Accident benefits denied and repayment ordered due to applicant's misrepresentation of employment and pre-existing injuries.
The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to weekly income benefits and rehabilitation expenses.
The insurer terminated benefits and sought repayment, alleging the applicant was not employed at the time of the accident and misrepresented his condition.
The arbitrator found the applicant lacked credibility, having concealed a pre-existing work-related knee injury and a prior severe head injury from both the insurer and medical assessors.
The arbitrator concluded the applicant was not employed at the time of the accident and did not suffer an ongoing disability caused by the accident.
The applicant's claims were dismissed, and the insurer was granted repayment of the weekly income benefits paid, as they were induced by the applicant's culpable error and failed to account for deductible workers' compensation benefits.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesDec 17, 1998
