The insurer raised a preliminary issue, arguing that the claimant’s claim was barred pursuant to section 55 of the SABS because she failed to notify the insurer of her intention to apply for accident benefits until over three years after the accident. Both parties agreed that the claimant failed to comply with the time limit set out in the SABS. The dispute centred on whether the claimant’s explanation for her delay in applying for benefits was a reasonable one. Vice Chair McGee found that the claimant’s lack of awareness as to what was covered by her automobile policy was not a reasonable explanation for her delay in seeking benefits. She also did not accept that the claimant’s stress of caring for her catastrophically injured daughter would have accounted for a more than three year delay in inquiring about her own accident benefit coverage, particularly given the high level of functioning demonstrated by the claimant in doing so. Vice Chair further noted that the claimant’s delay had resulted in prejudice to the insurer, as they were unable to conduct contemporaneous assessments and surveillance, and could face hurdles in attempting to gather medical records. As such, the claimant’s application was barred by section 55 and accordingly dismissed.
