Ontario's Divisional Court has ruled that accident benefits refusal notices need not map every appeal route up to the Supreme Court.
The decision, released July 20, 2026, dismissed an appeal and judicial review brought by an accident benefits claimant against Primmum Insurance Company and the Licence Appeal Tribunal. For insurers and claims professionals, it clarifies what a compliant refusal notice under section 54 of the Statutory Accident Benefits Schedule (SABS) must contain.
The dispute began after a motor vehicle accident on February 6, 2020. On February 6, 2022, the claimant submitted an OCF-18 Treatment and Assessment Plan for $17,967.00 to support a catastrophic impairment assessment. By letter dated February 15, 2022, the insurer partially approved the plan for $14,577.00 and refused the balance. The refusal letter included a form setting out the claimant's right to dispute the determination.
The claimant filed a dispute on April 13, 2023, then unilaterally withdrew it on May 1, 2024 without any agreement to toll the limitation period. On July 30, 2024 - more than two years after the denial - she filed again, disputing $3,390.00 in benefits. A preliminary hearing considered whether that application was out of time under the two-year limit in section 56 of the SABS.
The adjudicator found the insurer's notice complied with section 54 and had triggered the limitation period. On appeal, the claimant argued the notice was deficient because it did not describe every step of reconsideration, appeal and judicial review up to the Supreme Court of Canada, nor address discoverability and section 7 of the Licence Appeal Tribunal Act.
The court disagreed. Section 54 requires only that an insurer advise a person of the right to dispute the refusal, which is the right to apply to the Tribunal under section 280(2) of the Insurance Act. Reconsideration, appeal and judicial review, the court noted, are rights to challenge a decision that follows a refusal - not the refusal itself.
The court also rejected the argument that stating a hard two-year limit was misleading. Although the discoverability principle can occasionally postpone when the limitation period starts, the obligation is to communicate in clear language that a claim must be filed within two years of denial. Adding explanations of discoverability and tolling, the court reasoned, "would detract from the clarity of the warning."
The court acknowledged the adjudicator had erred in relying on an earlier decision, Turner, which addressed a different notice obligation. Even so, it held the finding that the notice complied with section 54 was reasonable. The appeal and application for judicial review were dismissed, with no costs ordered.
