Applicant v. Brant Mutual Insurance Company (17-003105)

The claimant was injured in an accident in 2005. She applied for accident benefits with the insurer. She was assessed for attendant care benefits shortly after submitting the OCF-1. The insurer subsequently denied entitlement to ACBs in an OCF-9 dated April 6, 2005. In 2017, the claimant applied to the LAT for entitlement to ACBs, arguing that the insurer’s denial of ACBs was premature and was therefore invalid. Adjudicator Gosio agreed with the insurer that the claimant was barred from seeking ACBs. He held that the denial was clear and unequivocal, and that such a denial was sufficient to trigger the limitation period. Adjudicator Gosio cited the Court of Appeal’s reasons in Sietzema v. Economical that even if the refusal to pay was premature or included benefits that an insured had yet to apply for, it could be valid if the denial was clear and unequivocal.