A Toronto man has been ordered to repay nearly $11,000 in income replacement benefits (IRB) to TD General Insurance Company after surveillance videos contradicted his claim of functional limitations.
The ruling, by the License Appeal Tribunal, concluded that the individual — BS — willfully misrepresented his functional limitations following an automobile accident on March 22, 2021, leading to the unwarranted receipt of these benefits.
BS initially sought benefits under the Statutory Accident Benefits Schedule after his accident, which were subsequently denied by TD Insurance. Following a dispute, the case was brought before the Tribunal for resolution. TD Insurance filed a motion to include the issues of repayment of the IRB and interest, which was granted.
Despite BS filing a Notice of Withdrawal, the Tribunal proceeded with the repayment issue. The key argument centered around whether BS had made a willful misrepresentation of material facts, thereby entitling TD Insurance to a repayment of $22,268.23, the total amount of IRB paid from March 30, 2021, to September 13, 2022. The Tribunal also considered whether TD Insurance was entitled to interest on any repayment due.
The evidence presented by TD Insurance included surveillance videos contradicting BS’ claims of functional limitations. These videos showed him engaging in various physical activities, such as yard work and shopping, which were inconsistent with his statements to medical assessors.
Consequently, the Tribunal found that BS’ misrepresentation was willful and ordered him to repay a portion of the IRB.
In a detailed analysis, the Tribunal noted that his misrepresentation began from Dec. 23, 2021, onwards, leading to a recalculated repayment amount of $10,988.42. However, the Tribunal ruled that TD Insurance was not entitled to interest on the repayment, as the company had not clearly indicated its intention to charge interest in its repayment notice and made no submissions on this point during the hearing.
For more information, see Sivaramesh v TD General Insurance Company, 2023 CanLII 103817 (ON LAT)
