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Unica Insurance Inc. v. Jeyabalasingam (19-013236)

  • November 26, 2021

The insurer sought repayment of three months of IRBs after determining overpayment had been made due to the claimant’s return to work. A request for overpayment dated April 10, 2019 was made by the insurer to the claimant and her legal representative by regular mail. The claimant took the position that the request for repayment was statute-barred since notice was not provided within the 12 months of the first disputed payment. The claimant also argued that the SABS did not allow for service on a legal rep by regular mail, and that repayment request letter was not sufficiently detailed because it did not specify the period for repayment and it did not provide calculations supporting the requested overpayment amount. However, the amount of overpayment was not challenged by the claimant. Adjudicator Mazerolle concluded the claimant received proper notice of the repayment request, and the claimant was ordered to repay IRBs in the amount of $4,800. Adjudicator Mazerolle agreed that the insurer’s letter could have been clearer regarding the payment period, but the letter was sufficient in notifying the claimant of the relevant timeline, indicating when the claimant resumed her pre-accident duties on September 21, 2018 and that IRBs would be discontinued effective December 15, 2018. Adjudicator Mazorelle was satisfied that the legal representative had received notice of the overpayment in accordance with s. 64(18). Adjudicator Mazorelle further found the notice letter contained all necessary requirements when reviewed as a whole. He noted that case law did not require calculations be included in the repayment request.

Full decision here

TGP Analysis

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  • FILED UNDER Repayment
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