K.B. v. Aviva General Insurance Company (17-009088)

The claimant sought entitlement to NEBs. Adjudicator Punyarthi dismissed the claim. He held that the claimant did not meet the “complete inability” test, and that the evidence submitted did not provide an in-depth assessment of the claimant’s pre-accident and post-accident activities or how he was practically prevented from engaging in the activities that were most meaningful to him. The insurer had argued that the claimant was barred from receiving NEBs because IRBs had been paid earlier in the claim. Adjudicator Punyarthi rejected that argument, reasoning that there was a Disability Certificate supporting both IRBs and NEBs, and the insurer had not requested an election from the claimant.