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Bewes v. TD General Insurance Company (22-009538)

  • July 25, 2023

A preliminary issue hearing was ordered at the Case Conference to determine if the claimant was barred from pursing her claim for IRBs as she did not submit an OCF-3 within 104 weeks of the accident. The claimant’s accident occurred on September 15, 2020. The claimant submitted an OCF-2 on October 29, 2020. TD responded to the form and requested a completed OCF-3 in order to address IRBs. The claimant submit an OCF-3 on November 5, 2020, but it was not endorsed by a health practitioner. TD then sent several follow-up requests for a completed OCF-3. The requests clearly stated that no IRB would be payable until the completed OCF-3 was received. On October 17, 2022 (i.e., over 2 years post-accident), the claimant submitted a completed OCF-3 dated October 3, 2022, indicating that she was entitled to IRBs. The claimant argued that an OCF-3 was not mandatory for consideration of benefits and that the claimant had substantiated via medical evidence that she was incapable of working. The Insurer argued that submission of an OCF-3 was required pursuant to the SABS and the Guideline. Adjudicator Kuar noted that the OCF-3 was a mandatory form, which shall be provided to the insurer in order to facilitate a claim for IRBs, and that the language supporting this was clear. Adjudicator Kuar ruled that the submission of an OCF-3 was mandatory in order to apply for an IRB, and regardless of any supportive medical evidence towards an IRB, the claimant had not applied for the benefit within 104 weeks of the accident via her failure to submit a completed form as requested. The Application was dismissed.

Full decision here

TGP Analysis

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