Citation: Thangavelautham v. Travelers Insurance Company of Canada, 2025 ONLAT 24-004447/AABS-PI
Licence Appeal Tribunal File Number: 24-004447/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:
Uthayasangar Thangavelautham
Applicant
and
Travelers Insurance Company of Canada
Respondent
PRELIMINARY ISSUE HEARING DECISION AND ORDER
ADJUDICATOR:
Kate Grieves
APPEARANCES:
For the Applicant:
Joseph Tanimowo-Reyes, Counsel
For the Respondent:
Amanda R.M. Faulkner, Counsel
Heard:
By Way of Written Submissions
OVERVIEW
1Uthayasangar Thangavelautham (the “applicant”) was involved in an accident on March 24, 2023 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 Travelers Insurance Company of Canada (the “respondent”) and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
PRELIMINARY ISSUES IN DISPUTE
2The preliminary issue to be decided is:
i. Is the applicant barred from proceeding with his claim for benefits because he failed to submit the application for benefits (OCF-1) within the time prescribed of the Schedule?
3The respondent indicated in its submissions that there is a further preliminary issue with respect to the applicant’s failure to notify the respondent of his intention to apply for benefits within seven days of the accident contrary to section 32(1). Given that the only preliminary issue identified in the case conference report and order is the one listed above, I have limited my analysis to that issue only. The parties have a right to receive notice of the issues in dispute. It would be procedurally unfair to the applicant to allow the respondent to add an issue in this manner. If the respondent wanted to add a further preliminary issue or request an amendment of the case conference report and order, it should have filed a notice of motion.
RESULT
4The applicant is statute-barred from proceeding with his application for failing to submit his application for benefits within the time prescribed by the Schedule.
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 to the benefit, 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 OCF-1 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 (“Horvath”), and was more recently reiterated in K.H. v. Northbridge, 2019 CanLII 101613 (ON LAT). The guiding principles are summarized as follows:
An explanation must be determined to be credible or worthy of belief before its reasonableness can be assessed.
The onus