amount of $3,257.14 plus interest.

Jevco Insurance v. Owusu-Achiaw (19-012474)

The insurer requested repayment as a result of IRB payments made based on the claimant’s material misrepresentation over his address and the resulting insurance premiums. The claimant did not participate in the hearing. Vice Chair Boyce found that the claimant made a willful misrepresentation in failing to disclose his correct address in order to attract a lower premium, and that the significant difference of $3,990 in the premium rate was material. As such, he held that the insurer was entitled to repayment of $7,181.76 due to the claimant’s material misrepresentation, and awarded costs in the amount of $106 as a result of having to submit an application to the Tribunal to secure an order.

Aviva General Insurance v. E.R. (19-001839)

The insurer requested repayment as a result of IRB payments made in error, as it was unaware that the claimant had returned to work until it received the information in a section 44 IE report. The claimant argued that it was prejudicial for his own insurer to penalize him as a result of their error. Vice Chair Boyce rejected the claimant’s argument, as the prejudice was actually to the insurer, who relied in good faith on the information provided to it by the claimant when issuing the IRB. He further noted that claimant had a responsibility to notify the insurer of a return to work when in receipt of an IRB. As the insurer’s notice of request for repayment met the 12 month timeline criteria to support its claim, Vice Chair Boyce held that the insurer was entitled to repayment of $8,650.60 plus applicable interest.

Aviva General Insurance Company v. Ghandahari (19-009382)

The insurer requested repayment as a result of benefit payments made based on the claimant’s wilful misrepresentation when she failed to disclose that the accident occurred during the course of her employment and she made a claim for benefits from the WSIB. The claimant did not participate in the hearing. Adjudicator Chakravarti agreed with the insurer that the claimant made wilful misrepresentations when she purposely failed to disclose that her accident occurred during the course of her employment, and again when she advised the insurer that she was commencing an action against a third party (and then failed to tell the insurer that she did not do so). As such, Adjudicator Chakravarti held that the claimant was liable to repay the insurer the benefits, with interest.

Aviva General Insurance Company v. Gurung (20-000592)

The insurer sought repayment of all IRBs paid to the claimant, totaling $36,456, based on the claimant failing to notify the insurer that she was earning income as the owner of a restaurant. The insurer argued that it was entitled to repayment of more than one year of IRBs because the overpayment was due to the claimant’s willful misrepresentation. Adjudicator Lake granted the insurer’s request for full repayment of IRBs. She held that the claimant made misrepresentations at an examination under oath, during IEs, and on OCF forms. Tribunal case law held that a misrepresentation was “”any manifestation by words or other conduct by one person to another that, under the circumstances, amounts to an assertion not in accordance with the facts””. This could include “”silence or a failure to report””.

Aviva General Insurance Company v. Muthusamythevar (19-009392)

The insurer applied to the LAT seeking repayment of an overpayment of IRBs made as a result of wilful misrepresentation. Adjudicator Boyce found that the insured failed to notify the insurer when he returned to full-time work, and he continued to collect IRB payments while working full time. Adjudicator Boyce agreed with previous LAT decisions that “silence or failure to report” can constitute wilful misrepresentation, and found that the insurer was entitled to repayment of IRBs made as a result of wilful misrepresentation, plus interest.

Unifund Assurance Co. v. M.D.C. (19-010729)

The insured applied to the LAT for various benefits. The insurer added repayment of an overpayment of IRBs to the issues in dispute. The insured failed to attend multiple case conferences, and his application was dismissed without a hearing as the LAT determined he had abandoned his claim. The matter proceeded to a written hearing on the issue of whether the insurer was entitled to a repayment of IRBs. Adjudicator Boyce found that the insured failed to notify the insurer when he returned to full-time work, and he continued to collect IRB payments while working full time. In addition, the insured submitted an Election of Income Replacement benefits after he had returned to work. Adjudicator Boyce found that the insurer was entitled to repayment of IRBs made as a result of wilful misrepresentation.

T.M. v. Aviva General Insurance (18-010477)

The claimant sought reconsideration of the Tribunal’s decision dismissing his claim for IRBs. The insurer sought reconsideration of the Tribunal’s decision that it was not entitled to repayment. Both requests for reconsideration were denied. Regarding the claimant’s reconsideration request, Adjudicator Grant held that the Tribunal did not make an error of law in finding that the claimant was not employed at the time of the accident and that she had not earned employment income prior to the accident. Regarding the insurer’s reconsideration request, Adjudicator Grant held that the Tribunal did not make an error in conclude that the insurer’s request for repayment sent via email did not comply with section 64 of the SABS; the insurer required the consent of the claimant to send the notice for repayment by email, even though the claimant and insurer had communicated by email on previous instances.

T.M. v. Aviva General Insurance (18-010477)

The claimant sought reconsideration of the Tribunal’s decision dismissing his claim for IRBs. The insurer sought reconsideration of the Tribunal’s decision that it was not entitled to repayment. Both requests for reconsideration were denied. Regarding the claimant’s reconsideration request, Adjudicator Grant held that the Tribunal did not make an error of law in finding that the claimant was not employed at the time of the accident and that she had not earned employment income prior to the accident. Regarding the insurer’s reconsideration request, Adjudicator Grant held that the Tribunal did not make an error in conclude that the insurer’s request for repayment sent via email did not comply with section 64 of the SABS; the insurer required the consent of the claimant to send the notice for repayment by email, even though the claimant and insurer had communicated by email on previous instances.