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B.F. v. Certas Direct Insurance Company (19-004944)

  • April 28, 2021

The claimant applied to Certas for accident benefits. Certas brought an application to the LAT arguing that the claimant was not involved in an “accident” and sought repayment of accident benefits because the claimant wilfully misrepresented facts in relation to her application for benefits. Adjudicator Maleki-Yazdi agreed that the claimant was not involved in an accident. Adjudicator Maleki-Yazdi considered the claimant’s EUO evidence as well as the evidence of Certas’ investigator. Adjudicator Maleki-Yazdi found there were several inconsistencies with the claimant’s reporting and that the claimant could not describe basic facts regarding the collision at both her EUO and at the hearing. Because Adjudicator Maleki-Yazdi found there was no accident, Adjudicator Maleki-Yazdi also found that the claimant had wilfully misrepresented material facts about her claim for benefits and that the claimant had to repay Certas accident benefits pursuant to section 53.

Full decision here

TGP Analysis

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  • FILED UNDER Accident Definition, Material Misrepresentation
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