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O’connor v. Aviva General Insurance Company (19-006131)

  • July 4, 2022

The claimant brought an application seeking entitlement to IRBs from December 16, 2017 to May 2018. The date of loss was December 9, 2017. She testified that she had returned to part-time work in January 2018 and transitioned to full-time work in April or May 2018. However, the insurer identified two IE reports in which the claimant had stated that she had returned to full-time employment in January 2018. In response to her conflicting claims, the insurer had requested the claimant’s paystubs and an OCF-2 in June 2018, and further requested in a letter dated October 23, 2018, that the claimant confirm the date that she had returned to work. As the claimant had not produced any income records that could confirm her post-accident income, the insurer argued that the LAT should rule that the claimant was not entitled to any IRBs for the period being claimed. Adjudicator Neilson found that she could not deny IRBs to the claimant under s. 33(6) for a failure to provide income information, because per s. 36(5), an insurer was required to pay IRBs withheld once the information sought was received, as long as a reasonable explanation was provided for the delay. However, Adjudicator Neilson stated that she was unable to make a determination on the claimant’s entitlement to IRBs until the claimant provided the income documents requested and provided reasons for the delay.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Section 33
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