Bogoroch & Associates secures favourable LAT decision after insurer unjustifiably refused to accept an accident benefits claim on the basis of delayed notice
This article was produced in partnership with Bogoroch & Associates
In the wake of a successful decision, Bogoroch & Associates’ Yoni Silberman has this practical advice for fellow plaintiff counsel when faced with a denial of accident benefits on the basis of delayed notice: “Challenge whether s. 32(1) will be applied on its plain reading if there is a legitimate reason for the delay. Take a run at it. In the worst-case scenario, the claimant remains in the same position – that is, without benefits. On the flip side, if successful, there is much to be gained by way of available benefits to the injured party or their loved one.”
In Benoit v. Sonnet Insurance Company, the License Appeal Tribunal (LAT) found that an insurer’s denial based on late notice could not stand because it failed to meet its own obligations once notified of the accident. Silberman, who represented Kim Benoit, says the case illustrates the upside for plaintiffs when lawyers push back on denials of this kind.
“In this case, it was the difference between Ms. Benoit receiving no benefits through any other source, to now having access up to $65,000 for medical and rehabilitation benefits, as well as a weekly indemnity benefit,” Silberman explains.
Benoit was a passenger in a motor vehicle accident on May 8, 2023, and she suffered a head injury that led to cognitive issues. Her husband called their insurance company, Sonnet, that same day to report the accident.
However, the insurer later claimed it had no record of that call and issued a denial months later when Benoit submitted her claim for accident benefits, citing non-compliance with the seven-day notice rule under s. 32(1) of the Statutory Accident Benefits Schedule (SABS).
But the LAT disagreed, with the adjudicator finding that Sonnet's own adjuster had acknowledged the initial call occurred and that it was sufficient to trigger the insurer’s obligations to Benoit — even if no injuries were specifically reported at the time of the initial call.
“Sonnet was never able to supply any evidence of what transpired during that call, even though it is their obligation to document these calls and advise their insured” says Silberman. “Here, they failed to do so.”
The LAT adjudicator followed the Divisional Court’s 2025 decision in Hussein v. Intact Insurance, which overturned the very precedent Sonnet tried to rely on. In Hussein, the court ruled that once an insurer is notified of an accident, it must take steps to determine whether benefits are sought, provide an application package, and explain available entitlements.
Silberman noted that the LAT granted the parties the opportunity to file supplemental submissions after Hussein was released, and before it rendered its decision in Benoit, likely because the tribunal was bound to follow the Divisional Court. The LAT found it directly applicable, with the decision stating: “Even though accident benefits were not raised at that time, I agree with the reasoning in Hussein that this was sufficient notice to the respondent.”
“Fortunately, the LAT allowed the parties the opportunity to make further submissions in light of Hussein,” Silberman says, noting that another pillar of the applicant’s argument was that her delay in formally applying was reasonable under s. 34 of the schedule.
Silberman explained how it took time for Benoit to fully appreciate the enduring impact of her injuries. This resonated with the LAT, which emphasized that “reasonable explanation” is both a subjective and objective test.
“There are many cases where several months after an accident or beyond, the injured party or their loved ones caring for them, realize that they are not coping well and are in need of support, such as psychological intervention when dealing with grief, caregiver burnout or the like,” Silberman says. “In such cases, strict adherence to timelines ignores the lived realities of injury and care.”
Such rigidity is common, Silberman notes, calling Benoit “an uphill battle.” Despite presenting a series of cases with comparable facts in initial submissions where courts and tribunals accepted notice periods far lengthier than her client’s — one up to five-and-a-half years post-accident — Sonnet would not budge.
“Insurers often default to a rote reading of the statute without looking at the individualized situation,” Silberman says, but there’s hope: decisions and rulings like Benoit and Hussein mark a turning tide.
“They underscore the fact that insurers responding this way will not be accepted.”
Both Benoit and Hussein also reinforce what has long been accepted: that the SABS is a benefits-conferring legislation. It was made contemplating consumers and the protections they are entitled to. Requiring injured persons or their loved ones to be held to such rigid requirements as it pertains to notice where there are still responsibilities upon the insurer, is not in keeping with these principles.
Sometimes, insurance companies issue denial letters as a matter of course, and Silberman stresses that none of these should be accepted at face value if there is a reasonable explanation for the delay. If the insurance company will not concede, it is imperative to fight these cases, she urges.
“Go to the LAT with comprehensive, well-thought-out submissions and advocate for your client,” she sums up. “Here, I’m glad to say, that resulted in a favourable outcome. The client has so much to gain, and you have so little to lose by taking the shot.”
