The court also rejected the argument that explicit notice of intent to claim benefits was necessary
The Ontario Superior Court of Justice overturned the denial of an insured person’s accident benefits claim, ruling that notifying the insurer of the accident was sufficient to meet the notice requirement.
The insured was involved in a motor vehicle accident on February 13, 2019, and reported it to his insurer, Intact Insurance, the following day. However, he did not apply for accident benefits until 17 months later. He explained that he was unaware of his entitlement to benefits until speaking with a paralegal in late 2020. Intact denied his claim, arguing that he failed to meet the seven-day notice period required under the Statutory Accident Benefits Schedule (SABS).
The insured sought a ruling from the License Appeal Tribunal (LAT), which dismissed his claim. The LAT found that he did not notify the insurer of his intent to apply for accident benefits within the required timeframe. The LAT also found his explanation for the delay—his lack of knowledge about accident benefits—not credible. When the insured sought reconsideration, the LAT upheld its original decision.
The Superior Court, however, ruled in favour of the insured. The court emphasized that insurers must interpret SABS as consumer protection legislation that supports accident victims. It determined that the insured’s report of the accident one day after it occurred was sufficient to satisfy the notice requirement under s. 32(1) of the SABS.
The court criticized the LAT’s interpretation of the notice requirement, stating that it ignored the realities of consumer protection law. It noted that insurance contracts are complex documents that most policyholders do not routinely review. The decision stressed that insurers must inform policyholders about available benefits when notified of an accident.
The court also rejected Intact’s argument that explicit notice of intent to claim benefits was necessary, citing previous LAT decisions where general accident notifications were deemed sufficient. The ruling stated that a reasonable insurer should assume that an accident victim may need benefits and should take steps to inform them of their rights.
The court allowed the appeal and returned the case to the LAT for reconsideration in accordance with its findings.
