The claimant sought entitlement to non-earner benefits. The insurer resisted the claim on two grounds: (i) the claim was limitations barred, and (ii) a claim for income replacement benefits precluded a non-earner benefits claim. Adjudicator Hines noted that the claimant received income replacement benefits which were ultimately stopped in August of 2014 due to her return to work. The claimant argued (and the insurer conceded) that the denial by the insurer was legally incorrect, in that, it indicated the claimant was ineligible for non-earner benefits given she qualified for income replacement benefits. Adjudicator Hines noted that although the denial was legally incorrect, it was still a clear denial of benefits triggering the limitations period. The insurer also argued that pursuant to section 12 of the SABS a claim for non-earner benefits cannot be allowed since a pre-requisite is that one must not qualify for income replacement benefits. Since the claimant failed to provide persuasive evidence on the subject, and the insurer clearly established the claimant qualified for income replacement benefits, the non-earner benefits claim was precluded.
