An Ontario tribunal let an injured cyclist's benefits claim proceed, ruling an auto insurer's duty to inform victims reaches beyond its own policyholders.
The Licence Appeal Tribunal released its preliminary issue decision on July 6, 2026, and it carries a pointed message for claims handlers deciding when the accident benefits clock starts running.
The dispute began on December 16, 2023, when the claimant was riding his e-bike and a vehicle insured by Zurich Insurance Company Ltd. turned right into him. He was, in his own words, "struck and pinned under this vehicle" and taken to hospital. Two days later, on December 18, 2023, he emailed the insurer's claims department to report the collision and his injuries.
Zurich treated the contact as a property damage matter tied to the e-bike and never sent an accident benefits package. When the claimant's representative later asked for the complete accident benefits file - on May 31, June 6 and June 11, 2024 - the insurer replied that no accident benefits claim was open and invited an application. The completed OCF-1 followed in early July 2024. Zurich then denied the claim as late and argued the claimant had no reasonable explanation for the delay.
At the tribunal, the question was narrow: was the claimant barred because he missed the 30-day filing window under section 32(5) of the Statutory Accident Benefits Schedule? Vice-Chair Trina Morissette said no.
Her reasoning turned on sequence. Section 32(2) requires an insurer, once notified that someone intends to claim, to send the OCF-1 forms, a written explanation of available benefits, and information to help complete the application. Only after that does the 30-day deadline in section 32(5) begin. Because Zurich never provided the package, the tribunal found the clock was never triggered.
Zurich argued its section 32(2) duty was never engaged, since the claimant had approached it about property damage, not injuries. It also relied on the Divisional Court's ruling in Hussein v. Intact Insurance Company, arguing that case was different because it involved the insurer's own policyholder.
The Vice-Chair rejected the distinction. Drawing on the consumer protection purpose of the Schedule, she found the positive duty to inquire and assist extends to people injured in an accident who are covered under a third party's policy - not only an insurer's own insured. The December 18 email, she held, flagged both a property damage claim and a possible injury claim, and the report of injuries triggered the insurer's obligation to explain the benefits process.
She was unpersuaded by an internal adjuster email, dated February 26, 2026, suggesting the claimant wanted only property damage coverage. She noted it came more than two years after the accident, and that the insurer's log notes omitted the initial December 2023 contact.
The result: the claimant may proceed to a two-day hearing on the substantive issues, set to begin August 25, 2026. For insurers, the takeaway is that notice of injury - even from someone outside the policy - can set the section 32(2) duty in motion, and inaction on that duty can stop the filing deadline from ever starting.
