Michael Sigsworth

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs).

The respondent insurer claimed deductions under s. 7(3) of the Schedule for post-accident payments the applicant received from her employer, a restaurant owned by her mother.

The Tribunal found that the payments were a gift intended to help the applicant financially, not employment income or a temporary disability benefit.

The applicant met the legal test for a gift, as there was an intention to give without expectation of remuneration, acceptance, and transfer.

The Tribunal ordered the respondent to pay the IRBs without deductions, plus interest.

The applicant was injured in a motor vehicle accident and received income replacement benefits (IRBs).

She later returned to work part-time.

The parties disputed the correct method for calculating the IRB deduction for her post-accident part-time income.

The applicant argued for an 'Equitable Approach' where her income would be prorated based on the hours she was unable to work.

The insurer argued that under section 7(3) of the Schedule, 70% of her gross weekly employment income should be deducted from her IRB entitlement.

The arbitrator agreed with the insurer, finding that the law requires the deduction to be based on the weekly income earned, not on a percentage of working versus non-working hours.

The applicant was injured in a motor vehicle accident and sought income replacement benefits and medical benefits from the insurer.

The arbitrator found the applicant suffered a substantial inability to perform the essential tasks of her employment as an educational assistant and awarded pre-104 week income replacement benefits.

However, the arbitrator dismissed the claim for post-104 week income replacement benefits, finding the applicant did not suffer a complete inability to engage in suitable employment, as she had returned to work part-time.

The arbitrator also awarded medical benefits for assistive devices, including a soaker tub, mattress, ergonomic desk, and treadmill, but denied the claim for physiotherapy and yoga.

The plaintiff insurer brought a summary judgment motion seeking repayment of over $100,000 in income replacement benefits (IRBs) paid to the defendant insured.

The overpayments occurred because the insured received retroactive long-term disability and Canada Pension Plan benefits that should have been deducted from the IRBs.

The court found that the insurer failed to provide proper statutory notice for most of the overpayments, limiting its recovery to a 12-month period.

The court also held that while it had jurisdiction to order repayment of the overpayments, it lacked jurisdiction to vary the existing Financial Services Commission of Ontario (FSCO) consent order governing the ongoing IRB payments.

The insurer was awarded $11,150 without costs.