Trina Morissette

The applicant was involved in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The respondent raised a preliminary issue arguing the applicant was barred from proceeding because he failed to submit his application for benefits (OCF-1) within the prescribed time.

The Tribunal found that the applicant's father had notified the respondent of the accident within three days, satisfying the notice requirement under section 32(1) of the Schedule.

The respondent failed to fulfill its positive obligation to inquire and provide an accident benefits package under section 32(2), meaning the 30-day timeline to submit the OCF-1 was never triggered.

In the alternative, the Tribunal found the applicant had a reasonable explanation for the delay, as he had reached out to the respondent for assistance and received no response.

The applicant was permitted to proceed with his claim.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the claim for catastrophic impairment and scheduled insurer's examinations (IEs).

The respondent alleged the applicant failed to attend rescheduled IEs and sought to dismiss the application as a preliminary issue.

The Tribunal found the respondent's allegation was pre-emptive and speculative, as there was no evidence the applicant failed to attend the most recently scheduled IEs.

The Tribunal held the respondent did not meet its burden to show non-attendance, and ordered the parties to proceed to the substantive hearing.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer argued the applicant was barred from proceeding because he failed to submit his application (OCF-1) within 30 days of receiving the forms, as required by section 32(5) of the Schedule.

The Tribunal found that although the applicant initially reported no injuries, the respondent failed to discharge its duty under section 32(2) to provide the accident benefits package.

Because the package was never provided, the 30-day timeline did not commence.

The applicant is not barred from proceeding with his claim.

The applicant sought non-earner benefits following a motor vehicle accident.

The respondent argued the application was statute-barred because the applicant failed to dispute a denial within the two-year limitation period under section 56 of the Schedule.

The Tribunal found that the respondent's correspondence did not constitute a clear and unequivocal denial, as the applicant had not yet submitted an OCF-3 to claim the benefit.

A pre-emptive denial does not trigger the limitation period.

The preliminary issue was resolved in favour of the applicant, allowing the application to proceed.

The respondent raised a preliminary issue that the applicant was barred from proceeding with her claim for accident benefits due to late submission of her application (OCF-1) under section 32(5) of the Schedule.

In its submissions, the respondent primarily argued late notification under section 32(1).

The Tribunal found that the issue of late notification was not properly before it, as it was not raised at the case conference or in the Case Conference Report and Order.

Regarding section 32(5), the Tribunal found no evidence that the respondent provided the applicant with an accident benefits package, which is required to trigger the 30-day timeline for submitting the OCF-1.

Therefore, the respondent failed to show the applicant did not comply with section 32(5).

The applicant was permitted to proceed with her application.

The applicant was involved in a motor vehicle accident and notified the insurer of her intention to apply for statutory accident benefits.

However, she failed to submit her completed application (OCF-1) within the 30-day time limit prescribed by section 32(5) of the Schedule, submitting it 311 days post-accident.

The applicant argued she believed her injuries would resolve with homeopathic treatment and home remedies.

The Tribunal found this was not a reasonable explanation for the delay, noting the significant prejudice to the insurer's ability to investigate the claim.

The application was dismissed as statute-barred under section 55(1) of the Schedule.

The applicant sought statutory accident benefits for psychological impairments developed while caring for her husband and son, who were injured in a 2014 motor vehicle accident.

The respondent raised preliminary issues regarding the applicant's failure to notify it of her claim within seven days under s. 32(1) of the Schedule, and whether a claim for an occupational therapy treatment plan was barred by res judicata.

The Tribunal found the applicant had a reasonable explanation for the delay, as her psychological impairments developed gradually and she notified the respondent as soon as she became aware of them.

However, the Tribunal held that the claim for the occupational therapy treatment plan was barred by res judicata, as it was identical to a plan previously denied by the Tribunal in a 2025 decision.

The applicant sought statutory accident benefits following a motor vehicle accident in September 2021.

The respondent denied benefits and raised preliminary issues regarding the applicant's failure to comply with timelines under the Statutory Accident Benefits Schedule.

The Tribunal found that while the applicant properly notified the respondent of the accident within seven days, he failed to submit his application for benefits (OCF-1) within 30 days, delaying submission for over three and a half years.

The applicant's explanations for the delay, including an inability to attend treatment and a schizophrenia diagnosis, were not supported by medical evidence and were deemed unreasonable.

Consequently, the applicant was barred under section 55(1) of the Schedule from proceeding with his application before the Tribunal, and the application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent denied the claim and scheduled insurer's examinations (IEs) to assess catastrophic impairment.

The respondent raised a preliminary issue arguing the application should be barred because the applicant failed to attend the IEs.

The Tribunal found that the respondent failed to meet its burden to show the applicant did not attend the rescheduled IEs, as the allegation was pre-emptive and speculative.

The Tribunal ordered the parties to proceed to the substantive hearing.

The applicant was struck by a vehicle and accepted a $3,000 cash settlement from the driver, signing an agreement not to pursue insurance claims.

Over a year later, after losing her job and access to collateral benefits, she applied for statutory accident benefits.

The insurer argued she was barred from proceeding due to her failure to notify them within seven days of the accident.

The Tribunal found the applicant's explanations for the delay were not credible or reasonable, noting she consciously chose the cash settlement and only sought benefits when her circumstances changed.

The application was dismissed as statute-barred.

The applicant was involved in a motor vehicle accident and notified her insurer.

When asked if she was injured, she initially said no, and the insurer did not provide her with an accident benefits application package.

Nine months later, she submitted an application for benefits.

The insurer argued she was barred from proceeding due to the delay.

The Tribunal found that the insurer failed to discharge its obligation under section 32(2) of the Schedule to provide the application forms, which meant the 30-day timeline was never triggered.

Alternatively, the Tribunal found the applicant provided a reasonable explanation for the delay, as she mistakenly assumed an additional application was unnecessary because the insurer did not provide the package.

The applicant was permitted to proceed with her claim.

The applicant was involved in a motor vehicle accident and notified the insurer, but failed to submit his completed Application for Accident Benefits (OCF-1) until more than three years later.

The insurer argued the claim was time-barred under section 32(5) of the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant had a reasonable explanation for the delay, as the insurer's communications failed to clearly convey the consequences of not submitting the form within 30 days.

The Tribunal held that the insurer's ambiguous language led the applicant to believe his claims would be considered whenever the form was submitted, and the resulting prejudice to the insurer was caused by its own actions.

The applicant was permitted to proceed with his claim.

The applicant was a passenger on a bus involved in a motor vehicle accident and sought statutory accident benefits.

He failed to notify the insurer of his intention to apply for benefits until approximately one and a half years after the accident.

The Licence Appeal Tribunal found that the applicant's explanations, including being new to Canada and hoping his injuries would subside, did not constitute a reasonable explanation for the delay.

Consequently, the applicant was statute-barred from proceeding with his application before the Tribunal.

The applicant was involved in a single-vehicle accident and sought statutory accident benefits.

The respondent insurer denied benefits, arguing the applicant failed to notify it of the accident within seven days as required by section 32(1) of the Schedule.

The Tribunal found that the respondent received sufficient notice the day after the accident via a CROMS report, triggering its positive obligation to inquire and assist the applicant.

Alternatively, the Tribunal found the applicant had a reasonable explanation for the delay due to significant cognitive and psychological impairments from a prior accident, which had resulted in a catastrophic impairment designation.

The applicant was permitted to proceed with his application.

The applicant was walking with his fiancée when a vehicle drove onto the curb towards them.

The applicant jumped out of the way to avoid being struck, but his fiancée was hit and killed.

The applicant sought statutory accident benefits for psychological impairments.

The insurer denied the claim, arguing the applicant was merely a witness and not 'involved in' the accident.

The Tribunal found that because the applicant was in immediate danger and had to take evasive action to avoid physical injury, he was engaged as a participant and was therefore 'involved in' the accident.

The applicant was deemed an 'insured person' eligible for benefits.

The applicant sought statutory accident benefits following a motor vehicle accident.

The respondent insurer scheduled several insurer's examinations (IEs) to determine ongoing entitlement to income replacement benefits and catastrophic impairment.

The applicant failed to attend or fully participate in three of the IEs, arguing they were excessive and not reasonably necessary.

The Tribunal applied the Travelers criteria and found the requested IEs were reasonably necessary and the applicant failed to provide a reasonable explanation for her non-attendance.

Consequently, the applicant is statute-barred from proceeding with her application under section 55 of the Schedule until she attends the IEs, and the application was dismissed.

The applicant, an Ontario resident, was struck by a vehicle in New York and sought statutory accident benefits from the respondent insurer.

The respondent initially processed the claim under the Ontario Statutory Accident Benefits Schedule (SABS), paying benefits and approving treatment plans.

Later, the respondent asserted the claim should be handled under a New York policy and denied further SABS benefits, arguing the applicant was not an 'insured person' under the SABS.

The Tribunal found it had jurisdiction to apply equitable remedies, including estoppel, under section 131 of the Insurance Act.

Applying the test for estoppel by convention, the Tribunal held that the respondent's clear representations and the applicant's detrimental reliance estopped the respondent from denying the applicant was an 'insured person.' The Tribunal concluded it had jurisdiction to hear the substantive application.

The applicant was injured in a motor vehicle accident and notified the insurer shortly after.

The insurer provided an application for accident benefits (OCF-1), but the applicant did not submit the completed form until nearly two years later.

The insurer argued the claim was statute-barred due to the delay.

The Tribunal found that the applicant failed to provide a reasonable explanation for the delay, noting the lack of medical documentation to support his claim of cognitive impairment and the insurer's fulfillment of its duty to inquire and assist.

The application was dismissed as statute-barred.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits.

The respondent insurer denied the claim, arguing the applicant failed to submit his application (OCF-1) within the 30-day timeframe prescribed by section 32(5) of the Schedule.

The Tribunal found that the respondent failed to meet its positive obligation under section 32(2) to assist the vulnerable applicant and provide the necessary forms, as it only left two voicemails and mailed a package to an incomplete address.

Consequently, the 30-day timeline was never triggered, and the applicant had a reasonable explanation for the delay.

The applicant was permitted to proceed with his claim.

The applicant sought statutory accident benefits following an alleged motor vehicle accident.

The respondent denied the claim, arguing the applicant was not a passenger in the vehicle and that the collision was staged.

The Tribunal found discrepancies in the applicant's evidence, noting he was not listed in the police report and the driver's examination under oath did not clearly identify him.

Relying on a forensic engineering report, the Tribunal also concluded the collision was staged.

Applying the Caughy test, the Tribunal held the incident did not meet the definition of an 'accident' under section 3(1) of the Schedule and dismissed the application.