Category: Insured Person

Boyle v. Travelers Canada (19-014423)

The claimant was a witness to a fatal motor vehicle accident. He applied for accident benefits based on claims of psychological impairments as a result of rushing to the scene to assist following the collision. The insurer determined that the claimant was not an “insured” who was “involved” in an “accident” under s. 3(1) of the SABS and denied the claim for accident benefits. The claimant applied to the LAT for resolution of the dispute. Vice-Chair Boyce agreed with the insurer and found that the claimant was not an insured person involved in an accident under s. 3(1). The claimant was not entitled to accident benefits.

N.I.F. v. Certas Home and Auto Insurance Company (19-004334)

The claimant’s adult son was involved in a motorcycle accident and died as a result of the accident. A preliminary issue hearing was held to determine: (1) if the claimant was an “insured person” under the SABS at the time of the accident, and (2) whether the claimant was statute-barred from claiming benefits sought as she failed to commence a LAT proceeding within two years of the respondent’s denial. In this case, the claimant was the registered owner of the motorcycle involved in the accident that she bought for her son’s use, but the named insured on the policy was a friend of the claimant’s son. At the time of the accident, the claimant lived alone, received a disability benefit and was self-supporting. Adjudicator Conway dismissed the LAT dispute. She found that the claimant was not an “insured person” under the policy because she was not principally dependant on her son for financial support or care at the time of the accident.

N.F. v. Certas Direct Insurance Company (19-004334)

The claimant’s adult son was killed in a motor vehicle accident. The claimant’s son was a listed driver on the insurance policy of the motorcycle he was riding at the time of the accident. The named insured on the policy was a friend of the claimant’s son. The claimant was the registered owner of the motorcycle, but she had not driven the motorcycle since 2007. The claimant sought accident benefits based on a claim of psychological impairment as a result of her son’s death. The insurer denied the claim for accident benefits on the basis that the claimant was not an “insured person” under the motorcycle policy of insurance nor a dependant of the named insured on the policy. The key issue at the hearing was the determination of whether the claimant was an “insured person” under the SABS at the time of the accident. As the claimant was not a designated driver under the policy and not a spouse of the named insured, Adjudicator Conway found that the only way the claimant could be eligible for accident benefits was if she were a dependant of her son’s friend, who was the named insured under the policy. The claimant failed to establish that she was principally dependant on the named insured for financial support or care. The application was dismissed.

L.M. v. The Co-operators General Insurance Company (19-003485)

The claimant’s brother was involved in an accident. The 21 year old claimant sought AB coverage under his mother’s policy. The insurer argued that the claimant was not an insured person, because he was not a dependant of his mother. Adjudicator Conway concluded that the claimant was principally dependent for financial support on his mother at the time of the accident. She used a time period of over one year for the purpose of her assessment and concluded that the claimant’s earnings were insufficient to meet more than 50 percent of his financial needs (both living expenses and debts). His mother both provided him with direct financial assistance and services, such as meals, laundry, and cleaning.

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.

L.M. v. Certas Home and Auto Insurance Company (18-002240)

The claimant was involved in an accident in California and sought accident benefits from his father’s policy. The insurer argued that the claimant was not an “insured person” because he was not a dependent of his father. Adjudicator Punyarthi agreed with the insurer. There was insufficient financial evidence provided by the claimant to determine whether the Miller v. Safeco factors applied to the claimant. Further, the claimant participated in his father’s business to an extent that he had marketing and networking abilities to be self-supporting.

J.W.C. v. Certas Direct Insurance Company (17-007593)

The claimant was involved in an accident in British Columbia. He sought accident benefits through a policy held by his sister, argued that he was financially dependent upon her. Adjudicator Ferguson held that the claimant failed to provide evidence supporting financial dependency. The claimant was married, had a daughter, and worked in various jobs in the two years leading up to the accident. He had no documentary evidence to prove that his sister provided monetary assistance. The claimant was not an insured person and therefore not entitled to accident benefits. The claimant also argued that he should be entitled to elect Ontario accident benefits under section 59. Adjudicator Ferguson held that the claimant did not satisfy criteria 59(1)(b) because he was receiving benefits from ICBC. He therefore could not elect to receive Ontario accident benefits even if he were an insured person. Finally, adjudicator Ferguson held that it was irrelevant to his decision that there was a priority dispute ongoing between the insurer and ICBC.

K.D. v. Wawanesa Mutual Insurance Company (18-001020)

The claimant’s mother was involved in an accident while an occupant of a friend’s vehicle. The mother did not have insurance of her own. The claimant applied for accident benefits under the friend’s policy. The insurer argued that the claimant was not an insured person under the policy and not entitled to accident benefits. Adjudicator Helt agreed with the insurer. As a preliminary issue, the adjudicator concluded that the LAT had jurisdiction to determine whether a claimant was an “insured person.” Turning to the claim itself, neither the claimant nor his mother had a familial or dependency relationship with the insurer’s policyholder. Finally, Adjudicator Helt rejected the claimant’s arguments that the insurer was estopped from arguing that he was not an insured person, writing that estoppel cannot be applied to create insurance coverage where none exists.

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.