“Formal application” for accident benefits not necessary: Ontario Court of Appeal

If a claimant has not submitted an OCF-1 form (Application for Accident Benefits) to an insurer, it does not automatically disqualify them from being considered to have provided a completed application for accident benefits, Ontario’s Court of Appeal ruled.
Four people travelling in a car were injured in a car accident in 2006. Francisco Quintera was the driver at the time of the accident. The car was allegedly insured by TD Insurance Meloche Monnex, but TD maintains it had terminated the policy prior to the accident.
The other car in the collision was insured by ING.
Ten months after the accident, ING received four OCF-23 forms (Pre-approved Framework Treatment Confirmation Form) from a chiropractor, one for each claimant riding in the Quintera car at the time of the accident. The forms included the names and addresses of each of the claimants, along with a brief description of the nature of the injuries each had sustained in the accident.
By July 2007, ING was unable to contact any of the four claimants, and had not received a completed OCF-1 form from any of the claimants so denied benefits and closed the file.
Shortly thereafter, TD received four OCF-1 forms from the claimants’ representative, GM Accident Claims & Dispute Resolution Specialists.
Neither insurer adjusted the files or paid benefits. ING and TD disagreed about which had been the first insurer to receive a completed application for accident benefits within the meaning of s. 2 of the Insurance Act.
In arbitration, it was determined that ING’s receipt of the forms from the chiropractor constituted the receipt of “completed application for benefits” within the meaning of s. 2.
ING’s application to the Superior Court to have the determination set aside was dismissed, and the Court of Appeal also upheld the arbitrator’s decision.
The arbitrator stated that a person “need not provide a formal application to an insurance company to be deemed to have provided a completed application for accident benefits,” the Court of Appeal decision says.
“A person need only provide sufficient particulars to an insurance company so as to reasonably assist the insurer with the processing of the application and the assessment of the claim.”
The OCF-23 forms submitted by the chiropractor, even though they are not OCF-1 forms, met the test, ruled the arbitrator.
“Accordingly, I would dismiss the appeal with costs to the respondent fixed at $8,000, inclusive of disbursements and applicable taxes,” wrote the panel of Court of Appeal judges.