Citation: Ali v. Northbridge General Insurance Company, 2026 ONLAT 25-010634/AABS - PI

Licence Appeal Tribunal File Number: 25-010634/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:

Choudhry Ali

Applicant

and

Northbridge General Insurance Company

Respondent

PRELIMINARY ISSUE HEARING DECISION AND ORDER

ADJUDICATOR:

Nadia Mauro

APPEARANCES:

For the Applicant:

Carlos Ortiz, Paralegal

For the Respondent:

Thomas Kurasiewicz, Counsel

HEARD:

By way of written submissions

OVERVIEW

1Choudhry Ali, the applicant, was involved in an automobile accident on November 22, 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, Northbridge General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

PRELIMINARY ISSUES

2The preliminary issues to be decided are:

1. 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?

2. 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?

RESULT

3The applicant is barred from proceeding with his application.

ANALYSIS

Background

4On November 22, 2022, the applicant was operating a freightliner truck for his employer, a trucking company, when his vehicle was struck by transport truck from the rear. At the time of the collision, the applicant was employed by the trucking company through a staffing agency.

5The applicant submitted an Application for Accident Benefits (“OCF-1”) on or around July 2, 2024.

6The respondent sent letter correspondence to the applicant on July 4, 2024 requesting the applicant submit a reasonable explanation for the delay in applying for accident benefits, and notice that it would be arranging an Examination Under Oath (“EUO”).

7The applicant underwent an EUO on August 14, 2024.

8The respondent sent letter correspondence to the applicant on October 16, 2024, advising the applicant that it had determined that there is no coverage for his claim for accident benefits based on the evidence obtained at the EUO and by thorough review of his OCF-1.

The Law

9Section 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.

10Once 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.

11Section 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.

12The 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:

1. An explanation must be determined to be credible or worthy of belief before its reasonableness can be assessed.

2. The onus is on the insured person to establish a “reasonable explanation”.

3. Ignorance of the law alone is not a “reasonable explanation”.

4. 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.

5. The lack of prejudice to the insurer does not make an explanation automatically reasonable.

6. 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.

13Additionally, 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.

Did the applicant comply with the notice requirement pursuant to s. 32(1)?

14The respondent submits that it is not liable to pay accident benefits to the applicant because the applicant has not complied with the statutory timelines. The respondent submits that it first received notice of the accident approximately 588 days after the occurrence, upon receipt of an OCF-1 submitted through the applicant’s counsel on or about July 2, 2024.

15The applicant submits that he notified his employer of his involvement in the accident and that his employer informed the respondent that he was involved in the accident on November 23, 2022, as evidenced by the adjuster log notes.

16Although the applicant also relies on Hussein, in that after the accident was reported, the respondent should have contacted him and advised him of his potential entitlement to accident benefits and provide him with information in a clear and straightforward manner, the evidence supports that the respondent was not in fact made aware of the accident on November 23, 2022.

17The respondent, in its reply submissions, submits that the adjuster log note dated July 4, 2024 indicating that it was notified of the accident on November 23, 2022, was made in error.

18I have reviewed the adjuster log notes with respect to the reporting of the accident, and find that the incident reported on November 23, 2022, was unrelated to the subject accident. The adjuster log note dated July 4, 2024 indicates that the insured, the respondent, reported a claim on November 23, 2022 wherein “the insured driver was changing to the right lane and made contact with a third party vehicle that cut in front of his truck.” The details provided for the mechanism of the accident that was reported on November 23, 2022 are different than the subject accident, as I have noted above. I also note that a subsequent log note dated July 22, 2024 confirms that the subject accident was not reported to the respondent. The applicant has not directed me to any evidence to support he reported the incident to the respondent, or any other insurer that he may have held a policy with at that time.

19As such I find that the applicant did not notify the respondent of his injuries or intention to pursue an accident benefits claim within seven days post-accident pursuant to s. 32(1) of the Schedule.

Does the applicant have a reasonable explanation for the delay?

20The applicant further submits that due to the fact that he was driving his company vehicle, he was not “a customer of the insurer of the policy in question”. The applicant submits that he could not have been expected to know the priority rules under the Schedule and he had asked his employer whether he “had to apply online”. The applicant also submits that he developed chronic back pain after the accident.

21The applicant relies upon the Court of Appeal decision in Tomec v. Economical Mutual Insurance Co., 2019 ONCA 882, 148 O.R. (3d) 438 (“Tomec”), at para 31:

“In Pioneer, which the Divisional Court did not have the benefit of, the Supreme Court provided guidance for determining when a limitation period is subject to the rule of discoverability and when it is a hard limitation period. Pioneer analyzed the cause of action found in s. 36 of the Competition Act, R.S.C. 1985, c. C-34. In that analysis, Brown J. made the following comments, at paras. 34-35:

First, where the running of a limitation period is contingent upon the accrual of a cause of action or some other event that can occur only when the plaintiff has knowledge of his or her injury, the discoverability principle applies in order to ensure that the plaintiff had knowledge of the existence of his or her legal rights before such rights expire.

Secondly (and conversely), where a statutory limitation period runs from an event unrelated to the accrual of the cause of action or which does not require [page446] [sic] the plaintiff's knowledge of his or her injury, the rule of discoverability will not apply.”

22While the Court of Appeal held in Tomec that the limitation period is subject to the discoverability rule, in my view the rule of discoverability does not apply in this matter. In the present case, the applicant did not notify the respondent of the circumstances giving rise to his claim until nearly two years after the accident, contrary to s. 32(1) of the Schedule, which requires that notice to be given within seven days. The applicant was therefore barred from claiming benefits. However, the Tribunal may still consider whether the applicant had a reasonable explanation for the delay so that his claim for benefits was not disentitled, in accordance with s. 34 of the Schedule.

23The respondent submits that the applicant has failed to meet the threshold required that his explanation be credible or worthy of belief. The respondent submits that the applicant has provided no corroborating evidence of any steps taken to inquire about his rights or obligations in the nearly 19-month period following the accident to date.

24I am not bound by Tribunal decisions, but I am persuaded by the respondent’s reliance on Abushban v. Definity Insurance Company, 2025 CanLII 102211 (ON LAT), in that ignorance of entitlement to accident benefits or the process alone does not constitute a reasonable explanation pursuant to s. 34 of the Schedule. During the EUO, dated August 14, 2024, the applicant testified that his friend informed him that he could make a claim for accident benefits. The applicant does not make submissions with respect to this assertion. The applicant has also not made submissions or tendered any evidence that would speak to when the applicant had this discussion with his friend with respect to applying for accident benefits. Despite this, the applicant indicates in his submissions that he “asked his employer whether he had to apply online”. Again, the applicant has not pointed me to evidence, other than his testimony at the EUO, that would corroborate same.

25An assessment of whether a claimant has a reasonable explanation for the delay 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 at section 32. I find that the applicant has not provided any documentation to support that he only learned of his entitlement to accident benefits after speaking with his friend, his ignorance of these rights is not sufficient on its own, the delay of 588-days in submitting his completed OCF-1 is significant, and his delays have caused prejudice to the respondent in fulfilling its obligations to investigate and assess his claim.

26For these reasons, I find that the applicant has not met his onus to establish a reasonable explanation for his delay.

27Pursuant 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 have not submitted an application for the benefits within the times set out in the Schedule.

CONCLUSION AND ORDER

28The applicant failed to notify the respondent of his intention to apply for benefits 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.

29The applicant is barred from proceeding with his application pursuant to s. 55(1) of the Schedule. The Tribunal shall vacate any date that has been scheduled for the substantive issues hearing.

30The application is dismissed.