Co-operators failed to prove a claimant missed her benefits deadline because it never sent the paperwork needed to start the clock, a tribunal ruled.
The claimant was driving to work on January 13, 2023 when another vehicle cut her off, causing her to lose control on ice and strike an electricity pole. She contacted Co-operators the same day to report the crash. Adjuster's notes from that day record her twice saying she had not been injured, once when she called in and again two hours later when a claims adjuster followed up.
The claimant applied for statutory accident benefits with an OCF-1 form on June 23, 2023 - about five months after the crash. Co-operators sought to bar her claim entirely, arguing the application fell outside the 30-day window set by section 32(5) of the Statutory Accident Benefits Schedule.
The Licence Appeal Tribunal disagreed. Vice-Chair Trina Morissette found the 30-day countdown under section 32(5) only starts once an insurer has sent the applicant an accident benefits package, as required under section 32(2). Co-operators sent that package on July 4, 2023 - after the claimant had already filed her OCF-1. Because the package arrived late, the 30-day clock never started.
Morissette rejected the insurer's argument that asking about injuries twice on the day of the crash satisfied its obligations under the Schedule. Citing Hussein v. Intact Insurance Company, she wrote that "accident victims are in a vulnerable position" and concluded Co-operators should have sent the benefits package regardless of the claimant's initial responses.
The insurer's submissions, Morissette found, also touched on a separate notice requirement under section 32(1), which requires notification of an intent to claim within seven days of an accident or as soon as practicable, even though Co-operators had not explicitly raised it. On that point too, the insurer had not shown the claimant fell short, and Morissette noted she had contacted Co-operators the day of the crash.
A procedural dispute surfaced separately. Co-operators argued the claimant filed her written submissions one day past a 28-day deadline set at an April 13, 2026 case conference, though it did not request any specific remedy. Morissette declined to strike the late filing, finding Co-operators had shown no resulting prejudice and had filed its own reply on time.
The tribunal noted the matter is complicated by a second accident the claimant was involved in on June 19, 2023, for which a separate OCF-1 was submitted around the same time - a timing overlap Co-operators argued raised questions about the legitimacy of the delayed claim. Morissette said that question remains for the substantive hearing, where the claimant will still carry the onus of proving her entitlement to benefits.
The application will proceed to a hearing on the substantive benefits dispute, scheduled for October 16, 2026.
