Highlights of Noteworthy Decisions

Decision 2078 13
25/04/2014
M. Keil - M. Trudeau - R. Briggs
  • Board Directives and Guidelines (overpayment) (time limits)
  • Fraud
  • Overpayment (debt due and owing)

The worker suffered a knee injury in March 1988, and returned to work in September 1988. He received further temporary total disability benefits during a period in which he laid off from May 1991 to February 1992. Subsequent investigation revealed that the worker had his own business and was working under a contract for a provincial ministry during this period. The worker appealed a decision of the Appeals Resolution Officer creating an overpayment for the benefits received from May 1991 to February 1992.

On the evidence, the worker was self-employed and performed work during the period in question. He did mislead the Board by indicating that he was not self-employed during the period when he was collecting temporary total disability benefits. Accordingly, there was an overpayment that constituted a benefit-related debt within Board Operational Policy Manual, Document No. 05-01-09.
According to the policy, to pursue recovery of debt resulting from payments before January 1, 1997, the Board must notify the debtor within three years of the date the debt is considered due and owing to the Board.
The worker submitted that the Board knew by the end of 1993 that the debt was due and owing. The employer submitted that the debt was due and owing as of May 1995. The Panel noted that the Board turned the matter over to the special investigations branch in 1993 to ascertain if there had been fraud. The Board did not, at that time, make a formal determination as to the status of the worker's benefits. It was not until May 1995 that the Board was in possession of three important facts: there were going to be charges laid; the worker had billed the ministry for about $48,000; the amount of the overpayment had been established as $17,000 (which differed from an earlier preliminary calculation of about $19,000).
The Panel concluded that the overpayment of $17,000 was established as due and owing in May 1995. There had been an earlier investigation but, to be due and owing, a conclusion must be reached, and this did not occur until May 1995.
The Board notified the worker of the overpayment within three years of that date. Therefore, there was a recoverable debt. The appeal was dismissed.