Edward Tawkin

The insurer appealed an arbitration decision finding that the insured's deliberate failure to disclose a brief period of post-accident employment did not preclude him from receiving weekly income replacement benefits.

The Director's Delegate upheld the decision, agreeing that the misrepresentation was not 'material' under section 48 of the SABS-1996.

The misrepresentation did not undermine the fundamental basis of the claim, as the insured remained disabled from his pre-accident employment, and the insurer's remedy was limited to repayment of the overpaid benefits under section 47.

The applicant was injured in a motor vehicle accident and received income replacement benefits.

The insurer terminated benefits, alleging the applicant wilfully misrepresented his employment status by failing to disclose a six-week return to work.

The arbitrator found that while the applicant's failure to report his return to work was a wilful misrepresentation, it was not a 'material' fact under Section 48 of the Statutory Accident Benefits Schedule, as it did not affect the fundamental relationship between the parties and the insurer had a remedy for overpayment under Section 47.

The applicant's claim for a special award was dismissed.