Claim for ongoing income replacement benefits dismissed due to pre-existing condition and lack of credibility.
The applicant was injured in a motor vehicle accident and received income replacement benefits until the insurer terminated them.
The applicant sought ongoing benefits, while the insurer claimed repayment of all benefits paid, alleging wilful misrepresentation of her pre-accident medical history.
The arbitrator found that the applicant had a significant, undisclosed pre-accident history of chronic back pain and lacked credibility.
The arbitrator concluded that the applicant's ongoing disability was not caused by the accident, dismissing the claim for ongoing benefits.
However, the arbitrator ordered the insurer to pay a shortfall in the benefits already paid, as the applicant had a reasonable explanation for initially failing to disclose a second job.
The insurer's claim for repayment due to wilful misrepresentation was dismissed.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesSep 27, 2000
