Category: Death Benefit

Carmel Jeffery v. Aviva Insurance Company (20-006381)

The claimant’s husband passed away from accident-related injuries in 2017. The insurer paid a funeral benefit and a spousal death benefit. The claimant also applied for a death benefit as a dependent, pursuant to section 26(2)2. of the SABS. The insurer denied the death benefit based on a determination that the claimant was not principally dependent on her late husband. The claimant applied to the LAT seeking entitlement to the death benefit and a Special Award. Vice-Chair Boyce found that the claimant was not principally dependent on her husband for financial support and not entitled to the benefit in dispute.

M.H. and T.H. v. Economical Insurance Company (19-004735)

The claimants were the mother and father of a child who died in a motor vehicle accident. They sought, and were paid, death and funeral benefits by the insurer. They disputed entitlement to interest and a special award. Vice Chair Farlam concluded that the claimants were not entitled to interest. The insurer requested a completed OCF-4, copies of the birth and death certificate, and documentation related to dependency. The OCF-4 was returned without supporting documentation. The supporting documentation was provided four months later, and the insurer paid the benefits within the next week. Vice Chair Farlam held that the benefits were not payable until the supporting documentation had been provided, and was therefore not overdue. The special award claim was also dismissed.

W.R. v. Aviva Insurance Company (19-000791)

The insured died while in his vehicle due to a suicide, in which he poured gasoline in his vehicle and set it on fire using the car’s cigarette lighter and a doused dishtowel. The claimant (the insured’s wife) sought death benefits and funeral benefits. Adjudicator Farlam held that the death was not a result of an “accident”, so no accident benefits were payable. The smoke inhalation and fire could not be considered “use or operation” of a vehicle. Rather, the vehicle was simply the venue of the death. Furthermore, she held that a suicide was an aberrant use of a vehicle, not the “ordinary and well-known activities to which automobile are put.” Finally, the adjudicator held that the act of intentionally starting a fire was an intervening act that broke the chain of causation.

A.G. v. Allstate Canada (18-004980)

The claimant filed a request for reconsideration following a decision in which the Tribunal concluded that the claimant’s death was not caused by the subject accident. The claimant argued that the Tribunal failed to properly analyze the evidence and over-exaggerated his pre-accident medical history. Adjudicator Watt dismissed the reconsideration request, finding that there was no misinterpretation or disregard of medical evidence relating to the claimant’s death.

M.H. v. Aviva General Insurance (17-006910)

The claimant’s son was struck by a car and passed away several months later. The claimant sought death benefits from the insurer. The insurer argued that the son was not a dependent of the claimant, and therefore no death benefit was payable. Adjudicator Mazerolle agreed with the insurer and held that the son was not principally dependent for financial assistance or care. As such, he was not a dependent of the claimant.

M.H. v. Aviva Insurance Canada (17-006910)

The insurer sought reconsideration of the Tribunal’s decision to award death benefits, on the basis that the deceased was a dependent for care on the claimant. Associate Chair Jovanovic granted the reconsideration and ordered a new hearing. He wrote that the Tribunal failed to consider whether the deceased was “principally” dependent on the claimant and failed to consider the appropriate time period for the dependency analysis.

Applicant v. Aviva Insurance Company (17-006910)

The claimant sought a death benefit in relation to the death of her adult child. Adjudicator Norris concluded that the deceased was principally dependent for care on the claimant due to mental disability and diabetes. The claimant was the principal provider of social and emotional support for the deceased and regularly spoke to the deceased by telephone. The claimant also provided housekeeping assistance and dietary assistance. Death benefits were therefore awarded.

S.J. v. Aviva Insurance Canada (17-002899)

The claimant’s mother died as a result of an automobile accident. She applied for death benefits. The insurer argued that the claimant was not dependent on her mother at the time of the accident, and therefore not an insured person under the policy. Adjudicator Watt agreed with the insurer. Although the claimant resided with her mother at the time of the accident, she was employed full-time for over one year, earned well over the low-income cut off level for her geographic region, and had a large amount of savings. As such, the evidence did not support the position that more than 51 percent of the claimant’s financial needs were provided by her mother.

N.J. v. Aviva Insurance Canada (17-002841)

The claimant’s mother died in an accident. The claimant sought payment of death benefits. The insurer denied the benefits, arguing that the claimant was not a dependent of her mother. Adjudicator Watt agreed with the insurer. He noted that while the claimant lived with her mother and did not pay rent, the claimant had earned in excess of $40,000 per year and was employed part-time as a nurse. While the claimant had a close relationship with her mother, she was not principally dependent for financial support. She could not prove that she relied on her mother for 50 percent plus one of her financial needs, nor was her income under the Low Income Cut Off for her geographic region.

R.D. v. Wawanesa Mutual Insurance Company (16-001535)

The deceased claimant had been involved in a motor vehicle accident in which his car rolled over and the airbags deployed. He did not seek medical attention at the scene, and met his brother-in-law at an auto repair shop. Shortly after arriving at the auto repair shop, the claimant was found unresponsive. He was taken to hospital and declared deceased shortly upon arrival. The cause of death was determined to be an artery blockage. The claimant’s wife and children sought death benefits; the insurer denied that the accident was the cause of the claimant’s death. Adjudicator Gottfried concluded that the claimant’s death had arisen from the direct use and operation of a vehicle. In particular, the adjudicator noted that stress from the accident was noted to be a contributing factor to the claimant’s death, and that there was no intervening event that broke the chain of causation. Death benefits were awarded to the wife and children.