Insurer awarded repayment of income replacement benefits after applicant found to have fraudulently concealed full-time employment.
The applicant sought ongoing income replacement benefits (IRBs) and payment for a medical assessment following a motor vehicle accident.
The insurer sought repayment of IRBs, alleging the applicant had been working full-time while claiming complete disability.
The arbitrator found overwhelming evidence, including surveillance and employment records, that the applicant had been employed full-time installing GPS units while simultaneously telling medical assessors he was completely disabled.
The arbitrator concluded the applicant obtained benefits through deliberate and material fraud.
The insurer was relieved of its obligation to pay ongoing IRBs and was awarded repayment of all IRBs paid since December 9, 2002, with interest.
The applicant's claim for the cost of a medical report was dismissed because the report was rendered useless by his intentional misrepresentations.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesSep 20, 2005
