Late Submission of an Application for Accident Benefits (OCF-1)

If you are injured in a motor vehicle accident, Ontario’s Statutory Accident Benefits Schedule, or “SABS” for short, provides you with access to a number of benefits known as “accident benefits”. Accident benefits under the SABS include, but are not limited to, medical and rehabilitation benefits, attendant care benefits, and income replacement benefits.

Accident benefits are included in all standard automobile insurance policies in Ontario. Moreover, accident benefits are accessible by persons injured in motor vehicle accidents regardless of whether or not they were at fault for the accident.

To apply for accident benefits, someone who is injured in a motor vehicle accident must submit an Application for Accident Benefits, or “OCF-1”, to the appropriate automobile insurer. It is important to submit the OCF-1 as soon as possible. The SABS sets out various legislative timelines that are to be adhered to. For example, section 32(5) of the SABS states that a person who intends to apply for benefits shall notify the insurer of said 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 thereafter. Additionally, section 32(1)(5)(10) of the SABS states that applicants for accident benefits shall submit a completed and signed OCF-1 within 30 days after receiving the application forms.

Failure to adhere to the timelines above could potentially result in your claim for accident benefits being denied.

However, if you have missed either of the timelines above, not all is lost!

Often, when someone is injured in a motor vehicle accident, submitting an OCF-1 promptly after the collision just isn’t practical. Injuries from an accident might confine one to a hospital bed for weeks if not months on end, focusing on health and recovery. The SABS has contemplated these types of scenarios. Section 34 of the SABS states that a failure to comply with a time limit set out in Part VIII of the SABS (Procedures for Claiming Benefits) does not disentitle one to benefits if a reasonable explanation is present. Similarly, section 32(10) of the SABS notes that persons may have reasonable explanations for failing to notify insurers of the intention to apply for accident benefits.

So what exactly constitutes a “reasonable explanation”?

There is no definition of “reasonable explanation” in the SABS or the Insurance Act. However, the case law in this area continues to develop. Reasonable explanations that have been accepted by the courts and Ontario’s Licence Appeal Tribunal include, but are not limited to, the following:

• Severe accident related injuries;
• Latent injuries;
• Personal or family illnesses;
• Extended hospitalization following a motor vehicle accident;
• Being new to Ontario and not having any knowledge of the province’s automobile insurance scheme;
• Possessing only a grade-school education level;
• The period of delay being relatively brief; and
• Being unable to obtain important information for the OCF-1 at the accident scene, such as the identity of the other driver, the other driver’s license plate number, the other driver’s insurance particulars, which police department attended at the scene, and the attending police officer’s name and badge number.

If you have been injured in a motor vehicle accident, call the Jasmine Daya & Co. team at 416-967-9100 or contact us online to schedule a free consultation.