The claimant and the insurer each sought a preliminary issue to answer the following question: was the insurer’s request for an OCF-10 and an IE prior to starting IRB payment in accordance with s. 36 of the SABS? Adjudicator Gosio agreed with the insurer that its request for an OCF-10 and an IE prior to paying an IRB complied with s. 36. Adjudicator Gosio noted that the claimant submitted an OCF-1 and two OCF-3s which indicated that she met the disability test for NEBs and IRBs. Adjudicator Gosio noted that it was proper for the insurer to request an election pursuant to s. 35 and that the language of s. 35 is clear and mandatory. Adjudicator Gosio held that by the claimant not making an election, the insurer could not identify the nature of the claim or the benefits sought. Adjudicator Gosio held that the completed OCF-10 was required for the application for accident benefits to be considered “complete”. As for the IEs, Adjudicator Gosio also agreed with the insurer that its request for IEs complied with s. 36 because, as the claimant’s application was incomplete for failing to provide the OCF-10, the insurer was under no obligation to initiate an IRB payment prior to arranging IEs.
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