Citation: Primmum Insurance Company v. Somwar, 2025 ONLAT 24-005191/AABS

Licence Appeal Tribunal File Number: 24-005191/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:

Primmum Insurance Company

Applicant

and

Steffany Somwar

Respondent

DECISION

ADJUDICATOR:

Melanie Malach

APPEARANCES:

For the Applicant:

Noura Bagh, Counsel

For the Respondent:

Steffany Somwar, Self-Represented

HEARD:

By way of written submissions

OVERVIEW

1Steffany Somwar, the respondent, was involved in an automobile accident on October 6, 2020, and received benefits from the applicant, Primmum Insurance Company, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant claims repayment of income replacement benefits (“IRBs”) paid to the respondent and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2The applicant filed its submissions on April 30, 2025. The respondent did not file any submissions with the Tribunal.

ISSUES

3The issues in dispute are:

i. Is the applicant entitled to a repayment of $6,621.30 relating to its payment of an income replacement benefit (“IRB”) during the period between August 19, 2021 to January 17, 2022?

ii. Is the applicant entitled to interest on any overdue repayment of benefits?

RESULT

4I find that pursuant to s. 52 of the Schedule, the applicant is entitled to repayment of IRBs in the amount of $6,621.30 plus interest.

PROCEDURAL ISSUES

5I find that the respondent did not file any submissions despite having notice of the written hearing that was sent by email on October 8, 2024. I further find that a reminder email was sent to the respondent by the Tribunal on May 22, 2025. I will therefore proceed with the hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act.

ANALYSIS

Entitlement to repayment of IRBs

6The applicant is seeking repayment of IRBs totaling $6,621.30, paid between August 19, 2021 and January 17, 2022.

7Under s. 52(1) of the Schedule, a person is liable to repay to the insurer any benefit that is paid to the person in error on the part of the insurer, the insured person or any other person, or as a result of wilful misrepresentation. Sections 52(2) and (3) require an insurer to give the insured person notice of the amount that is required to be repaid within 12 months after the payment of the amount that is to be repaid, unless it was originally paid to the insured person as a result of wilful misrepresentation or fraud.

8The applicant submits that IRBs were paid in good faith to the respondent for the period of October 12, 2020 to January 17, 2022, at the rate of $400.00 per week, totaling $27,038.58. By letter dated January 26, 2022, the applicant terminated the applicant’s entitlement to IRBs as of January 17, 2022, after learning from the respondent’s employer that she had returned to work, and she had been in receipt of short-term and long-term disability benefits following the accident. A request for financial disclosure pursuant to s. 33 of the Schedule was made in order to calculate the overpayment paid to date.

9By letter dated August 18, 2022, the applicant sent the respondent a letter providing notice of the overpayment and requested repayment of $6,621.30 for the period of August 19, 2021 to January 17, 2022, pursuant to s. 52 of the Schedule. Follow up letters were sent to the respondent on September 15, 2022, October 19, 2022, November 25, 2022, and December 23, 2022, with no response.

10The applicant filed an initial application with the Tribunal on February 3, 2023. A case conference took place on September 20, 2023, wherein the parties agreed to a repayment plan and the matter was considered resolved. The parties agreed that the respondent would pay $250.00 on the 15th of every month until the balance of $6,621.30 was repaid.

11The applicant submits that the respondent defaulted on the agreed upon payments. The applicant advised the respondent that it had not received the agreed upon payments by letters dated October 24, 2023, November 24, 2023, December 27, 2023, January 29, 2024, and February 21, 2024. No response was received from the respondent.

12The applicant submits that the 12-month notice period for repayment in s. 52(3) of the Schedule was complied with as a notice letter was sent on January 26, 2022, immediately upon learning of the respondent’s return to work and receipt of short-term and long-term disability benefits. The amount of the repayment was indicated in the applicant’s letter dated August 18, 2022. Section 33 and s. 52 letters were sent on July 22, 2022, August 12, 2022, August 18, 2022, September 15, 2022, October 19, 2022, November 25, 2022 and December 23, 2022, with no response from the respondent.

13I find that the applicant is entitled to repayment of $6,621.30 relating to its payment of IRBs to the respondent during the period from August 19, 2021 to January 17, 2022. I find that the applicant paid the respondent IRBs on a good faith basis. Upon learning of the respondent’s return to work and receipt of STD and LTD benefits, requests for financial disclosure and s. 52 notice letters for repayment were duly sent.

14I find that the applicant has complied with the repayment notice requirements as specified in ss. 52(2) and 52(3) of the Schedule. I find that the applicant’s letter dated January 26, 2022, properly notified the applicant of its concerns and advised the respondent that it was seeking repayment. The applicant then made s. 33 requests for information which the respondent did not respond to. I find that by letter dated August 18, 2022, the applicant advised the respondent of the amount of the repayment it was seeking. I find that this letter meets the notice requirements of s. 52, as it was provided within the 12-month period. The letter identified the amount of IRBs being sought in repayment and the reason that repayment was being sought.

15Based on the above stated reasons, I find that the pursuant to s. 52 of the Schedule, the respondent is liable to repay the IRBs to the applicant.

Interest

16Section 52(5) and 52(6) of the Schedule, provide guidance on when an insurer may recover interest when seeking repayment. The insurer may charge interest on the outstanding balance of the amount to be repaid for the period starting on the 15th day after the notice is given and ending on the day repayment is received in full, calculated at the bank rate in effect on the 15th day after the notice is given.

17As I have found that the repayment is owed to the applicant, it follows that the applicant is also entitled to interest on the amounts to be repaid under s. 52(5) of the Schedule.

ORDER

18For the reasons outlined above, pursuant to s. 52 of the Schedule, the applicant is entitled to repayment of IRBs in the amount of $6,621.30, plus interest.