An Ontario tribunal barred a driver from pursuing six disputed treatment plans after he offered no explanation for missing his notice deadline.
The applicant was involved in a motor vehicle accident on November 3, 2023, and later sought statutory accident benefits from Definity Insurance Company. Under the Statutory Accident Benefits Schedule, an insured person must notify their insurer within seven days of an accident, or as soon as practicable afterward, and submit a completed Application for Accident Benefits, known as an OCF-1, within 30 days of receiving it from the insurer.
Definity said it was not notified of the accident until January 30, 2024, when it received a Disability Certificate dated January 22, 2024. The insurer emailed an application package to the applicant that same day and requested a completed OCF-1. Follow-up letters went out on March 13 and September 27, 2024, but Definity said the completed OCF-1 did not arrive until September 30, 2024 - about 333 days after the accident.
The applicant did not dispute that notice was late. He argued instead that the OCF-1 and OCF-3 forms were submitted on the dates they bear, January 23 and January 22, 2024 respectively, and that this amounted to sufficient notice despite the delay. He also pointed to a lack of prejudice: Definity had already opened a claim, requested documentation and responded to several treatment plans, yet paid nothing.
Adjudicator Lisa Holland was not persuaded. Citing the test set out in Horvath and Allstate Insurance Company of Canada, she found an explanation for a delay must first be credible before its reasonableness can even be assessed - and the applicant offered none. His position that dated forms alone constituted notice "as soon as practicable" was not credible, Holland found, and ignorance of the notice requirement does not amount to a reasonable explanation.
On the prejudice question, Holland found Definity suffered limited prejudice but said that alone did not help the applicant meet his onus. The burden falls on the insured person to explain the delay, she noted, not on the insurer to prove harm.
Because the applicant could not show a reasonable explanation under section 34 of the Schedule, Holland ruled he is barred under section 55(1) from proceeding to a hearing. The ruling disposed of six disputed treatment plans, including neurological, optometric, chiropractic, physiotherapy and attendant care assessments, along with a related interest claim, without the tribunal reaching their merits.
The decision was released August 20, 2026.
