An Ontario tribunal will let a claimant pursue accident benefits for psychological injuries from his wife's crash, despite filing more than a year late.
The Licence Appeal Tribunal released its preliminary decision on July 13, 2026, and it offers claims handlers a cautionary read on when a late-notice bar will hold - and when it will not.
The dispute began with a motor vehicle accident on September 13, 2023. The claimant's wife, who was injured in the crash, notified the insurer two days later, on September 15, 2023, and a single adjuster handled her file throughout. The claimant himself was not in the accident. He later said the strain of watching his wife work through her ongoing symptoms brought on anxiety that developed gradually over time.
He did not apply for benefits until March 5, 2025 - more than a year and a half after the accident. The Dominion of Canada General Insurance Company (Travelers) denied the application on March 20, 2025, citing the notice and timing rules in the Statutory Accident Benefits Schedule. Under section 32(1), a person intending to claim must notify the insurer within seven days, or as soon as practicable. Section 34 allows a claimant to overcome a late filing where there is a reasonable explanation, and section 55(1) bars a tribunal application where the timelines are not met.
The insurer argued it had no duty to anticipate a claim from a family member who was not involved in the accident, and no obligation to tell every relative of the person who gave notice about the right to claim. The adjudicator agreed on that point, but found it did not change the fact that the claimant did not know he could claim.
Applying the reasonable-explanation test from Horvath and K.H., along with the consumer-protection approach in Tomec v. Economical Mutual Insurance Co. and Hussein v. Intact Insurance Company, the adjudicator weighed prejudice to the insurer against hardship to the claimant. She accepted that his injuries were not immediately apparent and developed as he watched his wife recover. A clinical note dated February 26, 2025 recorded anxiety and recommended counselling; he filed his application about a week later.
The adjudicator acknowledged the delay was long and had prejudiced the insurer's ability to investigate and assess the claim. Even so, she found the claimant was "an unsophisticated insured who was not familiar with the process," and that barring him would cause hardship far outweighing that prejudice. On balance, she ruled the explanation reasonable and let the claim proceed.
The win had limits. The claimant had also sought a special award under section 10 of Regulation 664, alleging the insurer unreasonably withheld or delayed payment. Because he made no submissions on that issue, the adjudicator found he had not proved his entitlement and declined to make an award.
For insurers, the decision shows that a long delay does not guarantee a bar - particularly where a claimant did not know benefits were available and injuries surfaced only over time.
