RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 24-009476/AABS
Case Name: Jasmin Isic v. Intact Insurance Company
Written Submissions by:
For the Applicant: Gordon W. Harris, Counsel
For the Respondent: Murleen Mclean, Counsel
OVERVIEW
1On March 24, 2026, the applicant requested reconsideration of the Tribunal’s decision released March 3, 2026 (“decision”).
2Stemming from an accident on January 7, 2019 and a request for benefits made pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”), the parties participated in a written hearing. In the decision, the Tribunal found it did not have the jurisdiction to determine entitlement to a non-earner benefit (“NEB”), pursuant to s. 280 of the Insurance Act, R.S.O. 1990, c. I.8. The Tribunal further concluded that the applicant was not entitled to the requested expenses, interest, award, or costs.
3The grounds for a request for reconsideration are found in Rule 18.2 of the Licence Appeal Tribunal Rules, 2023 (“Rules”). To grant a request for reconsideration, the Tribunal must be satisfied that one or more of the following criteria are met:
a) The Tribunal acted outside its jurisdiction or committed a material breach of procedural fairness;
b) The Tribunal made an error of law or fact such that the Tribunal would likely have reached a different result had the error not been made; or
c) There is evidence that was not before the Tribunal when rendering its decision, could not have been obtained previously by the party now seeking to introduce it, and would likely have affected the result.
4The applicant relies on Rule 18.2(b) to support his request. The request is limited to the NEB, as the applicant is asking the Tribunal to vary the decision to find it has the jurisdiction to consider this part of the claim. In the alternative, he asks the Tribunal to order a rehearing.
5The respondent asks the Tribunal to dismiss the request for reconsideration.
RESULT
6The applicant’s request for reconsideration is dismissed.
ANALYSIS
7The test for reconsideration under Rule 18.2 involves a high threshold, and the requesting party must show how or why the decision falls into one of the categories in Rule 18.2. The reconsideration process is not an opportunity for a party to re-litigate its position where it disagrees with the Tribunal’s decision, or with the weight assigned to the evidence.
8The applicant raises several alleged errors with the decision. I will address them in turn, but, first, it is necessary to provide some context about the decision under review and the operative sections of the Schedule.
9Section 36(2) of the Schedule requires an applicant to file a completed disability certificate (“OCF-3”) to apply for a specified benefit. Section 36(3) adds that: “An applicant who fails to submit a completed disability certificate is not entitled to a specified benefit for any period before the completed disability certificate is submitted.”
10Even if an applicant breaches a time limit under Part VIII of the Schedule (i.e., the Part that includes s. 36), they may continue with their claim if they have a “reasonable explanation” for the breach: “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.”
11The Divisional Court has confirmed that s. 34 may be used to remedy a breach of the time limit set out in s. 36(2): see Clouthier v. Co-Operators General Insurance, 2025 ONSC 6798.
12Key to the applicant’s NEB claim is his position that, despite alerting the respondent of the accident, he did not receive the application forms he needed to apply for this benefit until several years later in August 2022. This date is outside of the 104-week period that one may be entitled to an NEB, so, relying on Hussein v. Intact Insurance Company, 2025 ONSC 842 (“Hussein”), the applicant claimed the respondent’s inaction met the test under s. 34.
13The Tribunal accepted this “reasonable explanation” for the delay in applying for an NEB. However, at paragraphs 13 and 14 of the decision, the Tribunal took issue with how the applicant had still not filed a completed OCF-3:
I agree with the applicant’s reliance on the Divisional Court decision in Hussein insofar as the Schedule must be interpreted in accordance with its consumer protection purpose, and that insurers have a positive obligation to issue benefit application packages upon learning of a collision. However, in the present case, despite the lengthy delay in receiving a benefits package, the applicant has not provided evidence of a submitted disability certificate or denial of this specified benefit to date.
While the applicant provides a reasonable explanation for the delay in filing an application for accident benefits, I am not satisfied that the applicant has provided a reasonable explanation for failing to submit an OCF-3 for NEBs. The respondent sent letter correspondence on August 5, 2022, notifying the applicant of his potential entitlement for NEBs, despite being well after the 104-week entitlement period pursuant to s. 12(1) of the Schedule. The applicant has not pointed me to evidence that an OCF-3 has been completed and submitted to the respondent for consideration. While I agree with the applicant that he had a reasonable explanation as to why an OCF-3 was not submitted prior to receiving the application package for accident benefits at some point in July 2022, the applicant has not provided a reasonable explanation as to why an OCF-3 has never been submitted to overcome s. 36(3).
14By not meeting his obligations under s. 36(2), the Tribunal found the applicant had yet to apply for the NEB. As such, s. 36(3) acted as a bar to payment.
15The applicant challenges this conclusion by claiming that the Tribunal did not meaningfully engage with Hussein. If the respondent was found to have breached its obligations to provide the applications forms in a timely manner, the applicant claims the Tribunal cannot “move on as if it were legally inert”.
16I do not accept this argument. The quotation above demonstrates that the Tribunal accepted there was a reasonable explanation for why an OCF-3 was not filed within the 104-week mark. Yet, despite this finding, the Tribunal took issue with how the applicant—upon receipt of these forms—did not file a completed OCF-3. Section 34 may absolve an insured person of non-compliance with a time limit, but it does not remove the need to meet the statutory requirement at issue. By determining that the applicant has yet to file a completed OCF-3, the Tribunal correctly concluded that there is no basis for granting entitlement to the NEB, pursuant to s. 36(3).
17Following on this logic, the applicant alleges that the Tribunal’s findings amount to “an internal inconsistency”. I do not agree. Though the applicant may claim that it is unreasonable to find a procedural breach and then allow that same party to benefit from the breach, the fact remains that the applicant has still not complied with his obligations under s. 36(2). Put another way, while the late delivery of the forms would have reasonably explained why an OCF-3 was filed outside of the 104-week mark, it did not explain why the applicant had still not met his obligations under s. 36(2).
18Next, the applicant claims the Tribunal erred by finding it did not have jurisdiction under the Insurance Act to make a determination about his NEB claim. Not only was there a disputed benefit (which engages s. 280 of the Insurance Act), but there were “available Insurance Act remedies” that the Tribunal failed to consider. Most notably, the applicant cites the use of relief from forfeiture in Botbyl v. Heartland Farm Mutual Inc., 2025 ONSC 3349 (“Botbyl”).
19I do not accept this ground for reconsideration for several reasons.
20First, even if I accepted that the Tribunal erred by finding it did not have jurisdiction over the NEB claim, I do not find the applicant has shown how this error would likely have impacted the outcome. After concluding that he did not provide a reasonable explanation for not completing an OCF-3, the Tribunal went on to find it did not have the jurisdiction under the Insurance Act to make a determination about the NEB (at paragraphs 15 and 16, emphasis added):
Even if the applicant did have a reasonable explanation for not completing the OCF-3, the overarching issue is that there has been no denial of this specified benefit. At this impasse, I do not have jurisdiction to make a determination.
I find that because there was neither a completed application for NEB by way of OCF-3, nor a denial of a NEB by the respondent, the specified benefit is not properly in dispute. As such, I do not have jurisdiction to make a determination pursuant to s. 280 of the Insurance Act, R.S.O, 1990, c. I.8 because the Tribunal’s jurisdiction under s. 280(1) pertains to the resolution of disputes in respect of an insured person’s entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured person is entitled. If there has been no denial of the specified benefit, the Tribunal has no jurisdiction to make a determination.
21Before making this finding about jurisdiction, the Tribunal had already determined that the applicant was statutorily-barred from proceeding with his claim due to non-compliance with s. 36(2). Therefore, even if the Tribunal’s analysis had ended before any finding was made about jurisdiction under the Insurance Act, the outcome would likely have remained the same, namely, the applicant is not entitled to payment of the NEB.
22Second, I find the applicant has not shown how consideration of Botbyl (and relief from forfeiture) would likely have affected the outcome. The Tribunal accepted that the respondent’s inaction had to be remedied, namely, the applicant could not be held accountable for missing the 104-week filing deadline. However, the Tribunal further determined that the applicant did not provide any reasonable explanation for why this inaction stopped him from filing a completed OCF-3 once he had received these forms. The negative impact caused by the respondent was recognized and remedied, but there was no established link made between this inaction and the applicant’s continuing non-compliance with s. 36(2). Even if the Tribunal had turned its mind to other remedies under the Insurance Act, it would likely have reached the same result, i.e., the applicant has not provided a reasonable explanation for why he has not met his obligations under s. 36(2).
23I also note that there is a brief mention of Botbyl in the decision. The Tribunal noted that the applicant cited this case to support his position that an insurer should not be able to benefit “from its own inaction”.
24Finally, the applicant submits that requiring him to file an OCF-3 is tantamount to requiring him to “perform a futile act, contrary to basic principles of statutory interpretation and procedural fairness”. Since he did not receive the application forms until August 2022 (and the 104-week mark was in January 2021), it made no sense for him to submit this form. To support this position, the applicant cites case law that shows there is no entitlement to an NEB if the application is not made within 104 weeks of the accident.
25I accept that the Tribunal has consistently found there is no entitlement to an NEB if the insured person does not apply for this benefit within the 104 weeks following an accident. However, once again, the Tribunal found the applicant did not provide a reasonable explanation for why he did not take steps to comply with the requirement under s. 36(2) once the application forms were received. The applicant may believe it was not necessary for him to meet this procedural obligation (as so much time had passed), but, aside from the mandatory wording of s. 36(2), there is a practical purpose to filing an OCF-3. By providing a detailed account of an insured person’s accident-related injuries (along with the resulting impairments), an insurer is able to use the OCF-3 to determine how it will respond under s. 36(4). For example, if only psychological injuries are listed on the form, the insurer may choose not to schedule a physical s. 44 assessor.
26I accept that the usefulness of the information contained on an OCF-3 in this particular case would be limited, as the injuries and impairments noted on a contemporaneously prepared OCF-3 would have a circumscribed bearing on the applicant’s condition during the relevant 104-week period. Yet, this limited relevance would be the respondent’s issue to bear, considering it is the result of its delayed delivery of the application forms. However, regardless of the reduced efficacy of the form, the mandatory nature of s. 36(2) would still apply—an applicant must comply with this section before they can claim entitlement to an NEB.
27In sum, I find the applicant has not established any error that triggers Rule 18.2(b).
CONCLUSION & ORDER
28The applicant’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Released: June 4, 2026