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P.B. v. The Co-operators Insurance Company (19-008343)

  • September 18, 2020

The claimant was receiving IRBs of $400 per week. She settled her action against her LTD provider. The LTD release indicated that it covered all claims being made against the LTD provider, including punitive damages and costs. The insurer argued that it was entitled to deduct from IRBs the amounts received from the LTD settlement. Adjudicator Boyce disagreed with the insurer and held that it could not deduct the settlement. The inclusion of other types of compensation in the LTD release meant that the settlement could not be treated as income replacement assistance. The release did not provide any further information to allow the insurer to determine which amounts were for LTD benefits and which amounts were for other compensation. While the insurer improperly deducted the LTD settlement from IRBs, Adjudicator Boyce held that a special award was not warranted. He accepted that the facts of the case presented a genuine dispute over the deductibility of the LTD settlement.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Special Award
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