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Bailey v Traders General Insurance Company (24-003141)

  • December 10, 2024

The claimant was involved in an automobile accident in July 2020. She applied to the LAT seeking entitlement to IRBs and medical benefits. With regards to IRBs, the parties disagreed over the period when the “complete inability” standard comes into effect. The claimant argued that the wording “104 weeks of disability” means that this standard does not apply until an insured person has had a cumulative period of 104 weeks at the “substantial inability” standard. Since the applicant returned to her pre-accident role for a period following the accident, she argued that the nine-week period at issue remained within “the first 104 weeks of disability”. As such, the “substantial inability” standard would apply. The respondent disagreed, arguing that the stricter standard comes into effect once 104 weeks have elapsed since the accident. The LAT agreed with the respondent and found that the “complete inability” standard comes into effect 104 weeks after the accident.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Medical Benefits
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