The insured was employed at the same time that she was receiving income replacement benefits
In a recent decision, the Ontario Superior Court of Justice affirmed the order for the repayment of benefits received from an insurer, which were obtained through misrepresentation.
In Ravilotchanan v. Allstate Insurance Company of Canada, 2024 ONSC 1629, the court dismissed an appeal by Yogaranjini Ravilotchanan, and affirmed the order for her to repay Allstate Insurance Company of Canada for income replacement and attendant care benefits, which were obtained during a period of misrepresentation.
Following a motor vehicle accident in February 2016, Ravilotchanan received statutory accident benefits from Allstate Insurance, covering income replacement and attendant care. The case took a turn when Allstate, alerted by Wawanesa Mutual Insurance, discovered that Ravilotchanan was employed at North Agincourt Healthcare Inc., providing personal support worker (PSW) services while claiming these benefits.
The discovery was substantiated by a statutory declaration from Ravilotchanan. She attested that she had been working for Agincourt providing PSW services to Wawenesa’s insured at a time when she was receiving the benefits from Allstate. Under the Ontario Insurance Act, recipients of insurance benefits are required to repay any amounts received due to fraud or wilful misrepresentation. Consequently, Allstate sought the return of the benefits paid to Ravilotchanan through the Licence Appeal Tribunal (LAT).
During the LAT proceedings, the evidence presented included Ravilotchanan's statements and her defence in a separate legal action initiated by Wawanesa seeking repayment for services billed by Agincourt. Despite her denial of receiving payment for PSW services during the benefit period, the LAT found Ravilotchanan's evidence unreliable, concluding she had engaged in a scheme to defraud Wawanesa and, thus, misrepresented her claim to Allstate.
Ultimately, the Ontario Superior Court dismissed Ravilotchanan's appeal based on the finding that the appeal did not raise any questions of law but rather contested factual determinations made by the LAT. The court underscored that the LAT has jurisdiction to assess credibility and factual circumstances. Given this framework, the court upheld the LAT's decision, requiring Ravilotchanan to repay the contested benefits to Allstate and pay legal costs.
