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S.A. v. Aviva Insurance Canada (18-004334)

  • September 8, 2020

The claimant sought entitlement to IRBs in the amount of $195.81 per week, the cost of an IRB calculation report, interest and a special award. The claimant submitted that from March 9, 2016 to April 30, 2016, he suffered a substantial inability to perform the essential tasks of his pre-accident employment as a floor installer due to the physical and psychological impairments he sustained. The claimant was working approximately 10 hours per day as a floor installer and was also employed as a server. The claimant began to receive chiropractic treatment a few weeks post-accident. According to the OCF-3, the claimant was said to be unable to perform the essential tasks of his employment, but was able to return on modified duties and specifically, “the applicant reports returning to work despite medical advice to refrain from work”. The insurer received a second copy of the OCF-3, one day prior to the claimant’s return to work, but the OCF-3 was altered to remove the information that the claimant had returned to work post-accident and modified duties were no longer listed as being available. Adjudicator Gosio concluded that the claimant was not entitled to the IRB as the claimant only saw his family physician once for accident related issues, he had returned to his pre-accident employment with modifications, and the medical evidence suggested that he was dealing with primarily soft tissue injuries that were successfully managed through treatment modalities. There was no evidence or submissions which indicated that the claimant was suffering from anxiety. With regards to the IRB calculation report, Adjudicator Gosio found that the report was reasonable and necessary as the claimant was self employed, which could complicate the calculation and having a member of a designated body prepare the report was acceptable in the circumstances.

Full decision here

TGP Analysis

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  • FILED UNDER Income Replacement Benefits, Accounting Report
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