Licence Appeal Tribunal File Number: 23-011643/AABS
In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.
Between:
Rupinder Rana
Applicant
and
Economical Insurance Company
Respondent
DECISION
ADJUDICATOR: Christin Carmichael Greb
APPEARANCES:
For the Applicant: Ilia Estrah, Paralegal
For the Respondent: Jessica Meyerovich, Counsel
HEARD: By way of written submissions
OVERVIEW
1Rupinder Rana, the applicant, was involved in an automobile accident on November 8, 2022, and sought benefits pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Economical Insurance Company, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES IN DISPUTE
2Preliminary Issue: The preliminary issue in dispute is:
i. Is the applicant barred from proceeding to a hearing as he failed to notify the respondent of the circumstances giving rise to a claim for benefits no later than the seventh day after the circumstances arose or as soon as practicable after that day?
3Substantive Issues: The issues to be decided in the hearing are:
i. Are the applicant’s injuries predominantly minor as defined in s.3 of the Schedule and therefore subject to treatment within the $3,500.00 Minor Injury Guideline limit? Note: the parties agree the MIG limits have not been exhausted and the respondent submits that there is $2,010.00 remaining under the MIG limits.
ii. Is the applicant entitled to $3,715.90 for psychological treatment, proposed by H&M Medical Network in a treatment plan/OCF-18 (“plan”) dated September 13, 2023?
iii. Is the applicant entitled to $1,293.11 for chiropractic and massage services, proposed by Inline Rehabilitation Centre in a plan dated June 20, 2023?
iv. Is the applicant entitled to $2,652.00 for a Psychological Assessment, proposed by H&M Medical Network, in a plan dated May 23, 2023?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The applicant is barred from proceeding with his application for benefits.
ANALYSIS
Law
5Section 32(1) of the Schedule provides that a person who intends to apply for accident benefits shall notify the insurer of their intention no later than the seventh day after the circumstances arose that give rise to the entitlement, or as soon as practicable after that day.
6Once an insurer receives notice of an applicant’s intention to apply for statutory accident benefits, the insurer must provide the applicant with the appropriate application forms, a written explanation of the benefits available, information to assist the person in applying for benefits and information on the election relating to the specified benefits, if applicable (s. 32(2)). Pursuant to s. 32(5) of the Schedule, the applicant must then submit a completed and signed application for benefits to the respondent within 30 days after receiving the forms.
7Section 34 of the Schedule states that “a person’s failure to comply with a time limit set out in this Part does not disentitle the person to a benefit if the person has a reasonable explanation.” The onus is on the applicant to establish a reasonable explanation for the delay. The interpretation of “reasonable explanation” is guided by Horvath and Allstate Insurance Company of Canada, 2003 ONFSCDRS 92, and was more recently reiterated in K.H. vs Northbridge, 2019 CanLII 101613 (ON LAT). The guiding principles are summaries as follows:
a. An explanation must be determined to be credible or worthy of belief before its reasonableness can be assessed.
b. The onus is on the insured person to establish a “reasonable explanation.”
c. Ignorance of the law alone is not a “reasonable explanation.”
d. The test for “reasonable explanation” is both a subjective and objective test that should take account of both personal characteristics and a “reasonable person” standard.
e. The lack of prejudice to the insurer does not make an explanation automatically reasonable.
8An assessment of reasonableness includes a balancing of prejudice to the insurer, hardship to the claimant and whether it is equitable to relieve against the consequences of the failure to comply with the time limit.
Background and parties’ positions
9On November 8, 2022, the applicant was involved in a motor vehicle accident. He reported the accident to the respondent the same day and on November 10, 2022, he received a Claims Auto Notice from the respondent with details pertaining to the subject loss. The applicant submitted and OCF-1 through his counsel on March 28, 2023. On March 29, 2023, the respondent sent a letter to the applicant requesting various claim forms and on April 6, 2023, and May 2, 2023, requested a reasonable explanation for the late application under s. 33 of the Schedule.
10The respondent submits that the applicant did not comply with s. 32 and 34 of the Schedule by failing to notify the respondent of his intention to apply for benefits within seven days as well as failing to provide a “reasonable explanation” for this failure. The respondent also argues that the applicant should be barred from proceeding with his claim pursuant to s. 55 of the Schedule, because he failed to notify the insurer of any injuries sustained in the accident.
11The applicant does not dispute that the OCF-1 was submitted five months following the accident. However, he argues that as a relative newcomer to Ontario he did not have knowledge of the statutory scheme and that his injuries have been latent.
Late-filed OCF-1 and Reasonable Explanation for the Delay
12I find that the applicant has not established a reasonable explanation for the five-month delay in submitting an OCF-1.
13The applicant submits that the requirements of s. 32(1) were met when he reported having been involved in an accident to the insurer, whether he advised the insurer or not of any injuries. Hussein v. Intact Insurance Company, 2025 ONSC 842 considered the consumer protection nature of the legislation and held that the insured had met his obligations under s. 32(1) when he reported the accident the following day. However, the Divisional Court held that the insurer had an obligation to make further inquiry as to whether the insured was injured. Here, the evidence supports a finding that the insurer inquired as to whether the applicant suffered injuries, and he reported none. This was sufficient to discharge the insurer’s obligation in accordance with Hussein.
14The applicant’s evidence for the cause of the delay in submitting the OCF-1 include being a newcomer and not understanding the statutory scheme, latent injuries, and the delay is brief. The applicant, at no time, contacted the respondent to advise of any injuries once he notified them that he had been in an accident.
15The respondent submits that the applicant provided varying excuses in his Affidavit dated April 3, 2024, for his delay in submitting the OCF-1, none of which were credible. As well, the respondent submits that once the delayed oOCF-1 was submitted, it was requested of the applicant to provide a reasonable explanation for the delay on more than one occasion and this information was never provided. I agree with the respondent that the applicant’s answers about his injuries and the “shock” he experienced often changed throughout the Affidavit. The respondent did not simply deny the benefits to the applicant. The applicant did not respond to the respondent’s multiple attempts to ascertain the reason for the delay.
16I find that the applicant has not met his burden to establish a reasonable explanation for the delay in notifying the insurer of his intention to claim accident benefits.
The applicant is barred from proceeding with his application
17Pursuant to s. 55(1)1 of the Schedule, an insured person shall not apply to the Tribunal under subsection 280(2) of the Insurance Act if the insured person has not notified the insurer of the circumstances giving rise to a benefit within the times prescribed in s. 32.
18As outlined above, the applicant did not notify the respondent of the accident in accordance with s. 32(1) and has not provided a reasonable explanation for the delay. Accordingly, pursuant to s. 55(1)1 of the Schedule I find that the applicant is statute barred from proceeding with his application.
ORDER
19The applicant has not provided a reasonable explanation for failing to apply for accident benefits within the time limits prescribed by the Schedule. His application is barred by s. 55(1)1 of the Schedule from proceeding and is accordingly dismissed.
Released: October 6, 2025
Christin Carmichael Greb
Adjudicator