Citation: Unica Insurance Inc. v. Jeyabalasingam, 2021 ONLAT 19-013236/AABS
Licence Appeal Tribunal File Number: 19-013236/AABS
In the matter of an Application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8., in relation to statutory accident benefits.
Between:
Unica Insurance Inc.
Applicant
and
Logeswary Jeyabalasingam
Respondent
DECISION
ADJUDICATOR: Craig Mazerolle
APPEARANCES:
For the Applicant: Modupe Egunjobi, Counsel
For the Respondent: Adam Kuciej, Counsel
HEARD: By way of written submissions
BACKGROUND
1Due to injuries sustained from an accident on February 7, 2018, Logeswary Jeyabalasingam (the “respondent”) sought accident benefits from Unica Insurance Inc. (the “applicant”), pursuant to the Statutory Accident Benefits Schedule (the “Schedule”).1
2After paying the respondent an income replacement benefit (“IRB”) in the amount of $400.00 per week, the applicant eventually concluded that there had been an overpayment for the period of September 21, 2018 to December 15, 2018. When this overpayment request was denied by the respondent, the applicant filed an application with the Tribunal.
3In response, the respondent alleged that the applicant’s request for repayment is statute-barred, as notice was not provided within the requisite 12 months following the first disputed payment. Specifically, the main point of conflict between the parties is whether the applicant properly served its repayment request on the respondent within 12 months of the initial, disputed payment.
4For the following reasons, I find the respondent received proper notice for the repayment request from the applicant. As such, the respondent is ordered to repay the IRB to the applicant in the amount of $4,800.00.
RELEVANT LEGISLATION
5Sections 52(1) and (2) provide a means for insurers to request repayments of benefits paid to insured persons:
(1) Subject to subsection (3), a person is liable to repay to the insurer,
(a) any benefit described in this Regulation that is paid to the person as a result of an error on the part of the insurer, the insured person or any other person, or as a result of wilful misrepresentation or fraud;
(2) If a person is liable to repay an amount to an insurer under this section,
(a) the insurer shall give the person notice of the amount that is required to be repaid; and
(b) the insurer may, if the person is receiving an income replacement or caregiver benefit, give the person notice that the insurer intends to collect the amount by reducing each subsequent payment of the benefit by up to 20 per cent of the amount that would otherwise be the amount of the benefit.
6Section 52(3) then states that these requests must be made within 12 months of the disputed payment, failing which the liability ends:
If the notice required under subsection (2) is not given within 12 months after the payment of the amount that is to be repaid, the person to whom the notice would have been given ceases to be liable to repay the amount unless it was originally paid to the person as a result of wilful misrepresentation or fraud.
7Interest may be requested for repayment amounts, pursuant to ss. 52(5) and (6).
8Finally, s. 64(2) details the available means for affecting service of a document, including a notice for repayment:
Any document, including a notice in writing, required or permitted under this Regulation to be given to a person may be delivered,
(a) by faxing the document to the person or to the solicitor or authorized representative, if any, of the person in accordance with subsection (19);
(b) by leaving a copy of the document with the solicitor or authorized representative, if any, of the person, or with an employee in the office of the solicitor or authorized representative;
(d) by ordinary or registered mail,
(i) in the case of an insurer, addressed to the insurer or its chief executive officer at the insurer’s head office in Ontario as identified in the records of the Chief Executive Officer,
(ii) in the case of a person other than an insurer, addressed to the person at his or her last known address
9Section 64(18) provides the following caveat to service by way of ordinary mail:
In the absence of evidence to the contrary, a person is