2 total
Legal expenses for obtaining collateral benefits cannot be deducted from IRB collateral benefit deductions.
The appellant appealed an arbitration order regarding the calculation of her income replacement benefits (IRBs) and the deduction of long-term disability (LTD) benefits.
The Director's Delegate held that the matter must be returned to arbitration to determine the correct IRB calculation and whether the insurer gave proper notice for repayment of alleged overpayments.
However, the Delegate upheld the arbitrator's finding that the appellant could not deduct the legal expenses incurred in obtaining the LTD benefits from the amount of LTD benefits subtracted from her IRBs, as section 7(3) of the SABS only permits deductions for income tax.
Insurer permitted to vary consent order to deduct subsequently obtained long-term disability benefits from income replacement benefits.
TD Home and Auto Insurance Company applied to vary a consent order to deduct long-term disability benefits received by the insured from her income replacement benefits (IRB).
The arbitrator granted the variation, finding that the insured's subsequent receipt of disability benefits from Sunlife constituted a material change in circumstances and new evidence.
The arbitrator held that the disability benefits were deductible under the Statutory Accident Benefits Schedule as payments under an income continuation benefit plan.
The arbitrator also rejected the insured's argument that her legal expenses incurred in obtaining the Sunlife benefits should be deducted from the collateral benefits amount, as the Schedule does not provide for such a deduction.
