Divisional Court finds weekly benefits payable before submission of the disability certificate with reasonable explanation.
In a significant decision, the Ontario Divisional Court has allowed the appeal of Summer Clouthier, a claimant who was struck by a car while cycling in February 2020 and suffered injuries, including a traumatic brain injury. During her lengthy hospitalization, Ms. Clouthier was incapable of making decisions or completing insurance forms. She eventually submitted the required disability certificate on July 8, 2020, after which her insurer began paying non-earner benefits under the Statutory Accident Benefits Schedule (SABS).
The dispute centered on whether Ms. Clouthier could receive benefits for the period between March 12 and July 7, 2020, when she was medically eligible but did not comply with procedural requirement. The Licence Appeal Tribunal (LAT) had denied her claim, citing s. 36(3) of the SABS, which states that benefits are not payable for any period before the disability certificate is submitted.
On appeal, the Court held that s. 34 of the SABS—which excuses non-compliance with time limits where there is a reasonable explanation—applies to s. 36(3), overturning previous LAT decisions. Previous case law held that s. 34 was a remedial provision for a missed time limit, s. 36(3) did not include a time limit for it to be applied against, and therefore s. 34 did not apply to s. 36(3).
In coming to their decision, the Divisional Court found that the term “time limit” is used inconsistently in different places in the SABS and therefore needed to be read contextually. Within the context of s. 34, as applied to s. 36(3), the Court found that “time limit” refers to the “period before the completed disability certificate is submitted”.
The Court emphasized that the SABS is consumer protection legislation and should be interpreted broadly to avoid absurd and inequitable results. According to the Court, denying benefits to someone incapacitated from completing forms would undermine the remedial purpose of the scheme.
Clouthier v. Co-Operators General Insurance, 2025 ONSC 6798 (CanLII), <https://canlii.ca/t/kgwpj>
