The claimant applied to the LAT disputing entitlement to IRBs and a special award. The insurer argued that the claimant was barred from claiming accident benefits based on section 61. The claimant conceded that he was working at the time of the accident, but argued that he was not entitled to benefits from WSIB and argued that the insurer had not properly investigated the issue prior to the LAT hearing. Adjudicator Lake agreed with the claimant that the WSIB issues was not properly before her, as the section 61 defence had not been raised in any earlier Case Conference. Regarding entitlement to IRBs, Adjudicator Lake found that the OCF3 was only properly submitted in April 2019. An earlier version had been faxed to an incorrect fax number rather than the number given in accordance with section 64(21). The insurer’s denial in April 2019 was not clear as it said that the claimant both qualified and did not qualify for IRBs. Only in February 2020 did the insurer provide a proper section 36 notice. Adjudicator Lake ordered the insurer to pay IRBs for the period April 2019 to February 2020. However, the claimant failed to provide sufficient information for the Tribunal to calculate the IRBs (no income tax returns for the 52 weeks prior to the accident or post-accident were provided), so no amounts were payable. The claim for a special award was also dismissed.
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