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Reconsideration allowed in part to correct disputed dates, but ongoing income replacement benefits denied.
The applicant requested a reconsideration of a Licence Appeal Tribunal decision that found his injuries fell within the Minor Injury Guideline (MIG) and denied his claim for ongoing Income Replacement Benefits (IRB).
The applicant argued the Tribunal breached procedural fairness, ignored new medical evidence, and erred in fact regarding the MIG and the IRB dispute period.
The adjudicator found no breach of procedural fairness and held that the new evidence could have been obtained prior to the hearing.
While the adjudicator agreed the Tribunal made a factual error regarding the dates in dispute for the IRB claim, upon reviewing the evidence for the corrected period (February 26, 2020 to April 23, 2023), the adjudicator concluded the applicant failed to prove a substantial inability to perform the essential tasks of his employment.
The reconsideration was allowed in part to correct the dates, but the claim for ongoing IRB was dismissed.
Insurer failed to prove material misrepresentation, but applicant's injuries remained within the Minor Injury Guideline.
The applicant was injured in a motor vehicle accident and sought statutory accident benefits.
The respondent insurer denied benefits beyond the Minor Injury Guideline (MIG) limit and alleged the applicant was barred from receiving Income Replacement Benefits (IRB) due to a material misrepresentation regarding the use of his vehicle for ride-sharing.
The Tribunal found the respondent failed to prove the vehicle was used for ride-sharing, so the applicant was not barred from IRB and the respondent was not entitled to repayment of previously paid IRB.
However, the Tribunal concluded the applicant's injuries were predominantly minor, preferring the respondent's medical experts over the applicant's expert due to a lack of objective evidence.
As the MIG limit was exhausted, the applicant was not entitled to the disputed medical and attendant care benefits.
No co-appearing lawyers found.
No judges found.