The claimant sought entitlement to NEBs and five medical benefits. Adjudicator Shapiro found that the claimant was entitled to three of the treatment plans, but not NEBs. In referencing Heath v. Economical, the adjudicator found that the claimant failed to show that she was continuously prevented from engaging in substantially all of her daily activities. She was able to continue virtually all of her pre-accident activities, albeit with some restrictions. The claimant was driving, walking, volunteering, and began her first paid-employment in ten years in the year following the accident. The claimant also argued that the insurer’s letter denying NEBs was insufficient under s. 36(4) of the Schedule. The adjudicator found that while better practice would have been for the insurer to summarize the medical findings in the denial letter, the inclusion of and referral to the medical report minimally satisfied the Schedule. If it had not, Stranges v. Allstate states that a defective notice would not automatically entitle the claimant to the benefit.
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