Dispute Resolution Services
Services de règlement des différends
Neutral Citation: 2019 ONFSCDRS 42
FSCO A12-004267
BETWEEN:
MARYAM ALIZADEH-EBADI
Applicant
and
TD GENERAL INSURANCE COMPANY
Insurer
REASONS FOR DECISION
Before: Anne Sone
Heard: Final written submissions were received on October 9, 2019.
Appearances: No one appearing for Mrs. Alizadeh-Ebadi Paul Omeziri for TD General Insurance Company
Issues:
The Applicant, Maryam Alizadeh-Ebadi, alleged she was injured in a motor vehicle accident on July 23, 2010. She applied for and received statutory accident benefits from TD General Insurance Company (“TD General”), claimed under the Schedule.1 The parties were unable to resolve their disputes through mediation, and Mrs. Alizadeh-Ebadi applied for arbitration at the Financial Services Commission of Ontario under the Insurance Act, R.S.O. 1990, c.I.8, as amended.
In a decision dated November 27, 2017, Arbitrator Winer dismissed Mrs. Alizadeh-Ebadi’s claim for statutory accident benefits, and also dismissed a claim by TD General for repayment of the benefits it had previously paid to Mrs. Alizadeh-Ebadi. This decision was appealed.
In his appeal decision dated June 26, 2018, Director’s Delegate Evans confirmed that the collision in this case was staged. He also found that even though the collision was staged, it was still an accident under the broader definition of “accident” under the Schedule.
Director’s Delegate Evans agreed with numerous cases at the Commission where, if the fraud or misrepresentation related to the fundamental facts of the accident itself, then the insureds are required to repay all benefits that were paid to them because they received the accident benefits as a result of wilful misrepresentation or fraud.
With respect to the issue of repayment, Director’s Delegate Evans stated that he did not know which benefits were paid to the insured in this case. Accordingly, the matter was returned to arbitration to determine which benefits were paid to the insured, and entitling TD General to repayment of these benefits.
The issue in this hearing is:
- What is the amount of the repayment TD General Insurance Company is entitled to receive from Mrs. Alizadeh-Ebadi in connection with the benefits Mrs. Alizadeh-Ebadi received from TD General Insurance Company?
Result:
- Mrs. Alizadeh-Ebadi is ordered to repay $9,530.17 to TD General Insurance Company in connection with the benefits she received from TD General.
EVIDENCE AND ANALYSIS:
Mrs. Alizadeh-Ebadi was unrepresented in this proceeding. She was provided with numerous opportunities to make oral and written submissions. She was notified of these opportunities at the last address and telephone number she provided to the Commission.
Mrs. Alizadeh-Ebadi did not make any oral or written submissions in connection with this proceeding.
According to Rule 9.1(c) of the Dispute Resolution Practice Code “Parties … must provide the Dispute Resolution Group with written notice of any change of their address, telephone number and e-mail address. The Dispute Resolution Group is entitled to rely upon the last known address, telephone number and e-mail addresses contained in its records.”
Mrs. Alizadeh-Ebadi did not provide any written notice to the Commission of any change of her contact information. Accordingly, I am entitled to rely on the last known address, telephone number and e-mail addresses contained in the Commission’s records, and deem that she received appropriate notice of the opportunities she was given to provide submissions.
In an affidavit dated October 3, 2019, TD General provided proof that Mrs. Alizadeh-Ebadi had claimed and received various amounts for statutory accident benefits in connection with an accident that was found to have been staged.
Here is a list of the cheques issued directly to Mrs. Alizadeh-Ebadi at her home address. The list includes the total amount paid to Mrs. Alizadeh-Ebadi, the cheque number, the type of benefit paid and the date it was issued.
| AMOUNT | CHEQUE | BENEFIT | DATE ISSUED |
|---|---|---|---|
| $120.30 | 3590836 | Medication/Prescription Receipts | July 15, 2011 |
| $2,159.98 | 3572920 | Housekeeping and Medication/Prescriptions | May 9, 2011 |
| $ 366.54 | 3533800 | Income Replacement Benefit | January 20, 2011 |
| $ 366.54 | 3527135 | Income Replacement Benefit | December 30, 2010 |
| $4,031.94 | 3525023 | Income Replacement Benefit | December 22, 2010 |
| $606.79 | 3497940 | Housekeeping and Medication/Prescription Receipts | December 20, 2010 |
| $939.04 | 3495117 | Attendant Care | October 15, 2010 |
| $939.04 | 3478776 | Attendant Care | September 15, 2010 |
Mrs. Alizadeh-Ebadi cashed all of these cheques.
The amounts paid directly to Mrs. Alizadeh-Ebadi in connection with her claimed and received statutory accident benefits for housekeeping and home maintenance, medications/prescriptions, income replacement and attendant care total $9,530.17.
Accordingly, I find that Mrs. Alizadeh-Ebadi is liable to repay TD General the amount of $9,530.17 for benefits that TD General paid to her in connection with a staged accident.
November 28, 2019
Anne Sone Arbitrator
Date
Dispute Resolution Services
Services de règlement des différends
Neutral Citation: 2019 ONFSCDRS 42
FSCO A12-004267
BETWEEN:
MARYAM ALIZADEH-EBADI
Applicant
and
TD GENERAL INSURANCE COMPANY
Insurer
ARBITRATION ORDER
Under section 282 of the Insurance Act, R.S.O. 1990, c.I.8 as it read immediately before being amended by Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014, and Regulation 664, R.R.O. 1990, as amended, it is ordered that:
- Mrs. Alizadeh-Ebadi repay $9,530.17 to TD General Insurance Company.
November 28, 2019
Anne Sone Arbitrator
Date
Footnotes
- The Statutory Accident Benefits Schedule — Accidents on or after November 1, 1996, Ontario Regulation 403/96, as amended.