Category: Out-of-Province Accident

Del Grosso v. Intact Insurance Company (20-013318)

The claimant was involved in an accident in Michigan and elected to receive Michigan no-fault benefits, including Work Loss Benefits (the Michigan equivalent of IRBs). The insurer later learned that the claimant misrepresented his driving history and insurance history when applying for his auto policy. The insurer terminated the claimant’s entitlement to Work Loss Benefits and requested repayment of over $72,000 based on the section 31(1)(b) exclusion. The claimant argued that Michigan benefits were not equivalent to IRBs, and were not excluded and argued that the Tribunal did not have jurisdiction to consider his entitlement to Michigan no-fault benefits. Adjudicator Norris found that he had jurisdiction to consider the matter as the Michigan level benefits were being paid under the SABS. He agreed with the insurer’s position, concluding that the claimant made material misrepresentations in his application for insurance (failing to report an earlier accident and termination of an auto policy), that section 31 (1)(b) barred entitlement to IRBs, and that Work Loss Benefits were equivalent to IRBs. Adjudicator Norris ordered the claimant to repay all Work Loss Benefits received.

Maycid v. TD General Insurance Company (20-012985)

The claimant was involved in an accident in Quebec. He submitted his OCF-1 to the insurer, and elected under section 59 to receive SAAQ benefits. A disagreement arose between the claimant and the insurer as to the SAAQ benefits the claimant was entitled to. The claimant applied to the LAT. The insurer argued that the LAT did not have jurisdiction to hear the dispute, and argued that the claimant was required to apply to the Quebec tribunal. Adjudicator Flude rejected the insurer’s arguments, and held that the LAT had jurisdiction to decide the dispute. Although the claimant was receiving benefits provided by the SAAQ regime, those benefits were being paid in accordance with section 59 of the SABS. The dispute therefore fell within section 280 of the Insurance Act, which defines the LAT’s jurisdiction.

Ladene v. Intact Insurance Company (19-013428)

The claimant was involved in a motor vehicle accident in Alberta while driving a vehicle registered in Alberta and insured under an Alberta policy. She applied for and received benefits in Alberta under Alberta protocols. She then moved to Ontario and applied for benefits pursuant to the SABS. The claimant argued that she could elect to have benefits under the SABS because the insurer had offices in both Ontario and Alberta. Vice Chair Farlam found that the claimant was not entitled to received SABS benefits as she did not meet the statutory requirements for eligibility, pursuant to s. 3(1) of the SABS.

A.S. v. Intact Insurance Company (19-000979)

The claimant was involved in a motor vehicle accident in Alberta. At the time of the accident, he had an insurance policy that was sold in Alberta and was driving a vehicle that was registered in Alberta. He received benefits pursuant to the Alberta Automobile Accident Insurance Benefits and then claimed benefits under the SABS. The insurer refused to pay benefits under the SABS because the claimant was insured under an Alberta policy and had an Alberta address and driver’s licence. The issue at the LAT hearing was whether the Tribunal had jurisdiction to hear the dispute. Adjudicator Norris found that Part V of the Insurance Act did not apply to the claimant’s policy, therefore the claimant was not entitled to file an application pursuant to section 280(2) of the Insurance Act, and the LAT did not have jurisdiction to hear the matter.

J.W. v. Wawanesa Insurance (18-003407)

The claimant suffered catastrophic injuries in Quebec in 2000. She elected to receive no fault benefits under the Quebec SAAQ. Over time, Ontario had raised its hourly rates for service providers, while Quebec’s hourly rates remained lower. The claimant argued that despite receiving Quebec no fault benefits, she should be entitled to payment at the Ontario hourly rates for service providers. Adjudicator Flude rejected the claimant’s position, holding that once she had elected to receive Quebec no-fault benefits, she was to be treated as a Quebec resident under the Quebec SAAQ for the duration of her no fault claim.

I.M.N. v. Intact Insurance Company (18-005359)

The claimant sought reconsideration of the Tribunal’s decision that he was not entitled to accident benefits. The claimant had applied for benefits under Quebec’s SAAQ. He later filed an application for SABS benefits when he was unhappy with the SAAQ benefits. The Tribunal rejected the claimant’s arguments, stating that he was simply re-arguing the same points he had made at the preliminary hearing. The Tribunal had not breached the rules of natural justice or procedural fairness, and the claimant did not identify any errors of law made by the Tribunal.

I.M.N. v. Intact Insurance Company (18-005359)

The claimant sought reconsideration of the Tribunal’s decision that he was not entitled to accident benefits. The claimant had applied for benefits under Quebec’s SAAQ. He later filed an application for SABS benefits when he was unhappy with the SAAQ benefits. The Tribunal rejected the claimant’s arguments, stating that he was simply re-arguing the same points he had made at the preliminary hearing. The Tribunal had not breached the rules of natural justice or procedural fairness, and the claimant did not identify any errors of law made by the Tribunal.

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.

D.G. v. TD Home and Auto Insurance Company (17-000608)

The claimant was an Ontario resident involved in an accident while traveling in Michigan. He elected to receive accident benefits pursuant to Michigan’s accident benefits regime, rather than under the SABS. The claimant initially received accident benefits through Allstate Insurance pursuant to Michigan’s accident benefits scheme. TD Insurance then accepted priority, and informed the claimant that he was not entitled to receive benefits based on the Michigan regime as it was not a signatory to Michigan’s certification list. Adjudicator Watt concluded that as TD was not a signatory to Michigan’s no-fault certification list, the claimant did not qualify as an insured in Michigan for the purposes of electing Michigan accident benefits. As the claimant was entitled only to Ontario level accident benefits and TD had paid the maximum medical and rehabilitation benefits under the SABS, the application was dismissed.