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Applicant awarded 24 weeks of income replacement benefits for soft tissue injuries exacerbating pre-existing conditions.
The applicant was injured in a rear-end motor vehicle accident and applied for weekly income replacement benefits, which the insurer denied.
The applicant had a significant pre-existing history of back and arm injuries.
The arbitrator found that the applicant suffered soft tissue injuries in the accident that temporarily disabled him from his employment as a truck driver.
However, due to the severity of his pre-existing conditions and the lack of evidence showing long-term exacerbation caused by the accident, the arbitrator concluded the applicant returned to his pre-accident status within 24 weeks.
The applicant was awarded weekly income replacement benefits for 24 weeks, plus interest.
Insurer cannot deny accident benefits for misrepresentation if it was immaterial at the time of the accident.
The applicant was involved in a motor vehicle accident and applied for statutory accident benefits.
The insurer refused to pay income replacement benefits, alleging the applicant made a material misrepresentation regarding the ownership and use of the insured vehicles, relying on section 58(3)(a) of the Statutory Accident Benefits Schedule.
The arbitrator found that while misrepresentations were initially made, subsequent amendments to the policy prior to the accident rendered them immaterial to the risk at the time of the accident.
The insurer was therefore not entitled to rely on the exclusion to deny benefits.
