Category: Insured Person

The claimant appealed the Tribunal’s decision that she was not an insured person, and therefore not entitled to accident benefits. The claimant’s son was involved in an accident. The claimant sought benefits under a policy issued to her brother. To prove entitlement, the claimant needed to show that she was dependent on the brother. The Tribunal concluded that the claimant had sufficient financial means to cover at least half of her expenses, and that the relationship between the claimant and her brother was not one of financial dependence. The Court dismissed the appeal, holding that the Tribunal applied the correct legal test and considered the evidence submitted by the parties.

The claimant appealed the Tribunal’s decision that he was not an insured person under the Security National policy and was therefore not entitled to accident benefits. The claimant suffered a catastrophic impairment when he was injured in an uninsured vehicle. He applied to Security National for accident benefits under a policy issued to his aunt and uncle on the basis that he was a dependant. Security National commenced a priority arbitration against the Fund. In the interim, Security National adjusted the claim, and certain benefits were denied. When a LAT dispute was commenced, Security National requested a preliminary issue hearing on whether the claimant was an insured person. The Tribunal held that the claimant was not an insured person and dismissed the LAT application. The claimant appealed, arguing that the Tribunal should not have heard the preliminary issue decision while the priority dispute was pending. The Court agreed and reversed the Tribunal’s decision. The Court held that it was an abuse of process to determine the insured person issue while the priority dispute was pending. The Tribunal failed to consider the interplay between a priority dispute and the claimant’s entitlement to benefits, and the importance of the “pay pending dispute” aspect of the SABS and the priority rules. The Tribunal’s approach left the catastrophically injured claimant without benefits, even though he was entitled to receive the benefits from one of the two insurers involved in the priority dispute.

The insurer appealed the Tribunal’s decision that the claimant was an insured person due to dependency for care on his sister. The claimant was 19 years old at the time of the accident, which occurred in Nebraska. The claimant moved to Canada from Uganda when he was 14 years old and lived with his sister for a few years, before moving to Oklahoma to high school and then Nebraska for university. He was living in a student residence when the accident occurred. The Tribunal concluded that the claimant was principally dependent for care on his sister because he maintained her address as his mailing address and returned to her home during holidays and summers; the sister acted like a parent to him, the sister Facetimed with the claimant frequently; the claimant’s mother was unable to provide support and was mostly absent; the claimant never lived independently in his own residence or supported himself financially. The Court dismissed the appeal, holding that the Tribunal applied the proper test and legal principles, and applied those principles to the evidence.

The claimant appealed the Tribunal’s decision that he was not insured under the Coachman policy due to the policy being cancelled, and that Coachman was not required to open a claim. The Court dismissed the appeal, holding that the Tribunal correctly found that the claimant was not an insured under the policy, and it was therefore not required to accept the claim. The Court held that the Supreme Court’s decision in Zurich v. Chubb was not applicable, because that case related to a dispute with two active policies.