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B.B. vs. Aviva General Insurance Company 18-006826)

  • February 11, 2020

The claimant disputed entitlement to IRBs in the amount of $400.00 per week from October 26, 2016 to January 7, 2019 with interest. As a preliminary issue, the claimant sought to add entitlement to IRBs beyond January 7, 2019. Adjudicator Lake dismissed the claim, and the preliminary issue. She noted that the claimant did not bring the preliminary matter up during the Case Conference, and had sufficient time before the hearing to bring the matter up and submit a motion to include the issue, which would have allowed the insurer to respond. As it was highly prejudicial to significantly change the period of the benefit claimed, and an Order from the Tribunal was required to add issues to a hearing, the preliminary issue was dismissed. Adjudicator Lake dismissed the claimant’s claim for IRBs, noting that although an OCF-3 was completed on October 31, 2016, it was not provided to the insurer until April 9, 2018; therefore, there was no entitlement to IRBs prior to April 9, 2018. Furthermore, the claimant had failed to prove on a balance of probabilities that he was entitled to the benefit. The practitioners who completed his OCF-3s did not have direct knowledge of his job requirements, and instead used generic terms; the description of his employment was vague and generic when described by medical practitioners, and sick notes provided did not directly reference the subject accident.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, LAT Rules
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