The claimant was involved in two accidents and sought non-earner benefits for each date of loss. The insurer brought a motion seeking to bar the claimant pursuant to the limitations provision. Adjudicator Christopher Ferguson reviewed the denial letters and concluded that one of the two denials was not clear and unambiguous. While it is permissible to reference previous denials to maintain the initial denial date, this particular denial, when informing the claimant of the limitation period stated the window closed “within two years of receiving this notice” which vitiated the initial denial date. Moreover, because new reasons were provided in follow-up denials, the initial denial date could not practicably apply – since the claimant would have to determine whether or not to appeal given the new denial reasons. The claimant was permitted to proceed with one of the two NEB claims.
Menu