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How can you determine eligibility if you don’t know the insured’s pre-accident activities?

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Summary

Even if the insured has returned to work, they may still be eligible for an Income Replacement Benefit.  Know the scope of pre-accident activities before making a decision, as the insured may still qualify under the substantial disability test.

Tarantino v. Aviva Canada Inc., FSCO A04 B001781, June 28, 2006 – Arbitrator Ashby

Date of MVA – December 2, 2002

Mr. Tarantino returned to his salon the day after the accident, but limited himself to managing the shop, leaving the clients to his business partner. The Insured gradually began to give haircuts during April 2003. However, he was not as productive as he was prior to the accident and he was not in the salon as many hours.

The Arbitrator held that the insured was substantially disabled from performing the essential tasks of his employment.

What to do?

Be wary of discontinuing IRBs based on an insured returning to work without understanding the scope of activities before the accident and upon the Insured’s return to work.

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