The insurer raised two preliminary issues in advance of a hearing. The first issue was whether the claimant was prevented from appealing the insurer’s refusal to pay a number of claims because she failed to commence her appeal within two years of the date her claims for benefits was denied. Adjudicator Ferguson held that the claimant was prevented from appealing one claim but that the remaining four at issue could proceed. The parties agreed that the claimant’s appeal was filed more than two years after the dates that the insurer notified her of its refusal to pay the disputed benefits; however all but one of the denials failed to provide the claimant clear and unequivocal notice that it denied her claims and why. The second issue was whether the claimant was prevented from appealing two specific claims because she failed to submit those claims to the insurer within the time limits prescribed by the Schedule. Adjudicator Ferguson held that the claimant was prevented from appealing both denials at issue. Adjudicator Ferguson rejected the claimant’s explanations for failing to comply with the s. 32 timelines for making claims for lack of credibility.
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