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K.A. v. Intact Insurance Company (19-004459)

  • October 26, 2020

The claimant was in an accident in May 2017. He submitted an Election choosing NEBs in July 2018. He submitted an OCF3 supporting NEBs in September 2019, more than 104 weeks after the accident. The insurer denied entitlement to NEBs based on the failure to provide an OCF3 within 104 weeks of the accident. The claimant argued that he should be excused from submitting a late OCF3 because he was self-represented at the time. Adjudicator Boyce agreed with the insurer that section 36 provided no exceptions to the requirement than an OCF3 must be submitted before payment of NEBs could begin. Because the OCF3 was submitted after the 104 weeks of eligibility, no NEBs would be payable. The claimant’s reason for the late OCF3 was irrelevant.

Full decision here

TGP Analysis

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  • FILED UNDER Non-Earner Benefits, Election
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