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Valentine v AIG Insurance (20-008673)

  • August 17, 2022

A preliminary issue hearing was held to determine whether the claimant’s application for NEBs was statute-barred. The claimant was involved in a motor vehicle accident on December 5, 2017, and submitted an OCF-3 dated June 14, 2019, indicating that she did not suffer a complete inability to carry on a normal life. The insurer subsequently advised the claimant that she would not be entitled to an NEB benefit. The claimant submitted a second OCF-3, almost three years later indicating that she now suffered a substantial inability to carry on a normal life. The insurer argued that the claimant had failed to properly apply for NEBs as she did not submit a complete OCF-3 within 104 weeks of the accident. Adjudicator Grant agreed with the insurer, outlining that section 36(3) of the SABS provides that the entitlement period for the NEB commences once a completed OCF-3 is received. As the claimant failed to submit an OCF-3 which supported an entitlement to the NEB benefit within the prescribed time her claim could not proceed.

Full decision here

TGP Analysis

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  • FILED UNDER Non-Earner Benefits, Late Application
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