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Applicant v. State Farm Insurance (17-000018)

  • December 17, 2017

The claimant disputed her entitlement to IRBs. Adjudicator Paluch dismissed the claimant’s application finding that the claimant was not entitled to IRBs for either the pre- or post-104 week period. Adjudicator Paluch also concluded that the claimant did not comply with s. 33 and did not provide a reasonable explanation for her delay in providing documentation for the claimed period. Adjudicator Paluch noted that he found the IE assessors’ opinions persuasive. In particular, Adjudicator Paluch noted that the FAE IE report indicated to him that the claimant could tolerate light to medium physical demands and that the claimant was therefore able to return to her pre-accident employment as the owner and operator of a restaurant. With respect to the insurer’s s. 33 suspension, even though Adjudicator Paluch did not find the claimant entitled to IRBs, he would have found the claimant not entitled to IRBs for the period of 2.5 years in any event due to her non-compliance with s. 33 as the claimant failed to provide the insurer financial documentation necessary to calculate her IRB quantum.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Section 33
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