Ontario's Licence Appeal Tribunal has allowed a caregiver's accident benefits claim to proceed despite a notification delay of nearly seven years.
In Scandlan v Primmum Insurance Company, 2026 CanLII 48394, released May 19, 2026, Vice-Chair Trina Morissette found that Angela Scandlan provided a reasonable explanation for waiting until March 9, 2021 to notify Primmum Insurance Company of her intent to claim accident benefits arising from a March 24, 2014 automobile collision involving her husband and son.
Scandlan was not present at the accident and did not sustain immediate injuries. She submitted her Disability Certificate (OCF-3) six years, eleven months, and fourteen days after the collision. Her completed application for accident benefits followed on April 6, 2021.
Primmum argued the delay was excessive and unreasonable. The insurer pointed to events that, in its view, should have triggered an earlier claim - including the applicant's last day worked on June 13, 2018, her husband's deemed catastrophic impairment designation on February 21, 2019, and the couple's adoption of three children in 2016, 2017 and 2018. Primmum argued the injuries should have been identifiable by February 2019.
Scandlan submitted that her psychological impairments developed gradually through long-term caregiving demands and emotional trauma, and were not discovered until she submitted her OCF-3.
Morissette accepted that explanation. Applying the framework from Horvath and Allstate Insurance Company of Canada, 2003 ONFSCDRS 92, she held that imposing a strict seven-day notification window on someone who became an insured person through the gradual development of psychological impairments would produce "an absurd result" of the kind cautioned against in Tomec v. Economical Mutual Insurance Company. The Vice-Chair noted Primmum had been assessing the claim since April 2021 and only raised section 32(1) prejudice in this second Tribunal application.
The decision was not entirely in Scandlan's favour. Morissette barred her from relitigating a $3,791.06 treatment plan for occupational therapy services, applying the doctrine of res judicata under Danyluk v. Ainsworth Technologies Inc., 2001 SCC 44.
The 2024 treatment plan, prepared by Joanne Nunn, mirrored a 2022 plan the Tribunal had already found was not reasonable and necessary in a June 2, 2025 decision. Both plans listed identical goods and services in Part 12, the same total amount, and the same provider. The only structural difference was that the 2022 plan called for one eight-hour planning session, while the 2024 plan split that into four two-hour sessions.
Morissette rejected the argument that the earlier decision was not final, noting Scandlan had not sought reconsideration, statutory appeal or judicial review. The Vice-Chair also declined to waive res judicata, finding the applicant pointed to no new evidence that was previously unavailable.
The application proceeds to a substantive hearing on the remaining issues, with causation arguments preserved for that stage.
