Claims for accident benefits and insurer's claim for repayment of benefits both dismissed.
The applicant sought income replacement benefits (IRBs) and non-earner benefits (NEBs) following two motor vehicle accidents.
The insurer denied the benefits and sought repayment of $42,402.58 in IRBs previously paid, alleging material misrepresentation regarding the applicant's employment and income.
The arbitrator dismissed the applicant's claims, finding that his pain complaints were long-standing and pre-existing, and he failed to prove a substantial inability to perform his employment tasks or a complete inability to carry on a normal life.
The arbitrator also dismissed the insurer's claim for repayment, concluding there was insufficient evidence to prove the applicant wilfully misrepresented his employment or committed fraud.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesMar 26, 2015