The claimant applied for accident benefits arising out of an accident. There was conflicting information regarding his employment and education. In his OCF-1 , the claimant indicated he was in school, and employed. However, his OCF-3 noted that he had not worked at least 26 of the previous 52 weeks. His OCF-3 also indicated that he was substantially unable to complete the tasks of his employment, and suffered a complete inability to carry on a normal life. In responding to priority issues, the claimant also submitted a statement which indicated that he was a full-time student and was not working, but earned income through “side-jobs” of painting. The insurer advised the claimant that he may be eligible for IRBs, and requested the completion of an OCF-2 and OCF-10. On several different occasions throughout the next year, the insurer made repeated requests for more information to determine the claimant’s eligibility for IRBs or NEBs, and for the claimant to submit an OCF-10. The claimant’s lawyer replied via e-mail that “the benefit of choice would be NEB”, and “no IRB” because of the claimant was presently working as a forklift operator. The insurer continued to request an OCF-10. Adjudicator Pahuta held that the claimant was barred from proceeding with his claim for NEB as a result of his failure to submit his OCF-10. Adjudicator Pahuta found that there was sufficient ambiguity as to whether the claimant was entitled to IRBs or NEBs, and thus the insurer’s request for an OCF-10 was reasonable and valid. The claimant was not automatically disentitled to an IRB just because he had began working.
