Citation: Noor v. Definity Insurance Company, 2026 ONLAT 25-012086/AABS - PI

Licence Appeal Tribunal File Number: 25-012086/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:

Mohamed Ali Noor

Applicant

and

Definity Insurance Company

Respondent

PRELIMINARY ISSUE HEARING DECISION AND ORDER

ADJUDICATOR: Nadia Mauro

APPEARANCES:

For the Applicant: Maka Metreveli, Paralegal

For the Respondent: Danielle Gauvreau, Counsel

HEARD: By way of written submissions

OVERVIEW

1Mohamed Ali Noor, the applicant, was involved in an automobile accident on December 3, 2023, 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

2The preliminary issue to be decided is:

1. 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 December 3, 2023, the applicant was involved in a motor vehicle collision.

5On December 6, 2023, the applicant notified the respondent of the accident. The same day, the respondent adjuster attempted to contact the applicant by telephone but was unable to leave a voicemail.

6On December 12, 2023, the respondent adjuster sent the application package, inclusive of the OCF-1, to the applicant and advised the applicant that he had until January 12, 2023 to complete and submit the package. The same day, the respondent adjuster again attempted to contact the applicant by telephone and was unable to leave a voicemail.

7On January 16, 2024, the respondent adjuster contacted the applicant by telephone. The adjuster log notes indicate that during this phone call, the applicant stated he was waiting to speak with his doctor who was waiting on some imaging. The log notes indicate that the respondent adjuster advised the applicant could complete the forms himself. The applicant asked for the forms to be resent, and the respondent adjuster asked the forms to be returned by January 26, 2024.

8On May 28, 2024, the applicant submitted the Application for Accident Benefits (OCF-1).

9On June 4, 2024, the respondent sent letter correspondence to the applicant advising that the OCF-1 was received late and requested several documents, in addition to a Statutory Declaration to provide a reason for the late application.

10On July 2 and 15, 2024 and August 15, 2024, the respondent sent letter correspondence to the applicant again requesting the Statutory Declaration.

11On August 20, 2024, the respondent sent letter correspondence to the applicant requesting a reasonable explanation for his delay in submitting his application for accident benefits.

12On September 17, 2024, the applicant provided the respondent with his Statutory Declaration.

13On October 18, 2024, the respondent sent letter correspondence to the applicant advising that the reason for his late application was not sufficient and that his claim for accident benefits was denied.

The Law

14Section 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.

15Once 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 (s. 32(2)). 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.

16Section 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.

17The 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.

18Additionally, 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 respondent comply with s. 32(2)?

19The respondent's position is that it met the obligations under s. 32(2). The respondent submits it provided the applicant with covering correspondence with the application package explaining that an OCF-1 was required to make a claim for benefits and that failure to submit the OCF-1 within 30 days could jeopardize his claim for benefits. The respondent submits that the correspondence to the applicant provided a weblink for further information, he was provided with direct contact information for its adjuster, the blank OCF-1 provided also contains information with respect to the 30-day deadline, and the applicant was advised during telephone conversation that he needed to submit the OCF-1 and the process to submit same was explained.

20The applicant submits that the delayed submission of his application is a culmination of numerous shortcomings and failures by the respondent with regard to compliance with s. 32 of the Schedule. The applicant submits that despite providing him with an empty OCF-1 package for accident benefits, the respondent failed to equip him with adequate information to grasp the procedural significance of submitting an OCF-1 on time.

21I agree with the applicant's reliance on Horvath, in that s. 32(2)(c) must be read with the consumer protection mandate of the Schedule in mind. However, I distinguish Horvath from the present case, because, in this matter I find that the applicant was advised by the adjuster directly that he needed to complete the OCF-1 and was provided a copy of the forms on two occasions via email correspondence, December 12, 2023 and January 16, 2024.

22I find that email correspondence sent to the applicant from the respondent adjuster on December 12, 2023 is clear, indicating, "sending the forms in after 1/12/2023 will delay your access to benefits and may jeopardize your entitlement to benefits all together unless you have a reasonable explanation for the delay." I also find the email correspondence includes a hyperlink to the Financial Servies Regulatory Authority of Ontario should the applicant want to learn more about available benefits. The adjuster log notes also support that the applicant was advised during a telephone call with the adjuster on January 16, 2024 that he could complete the forms himself and that he did not need to have his doctor complete the OCF-1. In my view, this was sufficient to discharge the insurer's obligation in accordance with s. 32(2) of the Schedule.

23Accordingly, I find that the respondent was compliant with its obligations under s. 32(2) and that the applicant did not submit his application within the time limit specified in s. 32(5).

Does the applicant have a reasonable explanation for the delay?

24The applicant submits that despite having a phone call with the adjuster on January 16, 2024, when he received the second OCF-1 package, he had yet to be informed of any of the potential consequences and dangers of a delayed submission. The applicant submits that aside from a mere explanation that he can fill it out on his own, the adjuster log notes dated January 16, 2024 do not reflect or even suggest that any further guidance or information had been provided to him to assist him in his application for accident benefits.

25I am unpersuaded by the applicant's position that he had yet to be informed of any potential consequences of the failure to submit the OCF-1 after receiving the second application package because, as I have found above, the applicant was informed that access to benefits may be delayed or jeopardized in the adjuster's initial email dated December 13, 2023. I acknowledge that the deadline to file the OCF-1 had passed by the time the applicant and adjuster had a telephone conversation on January 16, 2024, however, in my view, this does not negate the contents of the initial email. What is more, the adjuster provided the applicant with a second application package and a new deadline to file the application. Despite this, the applicant did not submit the application package until May 2024.

26The applicant's submissions with respect to a reasonable explanation for the delay appear to hinge on the alleged failure of the respondent to comply with s. 32(2) of the Schedule. However, I note that adjuster log note dated January 16, 2024 indicates that the applicant "was waiting to speak with his doctor who was waiting on some imaging" during a telephone call with the respondent adjuster with respect to the OCF-1. The Statutory Declaration of the applicant indicates that the reason for the delay in submitting the OCF-1 was "I have not being [sic] well to finish the forms my situation was extreem [sic]."

27I note that pursuant to s. 34 of the Schedule, the onus rests with the applicant to advance a reasonable explanation for his failure to comply with the time limit. Even if the applicant believed his doctor was to complete the package, the CNRs of the applicant's family doctor, Dr. Murad Aktas, during a follow up appointment dated January 29, 2024, do not mention the application package, OCF-1, or accident benefits. After this appointment, the applicant did not attend his family practitioner's office until June 3, 2024, after the package was submitted to the respondent. It is not clear from the evidence or submissions why the applicant did not submit the OCF-1 until May 2024. The applicant's submissions do not expand on his responses within the Statutory Declaration.

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 his position. In my view, he has not.

CONCLUSION AND ORDER

29The applicant failed to submit the application for benefits (OCF-1) within the time prescribed in the Schedule.

30The 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.

31The application is dismissed.