N.T. v. Unica Insurance Inc. (16-000920)

The insurer requested a preliminary issue to address whether the claim for attendant care benefits was barred by the limitation period. The claimant argued that his Form 1 did not qualify as an application for attendant care benefits, and that the insurer therefore could not have denied attendant care benefits. Adjudicator John held that the submission of the Form 1 was an application and triggered a positive obligation on the part of the insurer to pay benefits, even without the submission of expense forms. She also held that the claim for attendant care benefits had been denied more than two years prior, and was therefore time-barred.