Licence Appeal Tribunal File Number: 25-008282/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:
Michael Sneyd
Applicant
and
TTC Insurance Company Limited
Respondent
PRELIMINARY ISSUE HEARING DECISION AND ORDER
ADJUDICATOR:
Melanie Malach
APPEARANCES:
For the Applicant:
Samuel Pevalin, Counsel
For the Respondent:
Kristin Tonack, Counsel
Heard:
By Way of Written Submissions
OVERVIEW
1Michael Sneyd, the applicant, was involved in an accident on June 3, 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 the respondent, TTC Insurance Company Limited, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
PRELIMINARY ISSUES IN DISPUTE
2The preliminary issues to be decided are:
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?
ii. Is the applicant barred from proceeding with his claim for benefits as he failed to submit his application for accident benefits (“OCF-1”) within the time prescribed in the Schedule?
RESULT
3The applicant may proceed with his application before the Tribunal.
PROCEDURAL ISSUE
Incorrect reference to the Schedule
4The respondent submits that throughout the applicant’s submissions regarding Issue 1 of this preliminary issue hearing, the applicant consistently refers to the incorrect section of the Schedule. The respondent submits that this is a fatal error to the applicant’s submissions as accurate statutory interpretation is essential in proceedings before the Tribunal. The respondent further argues that allowing the applicant to rely on incorrect and mis-referenced provisions would set a poor precedent of permitting submissions grounded in error to influence the outcome of proceedings. The respondent therefore requests that the Tribunal decline to consider the applicant’s submissions on Issue 1 of the preliminary issue hearing.
5I agree with the respondent that the applicant has referred to the wrong sections of the Schedule in making his arguments with respect to Issue 1 of the preliminary issue hearing. The applicant refers to s. 32(2) and s. 32(5) instead of s. 32(1). However, I find that it is clear that the applicant is making his submissions with respect to the seven-day notice period as evidenced by the heading of this section of his submissions.
6I further find that the respondent has not suffered any prejudice by the errors made and the potential prejudice to the applicant if his submissions were not considered, particularly since the error made is by his legal counsel, would be significant.
7For the reasons outlined above, I deny the respondent’s request to omit the applicant’s submissions on Issue 1 of the preliminary issue hearing.
Production of Adjuster Notes
8The applicant submits that the respondent’s First Party Contact Adjuster Notes (“Adjuster Notes”) were not provided to the applicant prior to the respondent’s submissions. He submits that the Adjuster Notes were not produced in the respondent’s Response by an Insurance Company dated July 10, 2025, nor in the respondent’s Case Conference Summary, dated September 19, 2025. He further submits that these Adjuster Notes were not requested to be produced at the Case Conference. The applicant therefore submits that the respondent has tendered inadmissible evidence that cannot be considered by the Tribunal.
9The respondent in reply submits that consideration of the Adjuster Notes poses no risk of prejudice to the applicant and therefore should be considered by the Tribunal. It argues that the applicant has not made any substantive argument as to why the Adjuster Notes cause prejudice or how they harm the applicant’s ability to respond in this preliminary hearing. In addition, the applicant had the opportunity to make submissions about the Adjuster Notes in his submissions. The respondent further submits that excluding the Adjuster Notes as evidence in this hearing will be prejudicial because the Tribunal would be excluding facts that are relevant to this hearing.
10I agree with the respondent that excluding the Adjuster Notes would be prejudicial as the Adjuster Notes provide relevant evidence with respect to the issues in dispute. I find that the applicant has not provided any submissions with respect to the prejudice suffered if the Adjuster Notes are allowed into evidence. I therefore find that the potential prejudice to the respondent would outweigh any prejudice to the applicant.
11For the reasons outlined above, I deny the applicant’s request to omit the Adjuster Notes.
ANALYSIS
Background
12On June 3, 2023, the applicant was involved in an accident with a bus insured by the respondent.
13On June 20, 2023, as part of internal reporting procedures, the respondent became aware of the accident and contacted the applicant and left a voicemail. A second voicemail was left on June 26, 2023. These phone calls are confirmed in the Adjuster’s Notes submitted by the respondent.
14On June 29, 2023, the applicant retained counsel to represent him in respect to his accident benefits claim.
15On June 30, 2023, the respondent mailed a letter to the applicant enclosing an Application for Accident Benefits Package. The Application Package contained information about accident benefits, instructions on how to apply, and the requirement to provide a completed OCF-1 within thirty days.
16On October 3, 2023, the applicant submitted his OCF-1 to the respondent.
17By letter dated October 17, 2023, the respondent advised the applicant that he was ineligible for accident benefits due to his failure to comply with sections 32(1) and 32(5) of the Schedule. The respondent requested that the applicant provide a reasonable explanation for the delay pursuant to s. 34 of the Schedule.
18By letter dated November 13, 2023, the respondent again advised the applicant that he was ineligible for accident benefits due to his failure to comply with s. 32 of the Schedule and requested that he provide a reasonable explanation for the delay pursuant to s. 34 of the Schedule.
19By letter dated November 16, 2023, counsel for the applicant responded with reasons for the delay.
20On January 19, 2024, the respondent requested that the applicant attend an Examination Under Oath (“EUO”) in accordance with s. 33 of the Schedule. The applicant subsequently attended on April 10, 2025.
21By letter dated April 11, 2025, the respondent maintained the denial of the applicant’s entitlement to accident benefits pursuant to sections 32, 34 and 55 of the Schedule.
Law
1Section 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.
2Once 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 benefits available, information to assist the person in applying for benefits and information on the election relating to income replacement benefits, non-earner benefits and caregiver benefits, if applicable. Pursuant to s. 32(5) of the Schedule, the applicant must then submit a completed and signed application for benefits to the insurer within 30 days after receiving the application forms.
3Section 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.
4The interpretation of “reasonable explanation” is guided by Horvath v. Allstate Company of Canada, 2003 ONFSCDRS 92 (“Horvath”) and was more recently reiterated in K.H. v. Northbridge General Insurance Company, 2019 CanLII 101613 (ON LAT) (“K.H.”). 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 is on the insured person to establish a “reasonable explanation”.
Ignorance of the law alone is not a “reasonable explanation”.
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.
The lack of prejudice to the insurer does not make an explanation automatically reasonable.
An 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.
5Additionally, pursuant to Hussein v. Intact Insurance Company, 2025 ONSC 842 (“Hussein”), an interpretation of s. 32(1) must recognize the reality that consumers who have motor vehicle accidents are in a vulnerable position, particularly in the period immediately following the accident. Hussein provides that the insurer has a positive obligation to inquire and assist an insured person with their application for accident benefits and affirms that insurers cannot simply rely on the insured person’s inaction to determine that no benefits will be claimed.
6Pursuant to s. 55(1)1 of the Schedule, an insured person may not apply to the Tribunal if they have not notified the insurer of the circumstances giving rise to the benefit or has not submitted an application for the benefits within the times set out in the Schedule.
Compliance with s. 32(1) of the Schedule
7The respondent submits that the applicant confirmed at his EUO that at no point did he notify the respondent of his intention to seek accident benefits as required by s. 32(1) of the Schedule. It further submits that the claim made by the applicant’s counsel that a letter was sent to the respondent on June 29, 2023, does not constitute notice to the respondent, as the letter was not addressed to the correct department, and it did not advise of an intention to claim accident benefits or refer to the Schedule. The respondent further argues that the applicant has not provided a reasonable explanation for his non-compliance.
8The applicant submits that he informed the respondent of the circumstances giving rise to his claim for benefits on the day of the accident as the respondent was aware of the accident through his presence at the accident and subsequent reporting to police. He further submits that his presence at the scene constitutes notice because the Schedule is remedial and is consumer protection legislation. He relies on the decision in Hussein which articulates that,
Consumers who have motor vehicle accident are in a vulnerable position, particularly in the period immediately following an accident and seven days is a very short notice period… The entitlement to damages for motor vehicle accidents in Ontario and the role of the SABS in that regime is not something that it is fair to assume the average consumer would be familiar with. Insurance adjusters and agents, on the other hand, can be presumed to know that if one of their insureds has an accident and is injured in that accident, they will want to make a claim for accident benefits.”
9I find that the applicant did not notify the respondent within seven days of the accident that he was involved in an accident. However, it is clear that the respondent was aware of the accident and a potential claim for accident benefits. I find that this is confirmed by the respondent subsequently fulfilling its positive obligations set out in Hussein, by contacting the applicant by telephone on June 20 and June 26, 2023. It then proceeded to send the applicant an Accident Benefits Package on June 30, 2023 by mail.
10The applicant’s evidence at his EUO is that he believed that his counsel, who he retained on June 29, 2023, responded to the respondent and advised that he would be pursuing an accident benefits claim. At page 12 of his EUO transcript he says,
Q. Did you notify TTCICL, TTC Insurance Company Limited of your intention to apply for accident benefits?
A. So, through my attorney, that was done
11At page 14 of the EUO Transcript, counsel for the applicant states that his office sent a letter dated June 29, 2023 to the legal department of Toronto Transit Commission putting the respondent on notice that there had been an accident and that the applicant was injured. While the respondent submits that this letter was not sent to the right department and did not address the applicant’s claim for accident benefits or refer to the Schedule, I accept that a letter was sent by counsel for the applicant to the respondent advising of the accident and that the applicant had suffered injuries. The respondent has not pointed to any authority that supports that the letter must be sent to the right department or specifically mention the Schedule. Based on Hussein, I do not find that this level of detail is necessary in any correspondence with the respondent to notify it of an accident. In any event, I accept the applicant’s evidence that he had a reasonable belief that his counsel was handling his claim and had advised the respondent of his intention to pursue an accident benefits claim.
12Based on K.H., an assessment of reasonableness includes a balancing of prejudice to the respondent, hardship to the applicant, and whether it is equitable to relieve against the consequences of the failure to comply with the time limits in s. 32(1). I find that the respondent did not sustain any material prejudice as it was aware of the accident and subsequently sent the applicant an Accident Benefits Package. I find that the hardship to the applicant would be significant if he is denied access to potential claims under the Schedule for his accident-related injuries.
13For these reasons, I find that the applicant has met his onus to establish a reasonable explanation for his delay pursuant to s. 32(1) of the Schedule.
Compliance with s. 32(5) of the Schedule
14The parties agree that that the applicant did not submit his completed OCF-1 within thirty days of receipt as required by s. 32(5) of the Schedule. The applicant was sent the Accident Benefits Package by mail on June 30, 2023 and was required to submit his OCF-1 within thirty days. He did not submit his OCF-1 to the respondent until October 3, 2023, which is approximately a two-month delay.
15The applicant submits that he has a reasonable explanation for failing to comply with the thirty-day period described in s. 32(5) of the Schedule. First, it was his genuine and credible understanding that he needed his employer and doctor to complete the requisite forms before he could submit them. Second, he made reasonable efforts to have the forms completed but he encountered external roadblocks along the way. He saw his family doctor in the first week of July but was then to sent to a physiotherapist before completing the forms. The physiotherapist then would not see him without referring him to a neurologist and orthopedic surgeon. With respect to his employer, he was unable to get the forms completed because his union was on strike at the time, and there was no one available to fill out the forms properly until the strike ended at the end of November. Third, the applicant had a reasonable belief that his counsel at the time was handling his claim and the harm he would suffer from his counsel’s conduct would outweigh the prejudice to the respondent.
16The respondent submits that at no point did the applicant or his counsel write to explain any delay caused by due diligence efforts. It argues that it was only after several requests that the applicant provided an explanation at all. The respondent argues that the explanation provided by the applicant for his non-compliance with s. 32(5) is not credible or reasonable. The respondent submits that there is no evidence that the applicant was medically or physically unable to complete and submit his OCF-1 to the respondent within the prescribed timeline. The respondent argues that the applicant’s ability to work, including the strike of his employer, are not relevant factors to the initial completion of the OCF-1 within the prescribed timelines. In addition, the applicant’s claim that his family doctor referred him to multiple specialists prior to completing his portion of the OCF-1 does not explain the delay in completing the OCF-1.
17The respondent further submits that if the applicant was mistaken as to what his obligations were, his counsel was in the position to act on his behalf to ensure that his obligations under the Schedule were met, and to assist with the completion of the OCF-1. The respondent argues that as solicitors with knowledge and experience in the accident benefits scheme, the applicant’s counsel would have been aware of the obligations imposed by s. 32(5), and should have taken the appropriate steps to ensure the OCF-1 was submitted on time. The respondent relies upon the Court of Appeal decision in Cervo v. Raimondo, 2006 CanLII 37119 (ON CA), where the Court found at paragraph 46 that:
In general, the solicitor is the client’s authorized agent in all matters that may reasonably be expected to arise for decision in the particular proceedings for which he has been retained. Where a principal gives an agent general authority to conduct any business on his behalf, he is bound as regards third persons by every act done by the agent which is incidental to the ordinary course of such business or which falls under the apparent scope of the agent’s authority.
18The respondent argues that it has suffered prejudice by the delay since it has been precluded from properly assessing and investigating the claim for the four-month period.
19I find that the applicant has a reasonable explanation for the delayed submission of his OCF-1. I find that while he was aware of the 30-day time limit, I accept his belief that he had to complete the forms in their entirety with the assistance of his physicians and his employer, before submitting them to the respondent. I find that he made an appointment with his family physician to fill out the form but was then told that he had to been seen by a physiotherapist to assess his injuries. He then experienced subsequent delays when he was referred to an orthopaedic surgeon and a neurologist. With respect to his employer, I accept that he attempted to have the forms filled out but was delayed due to the Union strike. While I agree that there should have been some communication with the respondent about the delays he was experiencing, I accept the applicant’s submissions that he was making attempts to complete the forms.
20With respect to submissions of the respondent that it has suffered prejudice by the delay, in my view, there was actually only a two-month delay between the date the applicant was required to submit his OCF-1, until it was submitted. I do not find that this was a significant delay given the particular facts of the case. Given the minimal delay, I find that there is limited prejudice to the respondent, and there would be significant hardship in denying the applicant access to potential claims under the Schedule.
21For these reasons, I find that the applicant is not disentitled from receiving benefits and may proceed with his application.
ORDER
22The applicant may proceed with his application before the Tribunal.
Released: February 10, 2026
Melanie Malach
Adjudicator