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Applicant v. Certas Home and Auto Insurance Company (17-003172)

  • March 27, 2018

The claimant sought entitlement to further income replacement benefits and the insurer sought repayment of IRBs it paid to the claimant calculated on the understanding that he was an employee rather than self-employed. The claimant did not return to work after the accident citing his daily use of marijuana to control his anxiety, depression, stress, paranoia, and pain as the reason. Adjudicator Maher held that the claimant was not entitled to further IRBs. With respect to the overpayment issue, Adjudicator Maher held that while the insurer had overpaid IRBs to the claimant, he was not required to repay the insurer because the insurer did not give proper notice of the amount to be repaid and did not satisfy the Adjudicator that the overpayment resulted from any wilful misrepresentation on the part of the claimant.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Repayment
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