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Clements v. The Co-operators Group Limited (19-009258)

  • February 23, 2021

The claimant witnessed the aftermath of an accident in October 2016 involving his brother, partner, and three children. He applied for accident benefits two years later. The insurer argued that the claimant’s application was barred as being late without reasonable explanation. Adjudicator Grant agreed with the insurer and dismissed the claim. The claimant argued that he did not know he could apply for accident benefits as a witness to an accident involving family members, and that once he found out he could apply, he did not know how. Adjudicator Grant rejected both arguments. The evidence showed that the claimant knew very early after the accident that he could receive accident benefits and notify the insurer of his intention. In the summer of 2017, the claimant met a personal injury lawyer who explained the accident benefits system and forms to him. The claimant also knew about the availability of accident benefits from dealing with the claims of his family members. Adjudicator Grant found that the claimant had no reasonable explanation for his delay in applying for accident benefits, noting that ignorance of the law was not reasonable. He also held that the claimant’s delay in submitting an application caused prejudice to the insurer because it could not assess the claimant in a timely fashion. Particularly prejudicial was the claimant’s development of psychological impairments from other issues that would be nearly impossible to separate from psychological impairment caused by the accident.

Full decision here

TGP Analysis

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  • FILED UNDER Late Application
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