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F.T. v. The Co-Operators Insurance Company (19-001291)

  • January 14, 2022

The self-employed claimant applied to the LAT seeking entitlement to medical benefits outside of the MIG and a determination of the quantum of IRBs. The insurer had paid IRBs in the amount of $59 per week, based on its expert accounting report. The claimant sought IRBs in the amount of $400 per week, based on his own accounting report. Adjudicator Chakravarti found that the claimant was outside of the MIG as a result of a psychological injury. The claimant was not entitled to the disputed OCF-18 for chiropractic treatment and massage. Adjudicator Chakravarti noted that the only evidence before the LAT recommending chiropractic and massage treatment was the OCF-18 itself, which was not sufficient to prove that the proposed treatment was reasonable and necessary. With regards to IRB quantum, Adjudicator Chakravarti found that the claimant’s accounting report made questionable assumptions that were not in keeping with the documentary evidence. Adjudicator Chakravarti also found that there were no documents showing that alleged pre-accident gross partnership income was reported as income to the CRA and, therefore, the gross partnership income could not form part of the IRB calculation. In addition, the claimant failed to prove that alleged post-accident losses were reasonable in the circumstances and necessary to prevent a loss and/or a result of the accident. The claimant was not entitled to further IRB payments.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Minor Injury Guideline
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