A preliminary issue hearing was held to determine whether the claimant was disentitled to accident benefits because he did not have a reasonable explanation for providing the insurer with notice of the accident and/or failing to apply for benefits within the time limits imposed by section 32(1) of the SABS. Adjudicator Lake held that the claimant failed to prove that he had a reasonable explanation for his significant delay in submitting his OCF-1 (three years and two months post-accident), and therefore was not entitled to accident benefits. In doing so, she rejected the claimant’s arguments that he was not in a “”frame of mind”” following the accident to apply for accident benefits and that he was not sophisticated enough to understand his accident benefits policy, given that there was no evidence that he suffered any cognitive or neurological conditions that would have impeded him from pursuing an accident benefits claim and that he was able to retain counsel following the accident. Adjudicator Lake accepted that the prejudice to the insurer would be significant, as it did not have an opportunity to investigate and assess the claimant’s claim contemporaneously when benefits may have been payable.
