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A.H. v. Aviva Insurance Canada (19-004639)

  • July 14, 2021

The claimant applied to the LAT seeking entitlement to IRBs and medical benefits. Vice-Chair McGee found that the claimant failed to meet the substantive test for IRBs. The claimant submitted that under s. 36 of the SABS the insurer was required to pay IRBs for a five-month period because the insurer failed to request insurer examinations within 10 days of receipt of the claimant’s OCF-3. Vice-Chair McGee found that the insurer was not required to pay IRBs during this period because the insurer requested an Election of Benefits (OCF-10) within 10 days of receipt of the OCF-3, and the claimant failed to submit a completed OCF-10. Vice-Chair McGee held that the s. 35 requirement to elect a benefit is mandatory and unambiguous. Failure to complete this step renders an application for a specified benefit incomplete. The claimant’s OCF-2 did not eliminate the ambiguity in the OCF-3, which supported IRBs and NEBs, and did not stand in the place of an OCF-10 election. The applicant’s failure to elect a specified benefit meant that the insurer’s obligations under s. 36 were never triggered. The application was dismissed.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Election
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