Botbyl v. Heartland Farm Mutual Insurance Inc. (2025 ONSC 3349)

The claimants applied to Economical for accident benefits following an accident. The claimants also had insurance with Heartland that carried optional benefits. The claimants sought to re-apply for accident benefits to Heartland after realizing that the Economical policy did not carry optional benefits. Heartland refused to allow the claimants to re-apply for benefits. The Tribunal initially granted the claimants the right to re-apply to Heartland based on the “relief from forfeiture” provisions of the Insurance Act. That decision was overturned on reconsideration. The claimants appealed the reconsideration decision. The Divisional Court allowed the appeal, and granted the claimants the right to re-apply to Heartland for accident benefits so that they could access their optional benefits. The Court affirmed that the Tribunal had the power to allow relief from forfeiture under the Insurance Act. The Court also held that the OPCF47 endorsement that granted the optional benefit could not be used by Heartland as a shield to prevent the re-application after the initial application had been made to Economical.

Applicant v. Allstate Insurance Company of Canada (17-006563)

The claimant had purchased optional benefits set out at section 28(1) 5 of the SABS and sought entitlement to payment of case management services, despite not suffering a catastrophic impairment. The insurer argued that case management services were only available if the claimant suffered a catastrophic impairment. Adjudicator Parish agreed with the insurer. She held that when reading section 28(1) 5 along with section 17 (case management services), the SABS only required payment for case management services if an insured suffered a catastrophic impairment.