The claimant filed a LAT application on May 4, 2017, seeking entitlement to NEBs. A written preliminary issue hearing was scheduled to determine whether the claimant was precluded from bringing the application to the LAT, pursuant to s. 56 of the SABS, for failure to dispute the denial of benefits within two years. The insurer initially denied NEBs by Explanation of Benefits on March 13, 2015. The insurer denied NEBs based on the claimant’s non-supportive OCF-3 and on its determination that the claimant’s impairments were within the MIG. On May 6, 2016, the insurer responded to further submissions of the claimant by advising that his entitlement to benefits had not changed since March 13, 2015. The claimant was removed from the MIG in June 2016. At the hearing, the claimant submitted that the March 2015 Explanation of Benefits was a blanket denial of benefits that was insufficient to trigger the two-year limitation period. Adjudicator Watt disagreed and found that the 2015 denial met the requirements of the SABS and case law by clearly giving reasons for the denial of benefits and advising the claimant of the steps required by the claimant to dispute the decision within two years. Adjudicator Watt held that the claimant was statute barred from proceeding with the LAT application as the two-year limitation period had expired. The application was dismissed.
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