Request for Repayment on Overpaid IRBs
In the recent Licence Appeal Tribunal decision, Murphy v. Wawanesa Mutual Insurance Company (19-006006/AABS), Adjudicator Boyce ruled that Wawanesa is entitled to the repayment of income replacement benefits (“IRBs”) in the amount of $28,402.30, plus interest due to the overpayment of IRBs to the applicant.
On January 17, 2016, the applicant was involved in a motor vehicle accident and was paid weekly IRBs of $400.00 effective January 24, 2016. On July 12, 2016, Wawanesa requested the applicant produce her short-term and long-term disability files to determine any reduction in the IRB due to the receipt of collateral benefits. On January 25, 2018, Wawanesa made a second request to the applicant. On February 8, 2018, after no response was received, Wawanesa advised the applicant that her IRBs were being stopped effective February 11, 2018, due to non-compliance with their Section 33 requests.
On June 14, 2018, Wawanesa received the applicant’s long-term disability (“LTD”) file from Great West Life. In correspondence to the applicant dated December 6, 2016, Great West Life advised that she was approved for LTD benefits effective May 15, 2016.
Wawanesa calculated that once the LTD benefits were deducted, the applicant’s IRB was reduced to zero. Accordingly, Wawanesa submits that there was an overpayment of IRBs from May 15, 2016 to February 11, 2018 as a result of the LTD file not being provided when requested.
Under Section 52(1)(a) of the Statutory Accident Benefits Schedule (“SABS”) for accidents occurring on or after September 1, 2010, a person is liable to repay to the insurer any benefit that is “paid to the person” as a result of an “error on the part of the insurer,” the insured person or any other person, or as a result of willful misrepresentation or fraud. Sections 52(2) and (3) provide timelines for repayment requests if a person is liable to repay an amount to an insurer. The insurer shall give the person notice of the amount that is required to be repaid. If the notice required is not given within 12 months after the payment of the amount that is required to be repaid, the person to whom the notice would have been given ceases to be liable to repay the amount unless it was originally paid to the person as a result of willful misrepresentation or fraud.
In accordance with Section 52 of the SABS, Wawanesa requested in correspondence dated August 30, 2018 that the applicant repay IRBs of $28,402.30 based on her receiving LTD benefits from May 15, 2016 to February 11, 2018. Wawanesa sent further correspondence to the applicant dated November 12, 2018, January 30, 2019 and March 7, 2019 reiterating the request for repayment of the IRB, plus interest. These notices were provided within the 12 month period prescribed in Section 52(2) (i.e. within 12 months of receiving the LTD file). In addition, the notices met the criteria outlined in Section 52(3) as they clearly stated the type of benefit paid (IRB), the payment period for which repayment was sought (May 15, 2016 to February 11, 2018) and the amount of repayment sought ($28,402.30).
Accordingly, Adjudicator Boyce found that Wawanesa complied with all of the procedural requirements for a repayment request under Section 52 of the SABS. As such, Wawanesa is entitled to the IRB repayment in the amount of $28,402.30 plus interest due to the overpayment of IRBs to the applicant while she was receiving LTD benefits from May 15, 2016 to February 11, 2018.
Read the decision in full detail here: Murphy v. Wawanesa Mutual Insurance Company (19-006006/AABS)
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