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A.J. v The Guarantee Company of North America (19-001321)

  • April 6, 2020

The claimant sought entitlement to income replacement benefits and physiotherapy treatment, while the insurer sought a repayment of IRBs which it claimed were wrongly paid to the claimant at the outset of the claim. The insurer relied on an orthopaedic IE report to justify its termination of IRBs. Adjudicator Grant placed little weight on the report, noting that it was flawed in that it did not comment on any testing that would have reflected the claimant’s workload demands, which were described as including operating heavy machinery and heavy lifting duties. Adjudicator Grant accepted the claimant’s evidence that she had attempted to return to both her full-time and part-time pre-accident employment, but had not been able to do so, and found that she was entitled to pre-104 week IRBs. However, he went on to find that she had not provided evidence to support that she met the more stringent post-104 week entitlement test. Adjudicator Grant also held that the claimant was liable to repay the IRBs as requested by the insurer for amounts paid while the claimant was being paid income for modified work, as the repayment request was sent within the required time period and clearly set out the amount to be repaid. Finally, Adjudicator Grant concluded that the claimant was entitled to the physiotherapy treatment plan, as her pain reports were consistent, credible, and ongoing since the accident, and the evidence supported that treatment had proven beneficial.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Repayment, Medical Benefits
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