Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 22-003958/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:
Wendy Betteley
Applicant
and
Certas Home and Auto
Respondent
DECISION
ADJUDICATOR: Tanjoyt Deol
APPEARANCES:
For the Applicant: Gordon W. Harris, Counsel
For the Respondent: Bruce Chambers, Counsel
HEARD: By Way of Written Submissions
OVERVIEW
1Wendy Betteley (the “applicant”) was involved in an automobile accident on June 15, 2018, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by Certas Home and Auto (the “respondent”) and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2The applicant’s entitlement to IRB is not in dispute. Rather, the dispute arises following the applicant’s approval for Canada Pension Plan Disability (“CPP-D”) benefits on November 23, 2021. Following the approval of her CPP-D benefits, two disputes have arisen between the parties, first over the quantum of IRB the applicant is entitled to and second whether the respondent is entitled to a repayment. Prior to the approval of the CPP-D benefits, the applicant was receiving $600.00 per week in IRB which is the maximum amount available under her optional benefits policy.
ISSUES
3The issues in dispute are:
i. What is the quantum that the applicant is entitled to for weekly income replacement benefits (“IRB”) from December 20, 2021 to 2023?
ii. Is the respondent entitled to a repayment relating to its payment of IRB during the period of December 2020 to December 19, 2021? If so, what is the quantum?
iii. Is the respondent liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iv. Is the applicant entitled to