Caregiver benefits denied as applicant failed to prove entitlement and submitted fraudulent expense reports.
The applicant sought weekly caregiver benefits following a 2009 motor vehicle accident.
The insurer terminated benefits without requesting a Disability Certificate under s. 37(1) of the Schedule.
The arbitrator applied the Court of Appeal's decision in Stranges, holding that the insurer's procedural failure did not relieve the applicant of her burden to prove entitlement.
The arbitrator found the applicant's evidence lacked credibility, noting she had submitted fraudulent expense reports bearing a forged signature of her cousin, and gave inconsistent testimony regarding her living arrangements, education, and work experience.
The applicant's medical reports were outweighed by the credible testimony of her cousin, who observed the applicant functioning normally shortly after the accident.
The application was dismissed, and the applicant was ordered to pay the insurer's arbitration expenses.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesMay 16, 2016
