When you're injured in a motor vehicle accident in Ontario, accessing accident benefits is crucial for your recovery and financial stability. These benefits, including medical and rehabilitation coverage, attendant care, and income replacement, are available to all individuals regardless of fault. However, it is essential to understand the statutory timelines outlined in Ontario's Statutory Accident Benefits Schedule (SABS) and the potential consequences of missing these deadlines.
To initiate the process of obtaining accident benefits, individuals must promptly submit an Application for Accident Benefits, known as an OCF-1, to the relevant automobile insurer. Adhering to the legislative timelines outlined in the SABS is critical. Section 32(5) states that individuals must notify the insurer of their intention to apply for benefits within seven days of the circumstances arising or as soon as practicable thereafter. Additionally, section 32(1)(5)(10) requires applicants to submit a completed and signed OCF-1 within 30 days of receiving the application forms.
Failing to comply with these timelines may result in the denial of your claim for accident benefits. However, it is important to note that not all hope is lost if you miss the deadlines. The SABS recognizes that certain circumstances may make it impractical to submit an OCF-1 promptly, particularly when dealing with severe injuries and extended hospitalization.
The SABS explicitly states that a failure to meet the time limits does not disentitle individuals from benefits if a reasonable explanation exists. While the term "reasonable explanation" lacks a specific definition in the SABS, case law has shed some light on what constitutes a reasonable explanation. The following examples have been accepted by Ontario's Licence Appeal Tribunal and courts:
- Severe accident-related injuries
- Latent injuries that only manifest later
- Personal or family illnesses
- Extended hospitalization following the accident
- Being new to Ontario without knowledge of the automobile insurance scheme
- Having a limited education level
- The delay period being relatively brief
- Inability to gather essential information for the OCF-1 at the accident scene, such as the other driver's details, police information, etc.