Overpayment Recovery: Is the Notice Valid?

Overpayment situations can be stressful and complex. Especially where Income Replacement Benefits (IRB) had at one time been terminated and then reinstated, or one or more sources of other income replacement assistance may have been retroactively paid, and possibly at different times.  And of course, the overpayment could just be due to calculation error.

We focus only on the recovery period in this post, which for overpayments is limited to the 12-months prior to a valid notice of overpayment being issued by the insurer.

But what makes the notice valid?  For the answer to this we need to look at s.52 of the SABS and recent decisions.

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Barter and Payment in Kind – What happens when income is paid in goods and services?

What happens when income is paid in goods and services (payment in kind)?  

When it comes to calculating income for SABS purposes, it is not always as straightforward as the wages on a pay statement. Occasionally, income comes in the form of goods and/or services.

How do we translate those goods and services, such as living rent-free in exchange for working as a handyman in an apartment building, into income when determining an Income Replacement Benefit (IRB)?

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Common Errors and Deficiencies with the OCF-2

In a recent LAT decision, the adjudicator determined “An Employer’s Confirmation Form is information reasonably required to assist within the meaning of s. 33(1)” of the SABS (17-005692 v Aviva Insurance Company of Canada).

But can the form really stand alone as the basis of an Income Replacement Benefit (IRB) calculation? We suggest that in most cases, it cannot. Although there are exceptions.

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The Role Employment Insurance Benefits Play in Calculating an IRB

The Role Employment Insurance Benefits Play in Calculating an Income Replacement Benefits (IRB)

Employment Insurance (EI) benefits appear in many ways within IRB calculations. They can be the entire basis of eligibility for an IRB, a component of an individual’s pre-accident income, or received post-accident as a form of payment for loss of income.

This blog provides all you need to know about how to treat EI benefits in your calculations.

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Fixed Versus Variable Expenses – What is the difference?

It may sound like a simple concept at first, but classifying expenses as fixed and variable in the context of a business interruption claim can be tricky.  The issue that often trips people up is thinking in absolutes, such as, how would the expense behave in the event the business is shut-down?  But, this is not the way to look at this issue.

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What constitutes 12-months for overpayment recovery in Section 47(3)?

Summary

12-months starts from the day the first payment in error is made, regardless of whether additional payments with the same error were subsequently made. However, subsequent decisions appear to indicate otherwise, and support an overpayment can be recovered for the 12-months prior to notification.

For an updated discussion on related overpayment topics, be sure to also read our subsequent post here. Continue reading →

Co-Insurance and Business Interruption – Nothing to be Afraid Of

In our experience, the concept of co-insurance in relation to business interruption is one of the least understood and most feared topics by all parties involved.  It could be the setting of appropriate policy limits for business interruption, determining co-insurance compliance, or insured’s feeling unfairly penalized when co-insurance requirements are applied following a claim. Continue Reading!

Business Interruption Policies…Things are a changing!

(Gross Profit vs. Gross Earnings vs. Hybrid Policies)

Traditionally, business interruption insurance policies have fallen under one of two styles, Gross Earnings or Gross Profits.  In recent years the consistency in policy styles has been eroding and new hybrid style forms are starting to become more prevalent.  Continue Reading