Neutral Citation: 1994 ONICDRG 93
File No. A-000999
ONTARIO INSURANCE COMMISSION
BETWEEN:
PRITPAL SINGH
Applicant
and
ALLSTATE INSURANCE COMPANY OF CANADA
Insurer
DECISION
Issues:
The Applicant, Pritpal Singh, was injured in a motor vehicle accident on May 14, 1991. He applied for and received weekly benefits from Allstate Insurance Company of Canada, ("Allstate") payable under Ontario Regulation 6721. Weekly income benefits were paid until August 27, 1991.
The Applicant claims to be entitled to benefits for the period from August 28 until Dec 2, 1991. The Insurer disputes this claim, and submits that an overpayment occurred, due to erroneous employment information submitted by the Applicant. The parties were unable to resolve their disputes through mediation and the Applicant applied for arbitration under the Insurance Act.
The issues in this hearing are:
Is the Applicant entitled to weekly benefits from August 28 until Dec 2, 1991?
Is Allstate entitled to repayment of the alleged overpayment?
The Applicant also claims interest on any outstanding amounts owing, and his expenses incurred in the hearing. In his application he also claims a special award under section 282 (10) of the Insurance Act.
Result:
- The Insurer is entitled to repayment of $560 paid in error to Mr. Singh.
Hearing:
The hearing was held at the offices of the Ontario Insurance Commission in North York, Ontario, on November 30, 1993, before me, Frederika Rotter, Senior Arbitrator.
Present at the Hearing:
Applicant:
Pritpal Singh
Applicant's Friend:
Jasbir Singh
Insurer's Representative:
Richard F. L. Rose Barrister and Solicitor
Interpreter:
Amirt Bahal Global Translations
Witnesses:
The Applicant, Mr. Singh Bradley Barber, Claims Manager, Allstate Insurance Company
The exhibits and other documents before the arbitrator are listed in Appendix A.
Evidence and Findings:
Ongoing Disability Benefits
This case concerns Mr. Singh's claim resulting from an accident which occurred on May 14, 1991. Mr. Singh claims to be entitled to ongoing weekly income benefits from August 28, 1991 to Dec 2, 1991, when he was involved in a second motor vehicle accident. His claims arising from the second accident are not dealt with in this arbitration.
Mr. Singh testified that the May, 1991 accident took place in a parking lot. Mr. Singh's vehicle collided with another vehicle while backing out of a parking spot. Mr. Singh testified that on impact, his head struck the interior of the car. He went to see his family physician, Dr. Seth, who examined him and had x-rays taken.
Mr. Singh complained of neck pain and pain in his lower back. His doctor referred him to physiotherapy and prescribed pain medication. Mr. Singh made a claim for weekly income benefits and Dr. Seth indicated, in an Ontario Automobile Insurance Medical Report dated June 4, 1991 (Exhibit 5) that Mr. Singh would be able to return to work in approximately 6 weeks.
Mr. Singh testified that he had been employed full-time prior to the accident, as an "oven man" at Central Bakery. He described his job as loading and unloading pans and trays of bread from the ovens. This required bending and lifting the trays, which weighed approximately 10-15 lbs. The job also involved placing trays of baked bread onto cooling racks, and pushing and pulling the racks about.
Mr. Singh testified that he also had a part-time job at Singh Foam, lifting and loading packages of foam onto trucks. He testified that as a result of the accident he could not work at either of his jobs. He testified that he was still unable to return to work in August, 1991, when his benefits were terminated, and remained unable to work until the second accident in December, 1991.
Mr. Singh confirmed, in cross-examination, that he received accident benefits after the second accident. He confirmed that the second accident aggravated his lower back pain. He testified that he finally returned to work full-time at Central Bakery in April, 1992, and has been working without interruption since then. He testified that his pain in April, 1992 was worse than in August, 1991, because of the second accident. However, he was obliged to return to work due to the "force of circumstances".
Bradley Barber, the Claims Manager for Allstate Insurance who was involved in this case, testified that he spoke with Dr. Seth after Mr. Singh had received benefits for about six weeks. Dr. Seth suggested that Mr. Singh be paid another six weeks of benefits.
Mr. Barber testified that Allstate then arranged for an independent medical examination, to be conducted by Dr. Hugh Cameron, an orthopaedic specialist. Dr. Cameron examined Mr. Singh on July 24, 1991, and prepared a report summarizing his findings dated July 26, 1991 (Exhibit 12). In his report, Dr. Cameron indicates, at page 3, that he "can find no evidence of any disability" and that he thinks that Mr. Singh "is perfectly fit to return to work". Mr. Barber testified that Allstate received the report on August 21, 1991 and terminated Mr. Singh's benefits based on this report.
Mr. Barber indicated that Mr. Singh received a copy of Dr. Cameron's report, together with his final cheques for benefits. Allstate also forwarded a copy of Dr. Cameron's report to Dr. Sethi, under cover of a letter dated Aug 21, 1991. The letter requests further comments from Dr. Sethi in response to Dr.Cameron's report. Mr. Barber testified that no reply or comments were received from Dr. Seth.
Mr. Singh confirmed that he returned to work at his old job in April, 1992 in worse pain than he had been in August, 1991, but he could not agree that he was able to work in August, 1991. However, Mr. Singh's testimony was vague, and his claim was not supported by any medical documentation. Based on the evidence before me, I conclude that as of August 27, 1991, when benefits were terminated, Mr. Singh was no longer substantially disabled from performing his essential tasks at Central Bakery. Therefore, he is not entitled to further weekly benefits for the period claimed.
Insurer's Claim for Repayment
Mr. Barber testified that benefits were paid to Mr. Singh, at the rate of $523.40 per week, until August 27, 1991 as summarized in Exhibit 11. He confirmed that Allstate calculated the rate of benefits based on the claims documents including the Employer's Confirmation of Income forms submitted by Mr. Singh (Exhibits 3 and 4). Mr. Barber testified that Allstate subsequently determined that Mr. Singh was only entitled to benefits at the rate of $483.40. Allstate requests repayment of the $560 overpayment (14 weeks x $40), pursuant to section 27(1) of the Schedule, which provides:
27.--(1) A person must repay to the insurer any benefit received under this Schedule that is paid to the person through error or fraud.
Mr. Singh did not dispute that the correct amount of weekly benefits was $483.40. I received no evidence explaining why the original income figures submitted were wrong.
However, I did receive evidence that Mr. Singh was first requested and subsequently ordered by the pre-hearing arbitrator to disclose medical and financial documentation (including employment records) relevant to this claim. Mr. Singh never did provide the required information to Allstate, despite an order from the pre-hearing arbitrator that he do so.
Mr. Singh testified that he attempted to obtain some of the information requested from his doctors, but was unable to. He also indicated that the rest of the documentation was in the hands of his former counsel, who would not release it. He did not explain why he had not signed the authorizations and directions for the release of information which the Insurer had forwarded to him on two occasions.
I am not satisfied with Mr. Singh's explanations and conclude that he made no genuine effort to obtain and provide the information legitimately required by the Insurer, despite repeated requests and opportunities to do so.
In the circumstances, I find he should repay the overpayment claimed.
Special Award and Expenses
I heard no evidence or submissions to substantiate the request for a special award, which is dismissed.
Mr. Singh failed to comply with requests for the production of documentation, properly made. My records indicate that this failure resulted in an adjournment of a hearing date, and a resumption of the pre-hearing discussions, on which occasion the pre-hearing arbitrator issued orders for production. These orders were not complied with.
This behaviour on the part of Mr. Singh unduly prolonged the arbitration process. I decline to grant Mr. Singh his expenses of the hearing, in this case.
Order:
- The Insurer is entitled to repayment of $560 paid in error to Mr. Singh.
October 4, 1994
Frederika Rotter Arbitrator
Date
APPENDIX A
Documents before the Arbitrator:
Report of Mediator, dated January 8, 1992
Response by Insurer, dated June 15, 1993
Application for Appointment of an Arbitrator, dated May 24, 1993
Pre-hearing letter dated August 23, 1993
Exhibits:
Exhibit 1
Photographs of car
Exhibit 2
Ontario Automobile Insurance Application for Accident Benefits
Exhibit 3
Ontario Automobile Insurance Employer's Confirmation of Income - Central Bakery
Exhibit 4
Ontario Automobile Insurance Employer's Confirmation of Income - Singh Foam
Exhibit 5
Ontario Automobile Insurance Medical or Psychological Report
Exhibit 6
Letter from Allstate dated September 11, 1994 regarding termination of benefits
Exhibit 7
Letter from Richard Rose dated August 25, 1993 to Mr. Singh requesting documentation
Exhibit 8
Letter from Richard Rose dated October 12, 1993 to Mr. Singh requesting documentation
Exhibit 9
October 12, 1993 letter returned to Richard Rose
Exhibit 10
Record of property damage claim from Allstate Insurance Company dated May 16, 1991
Exhibit 11
Summary of Accident Benefits Payments made to Pritpal Singh
Exhibit 12
Report of Dr. Hugh Cameron dated July 26, 1991
Exhibit 13
Letter to Dr. Seth from Allstate dated August 21, 1991
Exhibit 14
Report of Dr. Hugh Cameron dated February 5, 1992