S.A.R. v. State Farm Mutual Automobile Insurance Company (16-000212)

The claimant sought entitlement to NEBs and various medical benefits. Adjudicator Pay found that the initial denial of NEBs was not vitiated by subsequent correspondence from the insurer denying NEBs. The opposite result was found in relation to two treatment plans. Although the plans were denied four years prior to the LAT application, the insurer issued correspondence two years after the denial that was confusing and informed the claimant she had two years from that date to file a LAT application.