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Del Grosso v. Intact Insurance Company (20-013318)

  • January 4, 2023

The claimant was involved in an accident in Michigan and elected to receive Michigan no-fault benefits, including Work Loss Benefits (the Michigan equivalent of IRBs). The insurer later learned that the claimant misrepresented his driving history and insurance history when applying for his auto policy. The insurer terminated the claimant’s entitlement to Work Loss Benefits and requested repayment of over $72,000 based on the section 31(1)(b) exclusion. The claimant argued that Michigan benefits were not equivalent to IRBs, and were not excluded and argued that the Tribunal did not have jurisdiction to consider his entitlement to Michigan no-fault benefits. Adjudicator Norris found that he had jurisdiction to consider the matter as the Michigan level benefits were being paid under the SABS. He agreed with the insurer’s position, concluding that the claimant made material misrepresentations in his application for insurance (failing to report an earlier accident and termination of an auto policy), that section 31 (1)(b) barred entitlement to IRBs, and that Work Loss Benefits were equivalent to IRBs. Adjudicator Norris ordered the claimant to repay all Work Loss Benefits received.

Full decision here

TGP Analysis

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  • FILED UNDER Repayment, Exclusions, Jurisdiction, Out-of-Province Accident
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