Citation: Holmes v. St. Paul Fire and Marine Insurance Company, 2026 ONLAT 25-010175/AABS - PI

Licence Appeal Tribunal File Number: 25-010175/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:

Freddie Barron Holmes

Applicant

and

St. Paul Fire and Marine Insurance Company

Respondent

PRELIMINARY ISSUE DECISION AND ORDER

ADJUDICATOR:

Trina Morissette, Vice-Chair

APPEARANCES:

For the Applicant:

Marina Korshunova, Paralegal

For the Respondent:

Nicole Anozie, Counsel

HEARD: In writing

OVERVIEW

1Freddie Barron Holmes, the applicant, was a passenger in a bus involved in an automobile accident on December 31, 2023, and sought benefits from St. Paul Fire and Marine Insurance Company, the respondent, 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 and applied to the Licence Appeal Tribunal (“the Tribunal”) for resolution of the dispute.

PRELIMINARY ISSUE IN DISPUTE

2The Case Conference Report and Order dated December 3, 2025, identifies the preliminary issue as:

Is the applicant barred from proceeding with his claim for benefits as he failed to submit his application for benefits (OCF-1) within the time prescribed in the Schedule?

3The parties’ submissions on this preliminary issue address the applicant’s failure to notify the respondent of his intention to claim accident benefits pursuant to section 32(1) of the Schedule. The facts in this matter, which are not in dispute, support that the applicant did not notify the respondent of the accident and of his intention to claim accident benefits until he submitted his OCF-1 to the respondent on June 19, 2025.

4Neither party filed a motion to amend the preliminary issue. Based on both parties’ submissions, I accept that it was the parties’ understanding that the preliminary issue to be decided is in relation to the notification requirement of section 32 of the Schedule, rather than the submission of his application (section 32(5)).

RESULT

5The applicant did not notify the respondent of the accident within the timeline prescribed by the Schedule and has not provided a reasonable explanation for the delay.

ANALYSIS

6Section 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.

7Once 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 the benefits and information on the election relating to the specified benefits, if applicable (section 32(2)). Pursuant to section 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.

8Section 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 reiterated in K.H. v. Northbridge, 2019 CanLII 101613 (ON LAT) (“K.H.”). The guiding principles are summarized 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; and

f. 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.

The applicant has not provided a reasonable explanation for his delay

9The applicant was a passenger of a Northland bus travelling from Toronto to Iroquois Falls when it collided with a moose. Based on the applicant’s submissions, following the accident he exited the bus but only for a short time as the weather was cold. The applicant was new to Canada. He landed in Ontario with a visitor’s visa from Liberia six days prior to the accident, on December 25, 2023. He stayed the first six days with friends in Hamilton until taking the bus to visit another friend in Iroquois Falls where he remained until January 5, 2024. He then travelled to Edmonton, Alberta. The applicant currently has protective person status and has applied for permanent Canadian residency.

10In a signed declaration dated April 8, 2025, addressed “To Whom It May Concern”, the applicant states, in part, the following:

i. He never knew or had any idea of how the system worked;

ii. He never expected the pain to persist and to gradually get worse six months later at which time new symptoms began to appear;

iii. Due to personal responsibilities, limited access to medical care, and uncertainty about the reporting process, he did not seek immediate attention;

iv. Once it became clear that his condition was not improving, he promptly sought medical attention and reported his injuries; and

v. Due to limited knowledge of the claims process, uncertainty about his eligibility, and challenges in accessing proper medical and legal guidance, he did not complete the necessary documentation right away.

11The respondent submits that it was not notified of the accident or of the applicant’s intention to apply for accident benefits until approximately one and a half years post-accident. The OCF-1, dated June 9, 2025, was submitted ten days later on June 19, 2025 by his legal representative. The respondent points to an OCF-3 submitted by the applicant where the applicant states his first post-accident examination was conducted on June 5, 2024, more than one year earlier. The respondent submits that ignorance of the law and believing that injuries would resolve are not reasonable explanations for the delay.

12The applicant submits that he had no knowledge of the law or what to do in case of an accident. He had no insurance policy, did not rent or purchase a vehicle, had no place to live, no driver’s licence and no medical coverage. He also submits that he delayed notification because he was hoping that his injuries would eventually subside and heal but his condition worsened over time when he started experiencing numbness at the back of his right leg, severe lower back pain with a tingling sensation, left ear hearing loss, and vehicular anxiety which he alleges caused him to fail his driving test four times. It was only after speaking with people from his community as well as medical providers that he learned he should obtain legal advice, which he submits he did, on May 28, 2025. He added that the delay was also caused due to “personal responsibilities”.

13I agree with the respondent that the explanations provided are vague and/or unsupported by the evidence. While I am sensitive to the applicant being “new to Canada” and being in the country on a visitor’s visa, as per K.H., ignorance of the law alone is not a reasonable explanation. The applicant alleges “personal responsibilities” but does not expand on this. He submits that he only sought medical attention once he obtained his Alberta Health Card but the evidence he submitted shows that he was not eligible for public health care coverage until March 20, 2025. This is in contradiction with the evidence that shows he sought medical attention in June 2024. The applicant did not explain why, when symptoms worsened at six months post-accident, he failed to notify the respondent at that time and waited an additional year to do so even though he submits that it was after speaking to medical providers that he learned he should obtain legal advice.

14The applicant points to Tomec v. Economical Mutual Insurance Co., 2019 ONCA 882 where the Court of Appeal states that the Schedule is remedial and constitutes consumer protection legislation. I agree that the Schedule’s mandate is one of consumer protection but this does not negate the applicant’s requirement to provide a reasonable explanation for his delay in notifying the respondent pursuant to section 32(1).

15The applicant also relies on Hussein v. Intact Insurance Company, 2025 ONSC 842 (“Hussein”) where the Court found that an interpretation of section 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. The applicant argues that the “Court disagreed with the insurer’s interpretation of section 32(1)” but it is unclear to me what interpretation the applicant is referring to and/or how it is in contradiction with the Court’s finding In Hussein.

16The respondent relies on Martinez Garcia v. Definity, 2025 CanLII 61175 (ON LAT) where the Tribunal found that ignorance of the law and a belief that injuries would get better were not found to be reasonable explanations. Although I am not bound by this decision, I agree with its finding and note that the applicant has not pointed me to any caselaw that states otherwise.

17Taking into account the principles of K.H., I find that the applicant’s explanation for his delay in notifying the respondent of the accident and of his intention to claim accident benefits is not credible nor worthy of belief. Ignorance of the law alone is not sufficient, and an expectation that the injuries would subside is not a reasonable explanation. The delay in this matter is long (over a year and a half) and has caused prejudice to the respondent in fulfilling its obligations to investigate and conduct contemporaneous medical assessments. The applicant submits that he rejects the respondent’s argument that the late notification caused it to incur an “unfair financial burden” but the respondent did not make such an argument before the Tribunal. In these circumstances, I am not persuaded that it would be equitable to relieve against the consequences of the applicant’s failure to comply with the time limit.

18For these reasons, I find that the applicant has not met his onus to establish a reasonable explanation for his delay.

Section 55

19Pursuant to section 55(1)1 of the Schedule, an insured person shall not apply to the Tribunal under section 280(2) of the Insurance Act if the insured person has not notified the insurer of the circumstances giving rise to the claim or has not submitted an application for the benefit within the time limits prescribed in section 32.

20As outlined above, I find that the applicant did not notify the respondent within the timelines prescribed by the Schedule and he has not provided a reasonable explanation for the delay. Accordingly, I find that the applicant is statute-barred from proceeding with his application before the Tribunal.

ORDER

21For the above reasons, I find:

i. The applicant did not notify the respondent of the accident within the timeline prescribed by the Schedule and has not provided a reasonable explanation for the delay.

ii. The applicant is barred by section 55(1) from proceeding with his application before the Tribunal. The Tribunal shall vacate any date that has been scheduled for the substantive issues hearing.