The applicant sought entitlement to post-104-week income replacement benefits (IRBs), various medical and rehabilitation benefits, and a chronic pain assessment following a motor vehicle accident.
The respondent insurer denied the benefits and sought repayment of $14,381.91 in previously paid IRBs, alleging wilful misrepresentation.
The Licence Appeal Tribunal dismissed the claim for post-104-week IRBs, finding the applicant failed to establish a complete inability to engage in any employment.
The Tribunal also dismissed the respondent's claim for repayment, ruling that the repayment notice was defective because it failed to specify the period for which repayment was sought.
The applicant was granted entitlement to a chronic pain assessment, as evidence showed it was warranted and not reasonably available through OHIP, but the remaining treatment plans were denied.