Accident benefits denied and repayment ordered where insured wilfully misrepresented claims by concealing subsequent accident.
The applicant sought statutory accident benefits, including income replacement and supplementary medical expenses, following a motor vehicle accident.
The insurer terminated benefits and sought repayment, alleging wilful misrepresentation due to the applicant's failure to disclose multiple other motor vehicle accidents and pre-existing injuries.
The arbitrator found the applicant to be an unreliable historian and concluded he failed to prove that his ongoing complaints were caused by the subject accident or that they prevented him from working.
The claims for benefits and a special award were dismissed.
The arbitrator ordered the applicant to repay all benefits received after a subsequent undisclosed accident, finding his failure to report it constituted wilful misrepresentation.
The insurer's request for an assessment against the applicant for a frivolous arbitration was denied.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJun 15, 2000
