Category: Late Application

The claimant sought entitlement to IRBs and costs of examinations. As a preliminary issue, the respondent argued that the claimant was barred from appealing her claims as she had not followed the procedures for claiming accident benefits under section 32 of the SABS. The claimant did not file a claim for accident benefits until July 2016, two and a half years after the subject accident. No explanation for the delay was provided. Adjudicator Ferguson concluded that the respondent was not required to pay the claimant’s claim for IRBs, as she did not comply with the prescribed procedures for claiming accident benefits. However, the amounts incurred with respect to the costs of examinations were payable pursuant to section 38(11). The claimant filed two assessment plans in June 2016 which the respondent did not deny.

The claimant suffered a finger fracture in the accident. He was new to Canada and did not understand the accident benefits system. He first applied for EI, which was denied; he appealed and lost again. He first applied for accident benefits eight months after the date of loss. The insurer argued that the claimant did not have a reasonable explanation for his delay and could not claim accident benefits. Adjudicator Gottfried followed FSCO case law regarding late applications and concluded that the claimant did have a reasonable explanation for his late application, and that he could claim accident benefits. He was found entitled to IRBs based on his injuries from the date of his first OCF-3 up to the 104 week mark. IRBs beyond that date were denied. Various medical benefits were paid by the insurer. Adjudicator Gottfried held that claims for HST on proposed medical benefits were also payable.