Accountability For The Section 7(4) Accounting Report: When Is It ‘reasonable And Necessary'?

The requirement under section 7(4) of the Ontario Statutory Accident Benefits Schedule ¹ for insurers to fund accounting reports on behalf of insured persons is a reasonable one. To be eligible for funding by the insurer, the reports must be:

• for a person applying for an Income Replacement Benefit (IRB);
• prepared by an accountant; and
• reasonable and necessary for determining entitlement to an IRB. ²

The IRB calculation provisions of the Schedule are somewhat complex, particularly for self-employed insureds. The calculations, in some but not all respects, are similar to calculations under the Income Tax Act (Canada) and are subject to inclusions, exceptions and, in some circumstances, interpretation. Funding for an insured to assist in the IRB calculation serves the interests of both the insurer and the insured by allowing a timely calculation by a qualified professional. ³ The resultant calculation should reduce the potential for disputes, allowing for