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Ramkelawan v Aviva Insurance Company (20-006937)

  • July 27, 2022

The claimant retained an expert accountant to calculate their quantum of IRBs as a result of the subject accident. The insurer denied payment of the report. The matter eventually proceeded to a Case Conference and several issues were settled between the parties, the only remaining issue was the cost of the accounting report. The claimant’s report covered the period of July 8 to August 15, 2018 and noted that the claimant was entitled to $0.00 in IRBs for that period. The claimant argued that the report was necessary as it showed income loss and included copies of supporting documentation, such as tax forms, bank statements and pay stubs. Furthermore, she argued that she had two employers at the time of the accident and was on modified duties, and that the report was necessary to determine her eligibility for any other income assistance or whether she was entitled to collateral benefits and noted that her medical issues “could have” led to her stop working at any time. The insurer argued that the report was neither reasonable or necessary as the claimant was a salaried T4 employee, and an IRB calculation was straightforward. The insurer also noted that the claimant was not entitled to IRBs as 70 percent of her post-accident income exceeded the policy maximum of $400 per week. Adjudicator Goulet noted that the calculation of IRBs in this case was not a complex matter and queried why the claimant simply did not submit the financial documents directly to the insurer. Furthermore, the claimant retained the accountant only two weeks after she submitted her OCF-1, one day after submitting her OCF-3, and prior to submitting an OCF-10. Adjudicator Goulet noted M.G. v Intact in her reasoning, noting that the claimant retaining an accountant prior to there being an IRB quantum in dispute was premature. The accounting report was found not payable.

Full decision here

TGP Analysis

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  • FILED UNDER Accounting Report
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