Insurer's defective notice yields temporary non-earner benefits and a 10% special award.
The applicant sought non-earner benefits (NEB) following a motor vehicle accident.
The insurer initially denied the claim but failed to provide sufficient medical or other reasons in its denial letter, violating s. 36(4)(b) of the Schedule.
The Tribunal found the applicant was entitled to NEB for the period between the application and the date a compliant notice was finally provided.
However, the applicant failed to prove a complete inability to carry on a normal life for the remainder of the period, as the medical evidence was largely subjective and inconsistent.
The Tribunal awarded a 10% special award under s. 10 of O. Reg 664 due to the insurer's unreasonable withholding of benefits through defective notice.
OLATOntario Licence Appeal TribunalJun 6, 2023
