Accident benefits claimant misses notification period by two decades

Ontario’s Licence Appeal Tribunal (LAT) has denied an application for auto accident benefits from a woman injured in an auto accident because the tribunal found she missed the 30-day window to notify her insurance company — by more than 20 years.

On May 30, 2020, Siham Younes filed an application with the LAT for accident benefits related to an accident that occurred on Mar. 21, 1999. She sought lost educational expenses, a car loan and a student loan, a catastrophic impairment determination and interest.

Her auto policy with Liberty Mutual Insurance Company expired Oct. 17, 1998, according to the LAT decision.

In a follow-up to publication, Younes told Canadian Underwriter this core finding of the LAT decision is incorrect.

“At the time, I had spoken directly with my Liberty Mutual insurance agent, on Friday, Mar. 20, 1999, who then confirmed that coverage would continue as long as I paid the pro-rated amount, including the 30-day arrears, payment scheduled for withdrawal on Monday, Mar. 23, 1999,” Younes told Canadian Underwriter in an email on Apr. 4. “This arrangement ensured that my policy remained active from Feb. 19, 1999, onward, including the date of the accident on Mar. 21, 1999.”

At the tribunal, Liberty told the LAT it had no records of the claim.

“The applicant [Younes] has been unable to produce any records indicating that Liberty Mutual handled a claim for accident benefits on her behalf and has not produced an OCF-1 Application for Accident Benefits, or any denial letters regarding any issues in dispute. There is no claim number associated with Liberty Mutual’s records office and based on coverage search, the policy with Liberty lapsed Oct. 17, 1998, which predates the Mar. 21, 1999, date of loss listed on the application and within documents.”

Liberty first became aware of the claim on July 23, 2020, when it received a notice of case conference from the LAT. Counsel for the insurance company then wrote to Younes in February 2021 to tell her Liberty Mutual had ceased operations in Canada.

[In 1993, Liberty International opened for business in Toronto. A few years later, the company changed its name to Liberty International Underwriters (LIU Canada). In 2017, Liberty Mutual Insurance purchased Ironshore; the following year, LIU Canada and Ironshore Canada aligned operations, rebranding as Liberty Mutual Canada.]

The correspondence to Younes from Liberty’s counsel included a link about accident benefits in Ontario and an application form. Counsel also requested a copy of the OCF-1 application for accident benefits, which the LAT decision confirms the insurer did not receive.

LAT’s adjudicator observed the Statutory Accidents Benefits Schedule (SABS) allows for an exception to the mandatory 30-day notification period if there is a reasonable explanation for the delay.

Younes insisted she was covered by Liberty Mutual.

She told CU the accident occurred when a young women attempted to steal her vehicle. “During this attempt, she drove the car forward and struck me with my own vehicle,” she wrote. “Thus, resulting in a MVA [moving vehicle accident] vs. pedestrian.”

LAT’s decision says Younes “is of the view that the incident that occurred on Mar. 21,1999 is inexcusable and that the injuries were caused by the accident, medical malpractice and insurance negligence. She stated that she is ‘asking damages for negligence, and punitive damages restricted to situations in which the misconduct in question was intentional and deliberate, and extreme in nature and such that by any reasonable standard it is deserving of full condemnation and punishment.’”

The LAT declined to award punitive damages. In fact, the LAT didn’t find any reasonable excuse for the two-decade delay in notifying the insurer about the accident.

“I have…reviewed all of the documents that [Younes] submitted into evidence,” LAT adjudicator Tavlin Kaur wrote in a decision released Wednesday. “I do not find that these documents assist me in determining whether there is a reasonable explanation for the delay.

“While I recognize that the applicant has been through some difficult circumstances, the evidence does not address [the delay].”

 

Feature image by iStock.com/HAKINMHAN

Editor’s Note: This article has been updated to include new information from the claimant, Siham Younes