Gore Mutual loses bid to block bailiff's accident benefits claim filed 397 days after he was assaulted during a vehicle repossession.
Ontario's Licence Appeal Tribunal has ruled that Gerald Goegan, a bailiff injured during a repossession attempt in July 2023, can proceed with his statutory accident benefits claim against Gore Mutual Insurance Company despite notifying the insurer of the accident approximately 13 months after it occurred.
The decision, released on May 7, 2026 by adjudicator Melanie Malach, applies the Horvath principles to a fact pattern the adjudicator herself described as not a typical motor vehicle accident.
Goegan was on foot, attempting to repossess a vehicle on July 27, 2023, when the assailant punched him and then dragged him with the vehicle he was operating. He sustained injuries to his left shoulder and the right side of his neck. He did not contact a lawyer until August 14, 2024, when he sought advice about suing his assailant. Only then did he learn he might be eligible for accident benefits. He retained counsel on August 22, 2024 and submitted his OCF-1 the following day - the first notice Gore Mutual received of the accident.
Section 32(1) of the Schedule requires notice within seven days. Section 34 permits a claimant to overcome a late filing where a reasonable explanation exists. Gore Mutual denied the claim on November 20, 2024 under sections 32 and 34 of the Schedule. In its submissions to the Tribunal, the insurer argued that ignorance of one's rights is not a reasonable explanation, citing several Tribunal decisions where similar explanations had been deemed insufficient. It pointed to a delay of 397 days and argued it was prejudiced in obtaining contemporaneous medical information, conducting timely assessments, and investigating priority and loss transfer.
The adjudicator was not persuaded. She accepted Goegan's evidence that he did not realize an assault during a repossession qualified as a motor vehicle accident under the Schedule. She noted he had no accident report, has been denied access to the police file because the criminal matter remains before the courts, and had no prior experience with accident benefits claims. While Gore Mutual argued Goegan was sophisticated because he works as a bailiff and is the sole officer and director of his company, the adjudicator found this did not establish familiarity with the accident benefits system.
The reasonable explanation test, she wrote, is both subjective and objective. Citing Tomec v. Economical Mutual Insurance Co. and Hussein v. Intact Insurance Company, she emphasized that the SABS are consumer protection legislation and that accident victims occupy a vulnerable position.
On the balancing exercise, the adjudicator acknowledged Gore Mutual had been prejudiced by the delay, but found Goegan's medical records would be available on request. The hardship to him if barred from proceeding, she concluded, would be far greater. She also noted that, "ignorance of the law alone is not a reasonable explanation," but accepted that the unusual facts here met the threshold.
A point claims professionals may flag: the adjudicator highlighted that Gore Mutual had chosen not to conduct an Examination Under Oath to test the applicant's credibility or the reasonableness of his explanation, despite having his affidavit. The merits of the underlying accident benefits claim remain to be decided.
