The insurer appealed the Tribunal’s decision that the claimant was an insured person under its policy as a “dependant”. A LAT hearing on the benefits was scheduled for six months later. The Divisional Court dismissed the appeal as being premature because the claimant’s status as an insured person was only a preliminary matter that the Tribunal needed to address before adjudicating entitlement to benefits.
The claimants were out for a walk with their spouses when a member of their group, a close relative, was struck by a motor vehicle in a pedestrian accident. The claimants, who were uninsured, applied for accident benefits under the driver’s policy, claiming emotional shock and psychological distress. Adjudicator Norris had previously ruled that the claimants did not meet the definition of an “insured person” in section 3(1) of the SABS, and therefore had no entitlement to accident benefits under the driver’s policy. The claimants requested Reconsideration of the decision. The claimants alleged that Adjudicator Norris erred in fact or law by failing to recognize the broad, consumer-protecting threshold of section 3(1). Adjudicator Norris disagreed, noting that while protections did exist, the claimants had no relation to the named insured (driver) as required by law to claim benefits, and as unfortunate as the event may have been, they were not entitled to claim accident benefits from the insured driver. The request for reconsideration was denied.
The claimants made a claim for accident benefits following an incident in which they witnessed a vehicle strike a close family member (spouse and father-in-law, respectively). The incident was only a few feet in front of the claimant. The claimants heard the collision and witnessed the aftermath. The claimant alleged that they suffered psychological injuries. Because neither claimant had their own automobile insurance, they made a claim to the policy of the driver who struck the relative. Adjudicator Norris concluded that neither of the claimants were an “insured person” because they were not “a person who is involved in the accident involving the insured automobile”. The “insured person” definition in the SABS suggested that claims for nervous shock were limited to family members who qualified under section 3(1)(a)(ii).
The insurer sought reconsideration of the Tribunal’s decision that the claimant was an insured person as a dependent of his mother. Vice Chair Flude dismissed the reconsideration because the Tribunal’s decision had not finally disposed of the appeal. Rule 18.1 required that the insurer wait until the matters in dispute were finally disposed of. The preliminary decision did not finally determine the claimant’s entitlement to benefits.
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.
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 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.
150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850
© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles
Powered by Crow & Pitcher
150 York Street, Suite 1800
Toronto, Ontario M5H 3S5
416.507.1850