Ongoing IRBs denied due to misrepresented income, but psychological assessment granted as reasonable and necessary.
The applicant sought ongoing Income Replacement Benefits (IRBs) and a psychological assessment following a motor vehicle accident.
The insurer terminated IRBs after 104 weeks, arguing the applicant no longer met the test for entitlement.
The Tribunal found that while the applicant suffered from accident-related physical and psychological impairments, he failed to prove a substantial or complete inability to work as a real estate agent.
The applicant's credibility was significantly undermined by a forensic accounting report revealing he misrepresented his pre- and post-accident income to all assessors, and that he actually earned more in the year following the accident.
Consequently, the claim for ongoing IRBs was dismissed.
However, the Tribunal granted the $2,000 psychological assessment, finding it reasonable and necessary to address the applicant's ongoing psychological impairment.
OLATOntario Licence Appeal TribunalSep 21, 2021
