Citation: Sfeir v. Co-operators General Insurance Company, 2026 ONLAT 25- 009680/AABS-PI
Licence Appeal Tribunal File Number: 25-009680/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:
Rita Sfeir
Applicant
and
Co-operators General Insurance Company
Respondent
PRELIMINARY ISSUE HEARING DECISION AND ORDER
ADJUDICATOR:
Lisa Holland
APPEARANCES:
For the Applicant:
Mobina Khan, Counsel
For the Respondent:
Julianne Brimfield, Counsel
Heard:
By Way of Written Submissions
OVERVIEW
1On May 17, 2020, the spouse of the applicant Rita Sfeir, the applicant, was involved in an automobile accident on May 17, 2020. On August 26, 2024, more than four years after the accident, the applicant sought benefits on her own behalf from the respondent, Co-operators General Insurance Company, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). A dispute arose over the applicant’s claims and she 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 with their claim for benefits as they failed to submit the application for benefits (OCF-1) within the time prescribed in the Schedule?
ii. Is the applicant an “insured person” as defined in section 3(1) of the Schedule and therefore eligible for benefits?
RESULT
3The applicant is not an insured person involved in an automobile accident on May 17, 2020. She is not entitled to accident benefits.
PROCEDURAL ISSUE
4The parties attended a case conference on November 25, 2025, from which a Case Conference Report and Order dated November 27, 2025 (the “CCRO”) was released. The CCRO identified two preliminary issues to be determined at the preliminary issues hearing as whether the applicant was involved in an “accident” as defined in section 3(1) of the Schedule and whether her claim is barred because she failed to submit an OCF-1 within the timelines prescribed by the Schedule.
5In paragraph 5 of the respondent’s written submissions, it argues that the preliminary issues in the CCRO are inaccurate, and it refers to its Case Conference Summary dated November 13, 2025, which identifies the second preliminary issue as whether the applicant is an “insured person” as defined in s. 3(1).
6The applicant argues that the preliminary issue of whether the applicant was involved in an “accident” was not raised by the respondent at the case conference. However, in her written submissions, the applicant does address the issue of whether she is an “insured person” as defined under section 3(1)(a)(ii) of the Schedule.
7I find that the parties agree that the preliminary issue listed in the CCRO is incorrect and should be whether the applicant is an “insured person” under section 3(1) of the Schedule and therefore eligible for benefits. I have therefore made this correction in the preliminary issues listed above.
ANALYSIS
The parties’ positions
8On May 17, 2020, the applicant’s spouse, Charbel Daoud was involved in a motor vehicle accident wherein he sustained injuries. On August 26, 2024, the applicant applied for accident benefits claiming that she suffers from psychological injuries as a result of her husband’s involvement in the accident, which is beyond the time prescribed by s. 32(1) of the Schedule. On April 11, 2025, the respondent denied the applicant’s claim for accident benefits on the basis that she did not notify the respondent of the circumstances giving rise to a claim for benefits within the timelines set out in the Schedule, she has not provided a reasonable explanation for the delay, and she is not an insured person for the purpose of claiming benefits.
9The respondent is of the view that the applicant was not involved in an automobile accident. It is the respondent’s position that an individual who is not involved in an accident, but suffers a psychological or mental injury as a result of an accident in or outside of Ontario that results in a physical injury to his or her spouse, is only covered by the Schedule if they are the named insured, specified driver, spouse or dependent of the named insured pursuant to s. 3(1)(a)(ii).
10It is undisputed that the applicant was not directly involved in the accident occurring on May 17, 2020. Neither party has presented evidence regarding the named insureds on the policy which insured the vehicle involved in the accident, which was owned by a numbered company, 1717546 Ontario Inc. according to the Motor Vehicle Accident Report (the “police report”).
11The respondent submits that the applicant has not established that she has an accident-related psychological injury or that she is an insured person as required by s. 3(1) of the Schedule.
Was the applicant an “insured person”?
12I find that the applicant has not met her onus of proving that she was an “insured person” pursuant to s. 3(1) of the Schedule.
13Under s. 3(1) of the Schedule, an “insured person” means, in respect of a particular motor vehicle policy,
(a) the named insured, any person specified in the policy as a driver of the insured automobile and, if the named insured is an individual, the spouse of the named insured and a dependent of the named insured or of his or her spouse,
(i) if the named insured, specified driver, spouse or dependent is involved in an accident in or outside Ontario that involves the insured automobile or another automobile, or
(ii) if the named insured, specified driver, spouse or dependent is not involved in an accident but suffers psychological or mental injury as a result of an accident in or outside Ontario that results in a physical injury to his or her spouse, child, grandchild, parent, grandparent, brother, sister, dependant or spouse’s dependant.
14The respondent does not dispute that the applicant is the spouse of Charbel Daoud, who was involved in the May 17, 2020 accident. The respondent also concedes that Charbel Daoud is an insured person as defined in the Schedule. Further, the police report confirmed that the accident occurred in Ontario. The respondent does not dispute that Charbel Daoud sustained physical injuries as a result of the accident, and instead, it focuses its submissions on whether the applicant suffered psychological or mental injuries as a result of the accident.
15The respondent submits that the applicant has not met her onus that she sustained a psychological injury as a result of her husband’s injuries from the accident. The respondent submits that the clinical notes and records (“CNRs”) of the applicant’s family physician, Dr. Ziyad Altaweel do not mention any accident-related psychological condition despite the applicant’s frequent visits to Dr. Altaweel in 2020. The respondent further submits that Dr. Altaweel’s CNRs from August 2024, when the OCF-1 was submitted indicate that the applicant reported unrelated anxiety due to her husband’s recent diagnosis of lymphoma.
16The applicant submits that although there is an absence of clinical documentation in support of a psychological injury as a result of the accident, this should not be a procedural bar to her proceeding with the substantive issues of her claim.
17The applicable test is determining whether impairments were caused by the accident is the “but for” test: whether the applicant would not have had her psychological impairments but for the accident. The accident is not required to have been “the cause” – that is, the accident need not be the sole cause or have been sufficient in itself to have caused the applicant’s psychological impairments as suggested by the respondent. Rather, the accident need only to have been a “necessary cause.” (see Sabadash v. State Farm et al., 2019 ONSC 1121).
18I agree that the applicant does not need to provide evidence that her psychological impairments were only caused by the accident. However, I find that she has not explained how the accident is related to her psychological impairments nor has she directed me to any evidence in support of an accident-related psychological impairment. I have reviewed the medical documentation, and it is unclear whether her periodic psychological complaints to Dr. Altaweel are related to the accident or other factors involving her extended family. Dr. Altaweel does not mention the accident.
19The applicant’s submissions do not address her accident-related psychological impairments and only attack the respondent’s position on the applicable test for causation. The applicant can not meet her onus by undermining the respondent’s case alone. Therefore, I find the applicant is not entitled to claim accident benefits as an insured person under s. 3(1) of the Schedule.
Section 32(1) of the Schedule
20Section 32(1) of the Schedule requires an insured person to inform an insurer of their intention to claim accident benefits within seven days of the accident, or as soon as practicable after. Section 34 states that if the insured person does not comply with the time limits prescribed under Part VIII of the Schedule, the insured person may still be entitled to benefits if they have a reasonable explanation for the delay.
21Since I have found that the applicant does not meet the definition of an “insured person” as defined under the Schedule, and therefore she is not entitled to claim accident benefits arising out of the accident occurring on May 17, 2020, it is not necessary to determine whether she has provided a reasonable explanation for non-compliance with the notice provisions set out under s. 32(1), or whether she is statute-barred from proceeding with her application before the Tribunal.
ORDER
22For the reasons set out above, the applicant’s claim is dismissed and the substantive issues hearing is vacated.
Released: April 23, 2026
___________________________
Lisa Holland
Adjudicator