John P Desjardins

The insurer applied to the Licence Appeal Tribunal for repayment of medical benefits, insurer examination expenses, and adjusting expenses paid to the respondent, alleging the respondent staged the accident and wilfully misrepresented his claim.

The respondent did not participate in the hearing.

The Tribunal found that the respondent wilfully misrepresented the accident based on an engineering report and admissions.

The Tribunal ordered the respondent to repay $3,291.23 in medical benefits with interest.

However, the Tribunal dismissed the insurer's claims for repayment of insurer examination expenses and adjusting expenses, finding no basis in the Statutory Accident Benefits Schedule to recover such costs.

The Tribunal also denied the insurer's requests for a special award and costs.

The applicant failed to attend a preliminary issue videoconference hearing.

The adjudicator was subsequently advised that an administrative error had occurred, and the applicant was given the wrong videoconference link.

To facilitate a fair and accessible process, the adjudicator declined to dismiss the application for abandonment and instead rescheduled the hearing for new dates.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs), medical and rehabilitation benefits, and costs of examinations.

The respondent brought a preliminary motion to dismiss the application due to the applicant's failure to comply with production orders and attend an insurer's examination, which the Tribunal dismissed.

On the merits, the Tribunal found the applicant failed to prove a substantial inability to perform the essential tasks of his employment, noting significant credibility issues and a failure to produce relevant financial and employment records.

The Tribunal also dismissed the claims for medical benefits and examination costs, preferring the evidence of the respondent's assessors over the applicant's evidence.

The application was dismissed in its entirety.