Accident benefits denied and repayment ordered due to applicant's misrepresentations regarding pre-existing conditions.
The applicant sought statutory accident benefits following a motor vehicle accident.
The insurer had paid weekly benefits and physiotherapy expenses but terminated them, arguing the applicant no longer suffered a substantial inability to perform essential tasks, and sought repayment of benefits paid after March 1992.
The arbitrator found the applicant and her family physician lacked credibility, noting they had deliberately withheld information about significant pre-existing conditions and a prior work-related accident.
Concluding that the motor vehicle accident did not materially aggravate her pre-existing conditions, the arbitrator dismissed the claims for ongoing benefits and ordered the applicant to repay the weekly benefits and physiotherapy expenses received after March 16, 1992.
The applicant's claim for arbitration expenses was also denied.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesSep 13, 1996