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Dooley v. Aviva General Insurance (20-006951)

  • October 13, 2021

The insurer filed a Notice of Motion seeking a ruling that the claimant was precluded from proceeding with his application with respect to IRBs from the date of the loss to 104 weeks post-accident because the claimant failed to submit a Disability Certificate (OCF-3) supporting entitlement. Adjudicator Mazerolle agreed with the insurer and concluded that the claimant was unable to proceed with the application for an IRB for the time period in dispute. Adjudicator Mazerolle stated that the language of section 36(2) and (3) is clear: an insured person must submit a completed OCF-3 before they can request a specified benefit. While the claimant contended that his OCF-18s should have been a clear indication of his intent to claim an IRB, the obligation to adjust a claim for a specified benefit did not start until there is was completed OCF-3. Finally, Adjudicator Mazerolle found that section 129 of the Insurance Act (relief from forfeiture) was not available as a remedial provision as it did not apply to accident benefits disputes before the Tribunal.

Full decision here

TGP Analysis

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