Category: Repayment

Motor Vehicle Accident Claims Fund v. I.G. (18-000798)

The Fund sought repayment of IRBs and medical benefits, arguing that the claimant was not employed at the time of the accident and was not involved in a motor vehicle accident as claimed. Adjudicator Makhamra accepted that the claimant had committed a wilful misrepresentation. A few years after initially making the accident benefits claim, the claimant had been involved as a witness in the criminal trial of other individuals allegedly involved in the accident. Justice MacDonnell found that the claimant was not struck by a motor vehicle, as alleged. It was also found that the claimant had committed perjury and obstruction of justice. Adjudicator Makhamra accepted the findings from the Court, as well as an earlier FSCO arbitration regarding entitlement to IRBs, and ordered that the claimant repay all accident benefits paid to him.

Travelers Insurance v. C.B. (18-007878)

The insurer sought repayment of IRBs paid to the claimant for a period she was working in a job with similar job duties to her pre-accident employment. Adjudicator Paluch granted repayment of $13,134.06 in IRBs. He held that the claimant’s return to work suggested that she did not suffer a substantial inability to engage in her employment. Because the repayment request was sent within 12 months of the overpaid IRBs, the insurer was entitled to recover all of it.

M.F. v. The Personal Insurance Company (18-007929)

The insurer alleged that the claimant was not a passenger in the vehicle when the accident occurred and sought repayment of medical benefits paid on her behalf. Vice Chair Flude concluded that the insurer had the burden to prove that the claimant had made a wilful misrepresentation, and that the insurer failed to meet its burden. While the claimant’s evidence was extremely vague, there was medical evidence that the claimant had suffered from significant cognitive dysfunction for many years and was quite forgetful with decreased attention and concentration. Furthermore, an email from the attending police officer confirmed that he recalled the claimant being at the scene of the accident but had not written her name because she did not appear injured. The request for repayment was dismissed.

Certas Direct Insurance Company v. K.P. (18-005710)

The insurer sought repayment of IRBs alleging that the claimant had misrepresented his work status for a period of seven months. Adjudicator Parish accepted that the claimant was working during the seven month period he was receiving IRBs, and that the claimant wilfully misrepresented his work status in signing an OCF-13 which stated he had not earned any income, as well as stating the same during an examination under oath. The adjudicator also held that the insurer had requested repayment in accordance with section 52. Because the claimant committed a material misrepresentation, the 12 month time limit on the repayment request did not apply.

Aviva General Insurance Company v. H.H. (17-007805)

The insurer sought repayment of NEBs accidentally paid to the claimant from four weeks after the accident rather than 26 weeks after the accident. Adjudicator Hamud concluded that the insurer was not entitled to repayment. He held that because the first payment of NEBs that was made in error was more than 12 months prior to the repayment request, the insurer was unable to seek repayment. This was despite the repayment request being less than 12 months later than subsequent bi-weekly NEB payments made in error.

Aviva Insurance Canada v. R.R. (16-004445)

The insurer sought repayment of $9,673.38 in IRBs and accountant fees of $2,353.93. Adjudicator Ferguson concluded there was an overpayment of IRBs because the claimant had misrepresented his pre-accident income and that the insurer’s payment of IRBs was therefore made in error. He held that he had no jurisdiction to order the claimant to reimburse the insurer for the cost of the accounting costs.

G.L. v. Security National Insurance Company (18-002099 and 18-004400)

The Case Conference adjudicator listed repayment of non-earner benefits as an issue in dispute. The claimant brought a motion seeking to remove repayment as an issue. Vice Chair Hunter concluded that he did not have jurisdiction to alter the Case Conference Order, and that the claimant should have sought reconsideration. However, he did order the insurer to provide the particulars of the dates for which repayment was sought and if fraud or wilful misrepresentation was being alleged.

Unifund Assurance Company v. R.O. (17-001773)

The claimant sought reconsideration of the Tribunal’s order for her to repay IRBs of $17,200. She argued that the insurer still owed her IRBs for a period prior to her return to work, which should be offset against the repayment. The hearing adjudicator did not address her argument. Associate Chair Jovanovic ordered a new hearing on the claimant’s entitlement to IRBs in order to quantify whether there was any offset that the claimant was entitled to in relation to the ordered overpayment.

R.K. v. Aviva Insurance Company (16-003997)

The insurer sought reconsideration of the Tribunal’s award of medical benefits, arguing that the claimant had not provided invoices evidencing that services were incurred. Associate Chair Jovanovic denied the reconsideration. He held that the adjudicator had considered and weighed the evidence and accepted that the medical treatment in dispute was reasonable, and that it was incurred.

Aviva General Insurance v. Respondent (17-007666)

The insurer sought repayment of IRBs; the claimant sought entitlement to further IRBs. Adjudicator Kershaw held that the insurer was entitled to repayment of IRBs for the period the claimant was receiving disability benefits from Co-operators Insurance (Edge). She concluded that the Edge benefits were an income continuation plan, and that it was irrelevant whether the claimant was employed or self-employed at the time of the accident. Adjudicator Kershaw also concluded that the claimant was entitled to IRBs for the full 104 week period, subject to any payments of IRBs already made by the insurer.