16-004309/AABS v Allstate Insurance Company

Jan 11, 2018

Adjudicator: Blaine Baker

The applicant was injured in an automobile accident on November 15, 2014, and sought benefits under the Statutory Accident Benefits Schedule – Effective September 1, 2010. The applicant applied for non-earner and other benefits. The respondent, Allstate Insurance Company (“Allstate”), commenced payment of non-earner benefits to the applicant at the conclusion of the statutory six-month waiting period following her accident, and continued those payments until November 13, 2015. It then concluded on the basis of a series of insurer’s examinations that the applicant did not meet the test for that benefit, and now asks that the Tribunal retroactively terminate those benefits as of May 15, 2015.

Adjudicator Baker ruled that the applicant is not entitled to a non-earner benefit from November 13, 2015 to date and ongoing, but was entitled to that benefit during the May 14, 2015 to November 13, 2015 during which it was paid by the respondent. Adjudicator Baker found that in support of her claim for non-earner benefits, the applicant’s evidence was unconvincing as she provided limited information about her pre-accident life. The evidence that was available came from Allstate and indicated that little had changed in the applicant’s life since the accident.