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.
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 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.
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.
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.
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.
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.
The insurer sought reconsideration of the Tribunal’s decision that the claimant was a resident of Ontario at the time of the accident, and therefore an “insured person.” Executive Chair Lamoureux rejected the reconsideration. She held that the Tribunal was asked to make a determination that largely turned on the facts of the case, and that the Tribunal had not erred in finding that the claimant resided in Ontario. She also held that section 3 of the SABS was the pertinent section to consider, and that section 59 was only relevant to determining whether an insured could elect benefits in another jurisdiction. Finally, Executive Chair Lamoureux noted that the insurer was essentially asking for reconsideration on the Tribunal’s findings of fact, which was not an appropriate request.
The insurer sought reconsideration of the Tribunal’s decision that the claimant was a resident of Ontario at the time of the accident, and therefore an “insured person.” Executive Chair Lamoureux rejected the reconsideration. She held that the Tribunal was asked to make a determination that largely turned on the facts of the case, and that the Tribunal had not erred in finding that the claimant resided in Ontario. She also held that section 3 of the SABS was the pertinent section to consider, and that section 59 was only relevant to determining whether an insured could elect benefits in another jurisdiction. Finally, Executive Chair Lamoureux noted that the insurer was essentially asking for reconsideration on the Tribunal’s findings of fact, which was not an appropriate request.
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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP