Licence Appeal Tribunal File Number: 25-009911/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:
Rasha Ali Mohamed
Applicant
and
Definity Insurance Company
Respondent
PRELIMINARY ISSUE HEARING DECISION AND ORDER
ADJUDICATOR: Nadia Mauro
SUBMISSIONS BY:
For the Applicant: Mobina Khan, Counsel
For the Respondent: Renato Sordi, Counsel
HEARD: By way of written submissions
OVERVIEW
1Rasha Ali Mohamed, the applicant, was involved in an automobile accident on June 14, 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, Definity Insurance Company, 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:
Is the applicant barred from proceeding with their claim for benefits as they failed to submit the application for benefits (OCF-1) within the time prescribed in the Schedule?
Is the applicant barred from proceeding to a hearing as they 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?
RESULT
3The applicant is barred from proceeding with this application.
ANALYSIS
Background
4On June 14, 2022, the applicant was a passenger of a vehicle that was involved in an accident.
5On November 15, 2022, the respondent mailed an application for accident benefits package to the applicant. The covering letter correspondence of the application package indicated that the applicant had 30 days to return a completed and signed OCF-1.
6On April 4, 2023, the applicant retained counsel to represent her regarding her accident benefits claim.
7On April 17, 2023, after the applicant submitted five treatment plans, the respondent notified the applicant by way of Explanation of Benefit (“EOB”) that the applicant had not provided a completed OCF-1 or any reasonable explanation for the delay.
8On May 29, 2024, the respondent sent email correspondence to the applicant’s counsel noting that no OCF-1 had been submitted.
9On June 18, 2024 and May 21, 2025, by way of EOB, the respondent indicated that the applicant has not provided a completed OCF-1.
10On July 28, 2025, the applicant submitted a completed OCF-1, dated July 27, 2025.
11On July 30, 2025, the respondent responded to the applicant’s OCF-1, advising that, as the application was submitted 162 weeks and 6 days after the accident, the applicant was not compliant with s. 32 of the Schedule. The respondent requested a reasonable explanation for the late application, and other documents pursuant to s. 33 of the Schedule.
12On July 31, 2025, the applicant filed the within application with the Tribunal.
13On August 19, 2025, the respondent requested the completion of a statutory declaration.
14An Examination Under Oath (“EUO”) was scheduled for September 29, 2025, and Certificate of Nonattendance of the same day confirms the applicant did not attend the EUO.
15A second EUO was scheduled for October 22, 2025, and Certificate of Nonattendance of the same day confirms the applicant did not attend the EUO.
16On October 27, 2025, the respondent advised the applicant that her accident benefits claim was denied because of her non-compliance with s. 32 of the Schedule, failure to provide a reasonable explanation for the delay pursuant to s. 34 of the Schedule, and failure to attend an EUO.
The Law
17Section 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.
18Once 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.
19Section 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.
20The 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.
21Additionally, 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.
Compliance with s. 32(5) of the Schedule
22The parties agree that the applicant did not submit her completed OCF-1 within 30 days of receipt as required by s. 32(5) of the Schedule.
23The respondent submits that the applicant submitted her OCF-1 more than 37 months after the accident and two years, eight months and 13 days after she was provided with the OCF-1 for completion. The respondent submits that it advised the applicant on several occasions as to the need to submit a completed OCF-1. The respondent submits that the applicant has failed to provide a reasonable explanation for her delayed application, or any explanation whatsoever. The respondent submits that the applicant ignored its requests for a written explanation, statutory declaration, and/or EUO, despite being represented by counsel.
24The applicant submits that she was dealing with physical and functional consequences of the accident during the early post-accident period. The applicant submits that the Schedule does not impose automatic forfeiture of benefits solely due to late submission; rather, it requires an assessment of whether it is equitable to relieve against delay. The applicant argues that the respondent had knowledge of the accident and the applicant’s injuries well before the submission of the OCF-1, and as such, the respondent cannot claim to be entirely unaware of the claim or its potential exposure.
25I agree with the respondent that, although the applicant submits that the Tribunal should overlook the late submission of the OCF-1 due to personal circumstances and medical condition, the applicant has not made submissions with respect to what specific personal circumstances or medical condition precluded her from submitting a completed OCF-1. The applicant includes over 1000 pages of evidence within her document brief for the within hearing; however, the applicant does not cite or direct me to any evidence with respect to her alleged personal circumstances and medical condition.
26What is more, the applicant ambiguously submits that her failure to submit an OCF-1 within the prescribed timeline must be assessed contextually, taking into account her understanding of the accident benefits process. The applicant does not expand on what her understanding is, or lack thereof, of the accident benefits process. I note that although the applicant retained counsel on April 4, 2023, the OCF-1 was not submitted until July 28, 2025. It is also well established by this Tribunal that ignorance of the law, in itself, is not a reasonable explanation.
27The onus is on the applicant to provide evidence to support her explanation for the delay. I find that the applicant’s submissions are vague and lack engagement with specific details of the applicant’s circumstances. The applicant does not make submissions with respect to why she did not provide an answer to the respondent’s requests for an explanation in the delay. The applicant also does not make submissions with respect to her non-attendance of the EUOs. I find that the applicant has provided insufficient submissions and has not pointed me to evidence that would excuse the significant delay of nearly three years in providing her OCF-1.
28Given the foregoing, I do not find that the applicant’s explanation is credible or worthy of belief, therefore, there is no need to assess the reasonableness of the explanation. In other words, the first principle of K.H. is a threshold that must be met in order to engage the other principles. It is incumbent upon the applicant to provide evidence that supports her position. In my view, she has not.
29Pursuant 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.
30Given that I have found the applicant to be barred from proceeding with her claim for benefits as she failed to submit an application within the timeline prescribed by the Schedule, it is not required to determine whether the applicant notified the respondent within the timeline prescribed by the Schedule.
CONCLUSION AND ORDER
31The applicant failed to submit the application for benefits within the time prescribed by the Schedule.
32The applicant is barred from proceeding with her application pursuant to s. 55(1) of the Schedule. The Tribunal shall vacate any date that has been scheduled for the substantive issues hearing.
33The application is dismissed.
Released: March 23, 2026
Nadia Mauro
Adjudicator