Kazemnia v. Security National Insurance Company, 2026 CanLII 51001

Citation: Kazemnia v. Security National Insurance Company, 2026 CanLII 51001

Licence Appeal Tribunal File Number: 25-011674/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:

Mina Kazemnia

Applicant

and

Security National Insurance Company

Respondent

PRELIMINARY ISSUE DECISION AND ORDER

ADJUDICATOR:

Trina Morissette, Vice-Chair

APPEARANCES:

For the Applicant:

Aryan Kamyab, Counsel

For the Respondent:

Armin Mosaffa, Counsel

HEARD:

In writing

OVERVIEW

1Mina Kazemnia, the applicant, was involved in an accident on March 7, 2023, and sought benefits from Security National 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 preliminary issue before the Tribunal is whether the applicant is barred from proceeding with her claim for non-earner benefits (“NEBs”) because she failed to dispute the denial within the two-year limitation period.

RESULT

3The respondent has not shown that the applicant failed to appeal the denial of her claim for NEBs within the two-year limitation period pursuant to section 56 of the Schedule.

4The applicant is not barred from proceeding with her application. The application shall proceed to a hearing on the substantive issues as previously scheduled.

ANALYSIS

The respondent has not shown that the applicant failed to appeal the denial of her claim for NEBs within the two-year limitation period

5Section 56 of the Schedule provides that an application to the Tribunal in respect of a benefit shall be commenced within two years after the respondent’s refusal to pay the amount claimed. Pursuant to section 7 of the Licence Appeal Tribunal Act, 1999 (the “LAT Act”), the Tribunal has the authority to extend the limitation period beyond the two-year mark outlined by section 56 of the Schedule.

6On April 17, 2023, the applicant submitted her application for accident benefits (OCF-1) to the respondent. Pursuant to the information provided in the OCF-1, on March 7, 2023, the applicant was entering her parked vehicle when a large light post fell and crushed the driver’s side door.

7By correspondence dated April 17, 2023, the respondent acknowledged receipt of the OCF-1 and set out the applicant’s eligibility to accident benefits available under her automobile policy based on the information it had at that moment. This correspondence was accompanied by a document setting out the applicant’s right to dispute. The letter reviewed the applicant’s entitlement to medical and rehabilitation benefits under the Minor Injury Guideline; it advised that she was not eligible for income replacement benefits, caregiver benefits, or housekeeping and home maintenance expenses; and it advised that she met the requirements to apply for lost education expenses. Relevant to this preliminary issue, the letter stated the following with respect to NEBs:

This benefit if payable for the period you continue to suffer a complete inability to carry on a normal life. The amount of the benefit payable is $185 per week. No benefit is payable for the first 4 weeks of disability, after 104 weeks from the date of the accident and for any period before you attain the age 18, if applicable.

We are unable to determine your eligibility for the following benefits as you have not submitted a completed Disability Certificate (OCF-3). The OCF-3 is to be completed by a health practitioner of your choosing.

8On September 5, 2025, the applicant filed the within application with the Tribunal claiming NEBs, an award and interest.

9The respondent submits that the applicant should be statute-barred from proceeding with her application because she failed to appeal its denial within two years. It points to its correspondence dated April 17, 2023, which it argues denied the applicant’s claim to NEB and notified her of the two-year limitation period to dispute the denial and to file an application with the Tribunal. It relies on section 36(3) of the Schedule to argue that approximately 150 weeks have passed since the subject accident and the applicant has not yet submitted an OCF-3.

10The applicant submits that the respondent’s correspondence of April 17, 2023 did not constitute a clear and unequivocal denial of NEBs. It merely indicated that her eligibility to NEBs could not be determined without the submission of the OCF-3. She argues that the “denial” the respondent relies on was pre-emptive as she had not yet applied for the benefit. She also submits that once she did intend to apply for NEBs, she had not been made aware that the health practitioner who prepared the OCF-3 (as well as the updated OCF-3) had not submitted it to the respondent on her behalf.

11I find the respondent has not shown that the applicant failed to appeal the denial of her NEBs within the two-year limitation period for two main reasons. First, the respondent conflates the preliminary issue of the two-year limitation period (section 56) with the applicant’s requirement to submit an OCF-3 (section 36). Secondly, I find that the correspondence of April 17, 2023 does not constitute a denial for the purposes of section 56.

12First, the question to be determined at this preliminary issue hearing is whether the applicant disputed the respondent’s denial of NEBs within two years as per section 56 of the Schedule. Here, I find the respondent conflates section 56 with an insured’s statutory requirement to submit an OCF-3 found at section 36. The respondent submits that the applicant failed to submit an OCF-3 as per section 36 within the two-year limitation period. I fail to see how the applicant’s inaction of submitting an OCF-3 is relevant to the determination of the preliminary issue and the respondent has not provided any authority to support that an OCF-3 must be provided within two years of an accident.

13I therefore find the respondent’s submissions fall short of proving the applicant failed to dispute a denial of her NEBs and I specifically note that nowhere in the respondent’s submissions did the respondent even reference section 56, the relevant statutory provision.

14Secondly, the respondent relies on its correspondence of April 17, 2023 and infers that the letter constitutes a “denial” of the applicant’s claim to NEBs. Having not appealed this denial within the two-year limitation period, the respondent argues the applicant should be barred from proceeding with her application.

15I find the respondent’s arguments are contradictory. On the one hand the respondent argues that it denied the applicant’s claim for NEB on April 17, 2023, yet, on the other hand, it argues that the applicant is not entitled to NEBs because she never submitted her OCF-3 as per section 36.

16Section 56 of the Schedule states: “An application under subsection 280(2) of the Act in respect of a benefit shall be commenced within two years after the insurer’s refusal to pay the amount claimed.” Section 36 outlines the process for which an insured can claim an NEB. This process includes the submissions of a completed OCF-3 with their application. [emphasis is mine]

17The respondent itself argues that an OCF-3 was not submitted. As a result, the respondent could not have denied the applicant’s claim for an NEB through its correspondence of April 17, 2023. Therefore, the letter of April 17, 2023 cannot be construed as a denial of her claim for NEBs. As stated by the Court of Appeal in Tomec v. Economical Mutual Insurance Company, 2019 ONCA 882, a pre-emptive denial of benefits does not trigger the limitation period.

18For the reasons discussed above, I find the respondent has not shown that the applicant failed to appeal the denial of her claim for NEBs within the two-year limitation period. I am not persuaded that the notice of April 17, 2023 constitutes a denial of the benefit and therefore, I find the two-year limitation period was never triggered.

19The applicant may proceed with her application.

ORDER

20For the above reasons, I find:

i. The respondent has not shown that the applicant failed to appeal the denial of her claim for NEBs within the two-year limitation period pursuant to section 56 of the Schedule.

ii. The applicant is not barred from proceeding with her application. The application shall proceed to a hearing on the substantive issues as previously scheduled.