S.V. v. Aviva Insurance Canada (18-011347)

The claimant sought entitlement to ongoing NEBs, and medical benefits for physical therapy. With regard to NEBs, the claimant argued that the insurer failed to respond to the application within the timelines set out in section 36. Adjudicator Flude found that the insurer did not comply with its obligations under section 36(4)(b) of the SABS to issue a denial letter until more than one year after the accident. He ordered the insurer to pay NEBs from 26 weeks after the application was submitted up to the date of the proper denial. NEBs were not awarded beyond that time frame as the claimant failed to prove he suffered a complete inability to live a normal life. The medical benefits claim was also dismissed.