The insurer denied payment of IRBs and NEBs on March 30, 2017. The claimant argued that he mistakenly claimed IRBs instead of NEBs and requested to correct the Application at a Case Conference on September 26, 2019. He further claimed that the denials by the insurer were not clear and unequivocal, but confusing, ambiguous and therefore the limitation period did not apply. Vice Chair Farlam noted that the EOB sent to the claimant clearly stated that he was “not eligible” for an IRB or NEB, and further noted that the insurer did not believe that the claimant had suffered a complete inability to carry on a normal life as a result of the subject accident. An Applicant’s Right to Dispute was attached. The claimant argued that he was not employed at the time of the subject accident, and therefore, NEBs was the only benefit he could have chose. Vice Chair Farlam was not persuaded, as the EOB denied both benefits and provided clear medical and other reasons for the denials. Vice Chair Farlam did not find a bona fide intention on the part of the claimant to appeal the denial within the two year period set out in the SABS, and thus declined to exercise her discretion to extend the limitation period. The application was dismissed and all issues were statute barred from further litigation.
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