The claimant sought various accident benefits. The insurer argued that the claimant was not involved in an accident, and alleged that he had made material misrepresentations. The insurer sought repayment of all accident benefits paid. Regarding the burden of proof, Adjudicator Hines held that the claimant had to prove that he was involved in an accident, but that the insurer was responsible for proving a material misrepresentation in order to be entitled to repayment. Adjudicator Hines accepted that the claimant was not involved in the alleged accident, as he was not a passenger in the vehicle he had claimed to be. The claimant did not call any witnesses to support that he was in the vehicle at the time. The claimant’s EUO evidence was inconsistent with the evidence of two other involved parties. Further, the claimant did not mention the accident at various medical appoints after the date of loss. Adjudicator Hines ordered the claimant to repay all accident benefits (medical benefits and NEBs), but he was not required to pay for IE costs incurred by the insurer.
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