Category: Insured Person

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.

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.

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.

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.