Insurer cannot rely on late application defence where it failed to warn of consequences.
The applicant, a pedestrian struck by an unidentified vehicle in a parking lot, applied for statutory accident benefits from her own insurer, Allstate, nearly a year after the accident.
Allstate denied the claims, arguing the applicant failed to notify it within 30 days and failed to submit her application forms within 30 days of receiving them.
The arbitrator found the applicant had a reasonable explanation for the late notice, as she was unaware her own policy provided coverage for a pedestrian hit-and-run.
The arbitrator also held that Allstate could not rely on the late application defence because it failed to inform the applicant of the potential consequences of missing the 30-day deadline, applying the consumer protection principles from Smith v. Co-operators.
The applicant was awarded housekeeping benefits, five additional psychological treatment sessions, and payment of a prior mediation settlement.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesJun 9, 2003
