The Ontario Court of Appeal has clarified an important procedural requirement for accident benefits claims under Ontario’s Statutory Accident Benefits Schedule.
In Jakupovic v. Intact Insurance Company, 2026 ONCA 651, the Court held that simply notifying an insurer that a motor vehicle accident has occurred does not satisfy the notice requirement in s. 32(1) of the SABS.
The insured must notify the insurer that they intend to claim accident benefits.
The decision also provides broader guidance about the role of consumer protection principles in interpreting the SABS. While the Court accepted that the SABS is consumer protection legislation, it emphasized that this purpose cannot be used to rewrite clear statutory language or impose obligations on insurers that the Legislature did not include.
Background
The respondent was involved in a motor vehicle accident on February 13, 2019.
He contacted Intact Insurance Company the following day and reported the accident and damage to his vehicle. He subsequently had multiple communications with Intact concerning the property damage claim.
What he did not do was advise Intact that he intended to claim statutory accident benefits.
It was not until December 12, 2020, approximately 22 months after the accident, that he submitted an Application for Accident Benefits.
Intact initially approved the application but later raised the issue of late notice and terminated the respondent’s entitlement to benefits.
The respondent applied to the Licence Appeal Tribunal. The LAT determined that he had failed to comply with s. 32(1) of the SABS because he had not notified Intact of his intention to claim accident benefits within the required period. His request for reconsideration was also dismissed.
The Divisional Court reversed that decision. It concluded that notifying Intact about the accident itself was sufficient to satisfy s. 32(1). In its view, once Intact knew about the accident, it should have made further inquiries to determine whether its insured had been injured and intended to claim accident benefits.
The Court of Appeal disagreed.
Reporting an Accident and Claiming Benefits Are Different Things
Section 32(1) of the SABS requires a person who intends to apply for accident benefits to notify the insurer of that intention no later than seven days after the circumstances giving rise to the entitlement, or as soon as practicable thereafter.
The Court of Appeal held that the language is clear and mandatory.
An insured who intends to claim benefits must communicate that intention to the insurer. It is that notice which starts the accident benefits process.
Once the insurer receives the required notice, s. 32(2) requires it to provide the appropriate application forms, an explanation of the available benefits, information to assist with the application and, where applicable, information concerning the election of benefits.
The Divisional Court had effectively reversed that sequence.
Under its interpretation, once an insurer learned that an accident had occurred, the insurer would have to determine whether the insured was injured, ask whether accident benefits might be claimed and begin the application process.
The Court of Appeal held that s. 32(1) imposes no such obligation.
The Legislature drew a distinction between notice that an accident occurred and notice that a person intends to pursue a claim. Had the Legislature intended notification of an accident alone to commence the accident benefits process, it could have said so.
Consumer Protection Does Not Override Clear Statutory Language
One of the more significant aspects of the decision is the Court’s treatment of the consumer protection purpose of the SABS.
The respondent and the Ontario Trial Lawyers Association, which intervened in the appeal, argued that the SABS should be interpreted broadly because accident benefits legislation is intended to protect injured consumers.
The Court of Appeal agreed with the general proposition that the SABS is consumer protection legislation.
But that did not determine the interpretation of s. 32(1).
The Court held that the Divisional Court placed too much emphasis on the consumer protection objective without first considering the actual statutory language in its full context.
Statutory purpose informs interpretation. It does not permit a court to impose obligations that are inconsistent with clear statutory wording.
On the Court of Appeal’s interpretation, requiring insurers to commence the accident benefits process whenever an accident is reported would effectively require insurers to initiate potential SABS claims even where the insured suffered no injury and had no intention of pursuing accident benefits.
The Court considered that result inconsistent with the statutory scheme.
The SABS Already Provide Protection for Reasonable Delay
Importantly, the decision does not mean that every claimant who fails to notify an insurer within seven days necessarily loses entitlement to accident benefits.
The legislation itself provides flexibility.
Section 32(1) permits notice to be given “as soon as practicable” after the seven-day period. In addition, s. 34 provides that failure to comply with a time limit does not disentitle a claimant to benefits where there is a reasonable explanation for the non-compliance.
The Court described these provisions as mechanisms built into the statutory scheme to address cases where strict adherence to a time limit could produce an unfair result.
In this case, however, the LAT had already considered the respondent’s explanation for the lengthy delay and found that it was neither credible nor reasonable.
That factual finding was entitled to deference.
The Limits of an Appeal from the LAT
The Court of Appeal also identified a separate problem with the Divisional Court’s decision.
An appeal from the LAT involving the Insurance Act is limited to questions of law.
Despite that limitation, the Divisional Court made its own findings about such matters as the vulnerability of injured claimants, the brevity of the seven-day notice period and the likelihood that an average consumer would be unfamiliar with accident benefits.
The Court of Appeal noted that these generalized findings were not supported by the evidentiary record before the Divisional Court.
The Divisional Court also relied on medical evidence that post-dated the LAT decision.
The Court of Appeal concluded that the Divisional Court had exceeded the proper scope of appellate review and had improperly substituted its own factual findings for those made by the LAT.
Why This Decision Matters
Jakupovic provides useful clarity for both insurers and accident benefits claimants.
For insurers, the decision confirms that knowledge of a motor vehicle accident does not, by itself, trigger the obligations associated with an accident benefits application. An insurer is not required to assume that every insured reporting an accident also intends to make a SABS claim.
For claimants, the decision underscores the importance of communicating an intention to claim accident benefits promptly and clearly. Reporting vehicle damage or otherwise advising an insurer that an accident occurred should not be assumed to satisfy the separate notice requirement under s. 32(1).
At the same time, the Court preserved the remedial safeguards contained in the SABS. Claimants who cannot comply within seven days are not automatically barred. The legislation expressly provides flexibility where notice is given as soon as practicable or where a reasonable explanation exists for the delay.
Practical Takeaway
The broader significance of Jakupovic lies in the balance struck by the Court of Appeal.
The SABS remain consumer protection legislation and should be interpreted with that purpose in mind. But consumer protection does not permit courts to replace the procedure enacted by the Legislature with a different one thought to offer greater protection.
The statutory sequence remains important.
The insured communicates an intention to claim accident benefits. That notice triggers the insurer’s obligation to provide the forms and information required by the SABS. Where notice is delayed, the legislation provides specific mechanisms for determining whether the delay should be excused.
The decision therefore provides greater certainty about where responsibility for commencing the accident benefits process lies, while preserving the statutory protections available to claimants who have a legitimate explanation for failing to comply with the prescribed timeline.
At Flaherty McCarthy LLP, we regularly advise insurers and litigants on statutory accident benefits, automobile insurance coverage and appeals from decisions of the Licence Appeal Tribunal. Our lawyers continue to monitor developments in Ontario insurance law and their practical implications for insurers and insureds.
