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Insurer entitled to lump sum repayment of overpaid IRBs plus interest; statutory 20% cap inapplicable.
The applicant insurer sought repayment of $4,228.57 in overpaid Income Replacement Benefits (IRBs) from the respondent insured, plus interest.
The respondent acknowledged the overpayment but disputed the repayment method, arguing for a monthly repayment schedule capped at 20% of the monthly IRB under s. 52(4) of the Statutory Accident Benefits Schedule.
The Tribunal found that s. 52(2)(b) only applies when IRBs are actively being paid, which was not the case here.
The Tribunal ordered the respondent to repay the full lump sum of $4,228.57, plus interest, and denied the respondent's request for costs.
Application for accident benefits dismissed as treatment plans for physiotherapy, hearing aids, and neuro-visual therapy were not reasonable and necessary.
The applicant sought entitlement to statutory accident benefits for physiotherapy, hearing aids, and neuro-visual therapy following a motor vehicle accident.
The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the disputed treatment plans were reasonable and necessary.
The Tribunal preferred the evidence of the respondent's medical assessors, who concluded that the applicant had reached maximum medical recovery for soft tissue injuries, had normal audiogram results, and showed no ophthalmic sequela related to the accident.
As no benefits were payable, the claim for interest was also dismissed.
Applicant denied most treatment plans for lack of evidence, but awarded one incurred session due to late denial.
The applicant sought payment for several treatment plans for physiotherapy, chiropractic services, and a catastrophic impairment assessment following a motor vehicle accident.
The Tribunal found that the applicant failed to prove the physical therapy treatment plans were reasonable and necessary, noting a lack of compelling evidence of improvement.
However, because the insurer provided a late denial notice for one treatment plan, the applicant was entitled to payment for the single treatment session incurred during the late period.
The Tribunal also awarded $2,000 for a psychological assessment under criterion 8, finding it was not a duplication of services, but denied the remaining disputed assessment costs and the claim for a special award.
