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Insurer entitled to repayment of income replacement benefits after claimant admitted submitting fraudulent accident report.
The applicant insurer sought repayment of income replacement benefits paid to the respondent, alleging wilful misrepresentation.
The respondent admitted to submitting a fraudulent fire department accident report because she did not have a legitimate one.
The adjudicator found that the fraudulent report constituted wilful misrepresentation, as the insurer had no proof an accident occurred.
The insurer was entitled to repayment of the benefits under section 52 of the Statutory Accident Benefits Schedule.
Slip and fall on slush while walking to parked car is not an 'accident' under the SABS.
The applicant sought statutory accident benefits after slipping and falling on slush in a parking lot while walking towards her parked car to clear snow off the side view mirror.
The respondent denied benefits, arguing the incident was not an 'accident' under the Statutory Accident Benefits Schedule.
The Licence Appeal Tribunal held a preliminary issue hearing and found that the applicant failed both the purpose and causation tests.
The Tribunal concluded that the use of the vehicle had ended prior to the fall, and the slush on the ground was an intervening cause.
The application was dismissed.
