D.A.S. v. Western Assurance Company (19-010526)

The claimant applied to the LAT for NEBs. The claimant’s OCF3 indicated that she met the tests for IRBs and NEBs. The insurer requested an election pursuant to section 35 of the SABS. The claimant did not return the election and instead applied to the LAT two years later. About six months into the LAT proceedings, the claimant submitted an election for NEBs. The insurer argued that because the election was not submitted prior to the LAT application, there was no dispute between the parties that could be adjudicated. Vice Chair McGee agreed with the insurer and dismissed the claim. She held that the claimant’s failure to submit an election prevented the insurer from property adjusting the claim, and did not give the insurer the opportunity to approve or deny the benefit. Without a denial, there was no dispute for the Tribunal to adjudicate.