Jessy Hawley

The applicant sought income replacement benefits following a motor vehicle accident, claiming substantial post-accident business losses from her self-employment as a pet store owner.

The respondent insurer denied the benefits and sought repayment of an alleged overpayment.

The Tribunal found that the applicant failed to meet her burden of proving the quantum of her income replacement benefits, as her claimed business losses were unsupported by documentary evidence and not proven to be caused by the accident.

The Tribunal also dismissed the respondent's claim for repayment, finding its accounting evidence lacked sufficient detail to establish the overpayment calculation.

Both claims were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied income replacement benefits (IRBs), alleging the applicant wilfully misrepresented his pre-accident employment and income.

The Tribunal found no wilful misrepresentation, noting the applicant's language difficulties and reliance on his employer's cash payment and tax remittance practices.

The Tribunal awarded IRBs based on the applicant's CRA Notice of Assessment and medical evidence showing a substantial inability to perform his pre-accident heavy labour tasks.

Claims for a vision assessment and a recliner chair were dismissed for lack of contemporaneous medical evidence.

A claim for a special award was also dismissed.

The respondent insurer requested a reconsideration of a Tribunal decision that awarded the applicant ongoing income replacement benefits (IRBs).

The insurer argued the Tribunal exceeded its jurisdiction and breached procedural fairness because only the quantum of the IRB, not ongoing entitlement, was in dispute.

The adjudicator dismissed the request, finding that the application, case conference report, and the parties' own submissions clearly indicated that ongoing entitlement was a live issue.

The adjudicator confirmed there was no error of law or breach of procedural fairness.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including an income replacement benefit (IRB), attendant care benefits, and payment for treatment plans.

The respondent stopped paying the IRB based on an accounting report that deducted speculative Canada Pension Plan Disability (CPP-D) amounts.

The Tribunal found that vacation pay and pre-accident earnings should be included in the IRB calculation, and that speculative CPP-D amounts could not be deducted, entitling the applicant to an ongoing IRB.

The Tribunal denied the claim for attendant care benefits because the applicant failed to prove the expenses were incurred.

The Tribunal approved an in-home occupational therapy assessment as reasonable and necessary, but denied a small balance for physiotherapy services that exceeded the maximum hourly rate.

Claims for a special award and costs were dismissed, but interest was awarded on overdue benefits.

The respondent insurer requested a reconsideration of a Licence Appeal Tribunal decision awarding the applicant income replacement benefits.

The insurer argued the Tribunal violated procedural fairness and erred in law and fact by misinterpreting section 4 of the Statutory Accident Benefits Schedule and reversing the onus of proof regarding post-accident income deductions.

The Vice Chair dismissed the request, finding the insurer had a full opportunity to present its case and failed to establish any error of law or fact that would have changed the outcome.

The Vice Chair noted the onus remained on the insurer to prove any deductions it sought to rely upon.

The Applicant, a self-employed truck driver, sought income replacement benefits (IRBs) following a motor vehicle accident.

The parties disputed the quantum of the IRB, specifically the base weekly rate, the treatment of post-accident income, and the deductibility of a collateral life insurance benefit.

The Tribunal preferred the Respondent's accounting expert, finding the Applicant's expert's treatment of capital cost allowance and rental expenses to be problematic and unreliable.

The Tribunal also determined that the Applicant's business profits should be deducted as post-accident income and that his Co-Operators disability benefit constituted an income continuation benefit plan, making it deductible from his IRB.

Consequently, the Tribunal found the Applicant was overpaid and ordered him to repay $6,535.62 to the Respondent.

The insurer appealed an arbitrator's decision that a self-employed pharmacist's post-accident business income was not deductible from her income replacement benefits (IRBs).

The arbitrator had found that the insured was not 'actively engaged' in the business post-accident, relying on a definition of 'earned income' from the Income Tax Act.

On appeal, the Director's Delegate held that the arbitrator erred by applying an irrelevant definition from the Income Tax Act and by reading an 'active participation' requirement into the deduction provision.

The Delegate concluded that a self-employed person's post-accident income is the profit of the business, which is deductible from IRBs regardless of the insured's level of active participation.

The appeal was allowed in part, and the post-accident business income was ordered to be deducted from the IRBs.