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Applicant v. Certas Home and Auto Insurance Company (17-001090)

  • December 27, 2017

The claimant disputed his entitlement to income replacement benefits (IRBs). The insurer sought repayment for overpayment of IRBs in the amount of $16,000. Adjudicator Bickley dismissed the claimant’s claim for IRBs and the insurer’s repayment request. Adjudicator Bickley dismissed the claimant’s special award claim and the insurer’s cost award claim. Adjudicator Bickley dismissed the claimant’s dispute for IRBs on the basis that the claimant returned to her full-time pre-accident employment after the accident and then went to school to become a PSW. Adjudicator Bickley concluded that the claimant’s ability to return to work and then attend school and become a PSW persuaded her (Adjudicator Bickley) that the claimant did not meet the pre-104 week IRB test. With respect to the insurer’s IRB repayment request, Adjudicator Bickley dismissed the insurer’s dispute on the basis that the insurer paid the claimant IRBs even though it was aware of issues with the claimant’s IRB eligibility and therefore, concluded that the insurer did not pay the claimant in error.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Repayment
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