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Jama v. Unifund (20-005328)

  • January 28, 2021

The insurer brought a preliminary issue hearing seeking an order that the claimant was not entitled to receive an IRB pursuant to section 57, which outlines an insured person’s responsibility to pursue reasonable, necessary, and available forms of treatment if the insured person continues to receive a weekly benefit, such as an IRB. Adjudicator Mazerolle held that the insurer did not provide proper notice of its intention to cease payment of the claimant’s IRB and dismissed the insurer’s motion. Adjudicator Mazerolle found that the insurer did not provide proper notice per section 57(5) as the insurer did not make any specific mention of the IRB payment nor did the insurer advise the claimant of an intention to stop paying benefits in its notice letter. Adjudicator Mazerolle held that it was the insurer’s obligation to adhere to notice requirements if it was going to stop benefits.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Section 57
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