Category: Repayment

Applicant v. Aviva (16-001144)

The claimant sought entitlement to income replacement benefits and an orthopaedic assessment. The insurer paid IRBs for four months and terminated them after a number of IE reports. The orthopaedic assessment was denied based on a MIG position. As a preliminary issue, the insurer sought to add the claimant’s LinkedIn page to show the claimant was working and therefore required IRB repayment. Adjudicator Treksler allowed the new evidence to be admitted, but found the page insufficient evidence to warrant repayment of IRBs. Adjudicator Treksler found that the claimant was entitled to IRBs and held that he should be removed from the MIG. The fact that the claimant did not return to his employment, but instead, went to school in a different field was seen as supporting the IRB claim.

Aviva Canada v. S.A. (16-000409)

The insurer alleged that the claimant had made material misrepresentations, and sought repayment of IRBs. After reviewing the chronology of events, Adjudicator Bass found the claimant provided a “shifting version of the facts as a whole” that evidenced “a persistent attempt to receive benefits to which he was not entitled.” Repayment of IRBs was ordered.

TD General Insurance Company v. A.B. (16-000060)

The insurer sought repayment of IRBs based on the claimant’s return to work prior to IRB discontinuance. Adjudicator Go found that the claimant had returned to work as of at least May 1, 2014, and ordered repayment of IRBs from that date onward. The adjudicator was unwilling to find that the claimant had returned to work at an earlier date.