An Ontario tribunal has barred a claimant's accident benefits application, ruling his seven-month delay in notifying Definity Insurance Company wasn't excused by circumstance.
The Licence Appeal Tribunal released its preliminary issue decision on August 25, 2026, in a dispute over statutory accident benefits stemming from an August 7, 2024 collision. The applicant was a passenger in a vehicle insured by another company when a third-party vehicle struck it; emergency responders took him to hospital by ambulance. The driver of the vehicle he was riding in left the country afterward, and the applicant never contacted that driver's insurer.
Under section 32(1) of the Statutory Accident Benefits Schedule, an insured person must notify their own insurer of an intent to claim benefits within seven days of an accident, or as soon as practicable after. The applicant did not notify Definity - his own insurer - until he submitted his OCF-1 application on February 28, 2025, six months and twenty-one days after the collision.
The applicant argued he had a reasonable explanation for the delay: he believed the insurance on the vehicle he was riding in would address his injuries, he thought his own policy only covered vehicle repairs, his English is limited, he relied on others to navigate insurance paperwork, and he was managing physical pain and worsening mental distress. He also invoked Hussein v. Intact Insurance Company, a 2025 Ontario Superior Court decision recognizing that insurers carry a positive duty to inquire and assist accident victims.
Vice-Chair Trina Morissette distinguished Hussein. In that case, she noted, the insurer knew about the accident but not about any intent to claim benefits - whereas Definity had no notice of the applicant's accident at all until the OCF-1 arrived. Under cross-examination, the applicant acknowledged he never contacted the driver's insurer, never discussed a possible claim with the driver, and did not understand his own accident benefits process, yet still expected that insurer to address his injuries. Only his hospital records fell within the notice period, and Morissette found they didn't support his claim of incapacity. His family doctor's clinical notes contradicted his testimony further: rather than the early visit he described, the notes show his first appointment wasn't until October 22, 2024, for an unrelated mental health follow-up with no mention of the accident, where the doctor recorded that the applicant "appears well and no apparent distress."
Morissette found the applicant's explanations not credible and ruled he failed to meet his onus of establishing a reasonable explanation under the Schedule. The delay caused Definity prejudice by preventing a timely investigation, she found, and that outweighed the hardship to the applicant. He was barred under section 55(1) from proceeding with his claim, and the tribunal vacated a two-day hearing that had been scheduled for September 29, 2026. The application was dismissed.
