Missed Accident Benefits Deadline: What Happens in Ontario?

What is Ontario’s 7-day accident benefits notice rule?

Anyone who intends to claim accident benefits in Ontario must notify their auto insurer within seven days of the accident — or as soon as practicable after that. This rule applies to all road users, including pedestrians. Missing this window without a satisfactory explanation can bar a claimant from pursuing benefits at the Licence Appeal Tribunal (LAT) entirely.

In McLean v. TD General Insurance Company, 2026 CanLII 112114 (ON LAT) (https://www.canlii.org/en/on/onlat/doc/2026/2026canlii112114/2026canlii112114.html), the LAT examined what happens when a pedestrian waits more than two and a half years before submitting an accident benefits application. The adjudicator found the delay was neither explained nor excused, and the application was dismissed.

Our Ontario accident benefits lawyers regularly advise clients on these strict reporting timelines — understanding them early can make the difference between accessing benefits and losing them.

Does “as soon as practicable” give injured people extra time?

The phrase “as soon as practicable” does provide some flexibility, but it is not a broad extension of the deadline. The LAT applies a two-part test: the explanation for the delay must be credible, and it must be reasonable when measured against what a person in similar circumstances would have done.

In this case, the claimant argued she did not appreciate the full extent of her injuries until diagnostic imaging was reviewed more than two years after the accident. The adjudicator acknowledged that the severity of her injuries may not have been immediately apparent — but found that she was clearly aware she had been injured. She attended hospital on the day of the accident, missed five days of work, and reported ongoing accident-related pain at a medical clinic over a year before she filed her benefits application. That awareness, the adjudicator concluded, was enough to trigger the obligation to report.

Is “I didn’t know I had to report” a valid excuse?

No — not on its own. The LAT has consistently held, following the principles in Horvath and Allstate Insurance Company of Canada, 2023 ONFSCDRS 92, that ignorance of the law is not a reasonable explanation for a reporting delay. A claimant who simply did not know they were required to notify their insurer cannot rely on that lack of knowledge to save a late claim.

The adjudicator also rejected the argument that the claimant was too unsophisticated to navigate the system. The evidence showed she had successfully filed a WSIB claim through her employer shortly after the accident — a process that itself requires understanding and engagement with a formal benefits system.

What if the claimant was already receiving WSIB benefits?

A separate and independent bar applies when a claimant is entitled to WSIB benefits. Under section 61 of the Schedule, auto insurers are generally not required to pay accident benefits to someone who is entitled to claim worker’s compensation. A limited exception exists for injured workers who elect to pursue a tort action instead of WSIB benefits — but that election must be genuine and not made primarily to access accident benefits.

In this case, the claimant’s employer filed a WSIB report the day after the accident, and WSIB accepted the claim. The claimant submitted her accident benefits application in October 2021 but did not issue a Statement of Claim in tort until June 2022 — more than eight months later. The adjudicator found that the delay in pursuing the tort action, combined with the absence of any assignment of WSIB benefits to the insurer, supported the conclusion that the accident benefits application was made primarily to obtain those benefits rather than as a genuine election to pursue tort damages.

Can a claimant argue the insurer’s conduct waived the deadline?

The claimant argued that because the insurer processed her file — arranging assessments, corresponding with counsel, and seeking surveillance — after receiving her late application, the insurer was estopped from later relying on the missed deadline. The adjudicator disagreed.

Under Ontario law, an insurer that receives an accident benefits application is required to adjust the file regardless of whether it believes the claim is late. That mandatory adjustment process does not amount to a promise or assurance that the late notice will be overlooked. The adjudicator found no evidence of any specific representation by the insurer that the claimant’s compliance with the reporting requirement was excused — which is what promissory estoppel requires.

Can a claimant seek relief from forfeiture at the LAT?

Yes, the LAT has jurisdiction to grant relief from forfeiture under section 129 of the Insurance Act — but it is a discretionary remedy and the onus is on the claimant. Courts and tribunals consider the claimant’s conduct, the seriousness of the breach, and the proportionality between what is forfeited and the harm caused by the breach.

Here, the adjudicator found that the reasonable explanation analysis under section 34 of the Schedule already incorporates these factors. Because the claimant had not established a reasonable explanation for the delay, and because the insurer was prejudiced by its inability to investigate the claim promptly, relief from forfeiture was also denied.

Questions and records to discuss with a lawyer

• When did you first seek medical attention after the accident, and what injuries or complaints were documented at that time?
• Did you or your employer file a WSIB claim following the accident, and what was the outcome of that claim?
• How much time has passed since the accident, and have you yet notified your auto insurer of your intention to claim accident benefits?
• Do you have records of any communications with your insurer after submitting your benefits application, including letters, assessment bookings, or denial notices?
• If you were injured as a pedestrian or while working, have you considered whether both WSIB and accident benefits may be relevant to your situation?

If you have questions about accident benefits timelines or how a WSIB claim might affect your options, the team at UL Lawyers is available to discuss your circumstances. Reach out through our motor vehicle accident practice page or contact us directly at /connect.

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This article is automated commentary on a public court decision and is for general information only — not legal advice. Decisions rely on facts unique to each case. If you are affected by a similar issue, contact a lawyer for advice specific to your situation.