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Insurance Benefit Exclusions: Who's not Covered?

Posted by Kotak Law Office on September 09, 2015
Posted under Car Accidents, General Information

The Statutory Accident Benefits Schedule (‘SABS’) limits the entitlement of some ‘insured persons’ to accident benefits by creating a number of exclusions.1 Exclusions disentitle insured persons from certain benefits. These benefits are: a) income replacement benefit, b) non-earner benefit, c) education benefit, d) visitor benefit, and e) housekeeping benefit.

A driver is disentitled to these benefits if they were driving without insurance, without a valid drivers license, without consent2 of the owner of the vehicle, while being an excluded driver under the contract, or while engaging in a criminal offence. An occupant of a vehicles is disentitled to these benefits if they are aware the driver is operating the vehicle without the owner’s consent, was engaged in and convicted3 of a criminal offence, or is occupant of an automobile used in connection with a criminal offence.

A ‘criminal offence’ is broadly defined in the SABS. It includes operating an automobile while impaired by drugs or alcohol, while the concentration of alcohol in the operator’s blood exceeds the lawful limit; refusing to provide a breath sample, and any other criminal offence whether or not the insured was operating an automobile. It does not include provincial offences.4

In addition, a person will be excluded from the accident benefits specified above if they made, or know of, a material misrepresentation that influenced the insurer to enter into the car insurance policy, or if an insured fails to inform the insurer of a change in a risk material to the policy, such as a change in health condition.

To learn more or to discuss your motor vehicle accident, contact your team at Kotak today!

 

Citations:

  1. Insurance Act, Ontario Regulation 34/10, (s.31).
  2. In the automobile context, ‘consent’ is a fact driven question about which the Court has distilled 8 principles, or indicia where consent may be implied. Myers-Gordon (litigation guardian of) v. Martin, 2013, ONSC 5441 (S.C.J.) upheld on appeal, Myers-Gordon v. Martin, 2014 ONCA 767.
  3. The Court takes a literal interpretation of the term ‘convicted’ creating a situation where a different disposition of the criminal charge, such as guilty plea, does not trigger the exclusion. See J.K. and Wawanesa, (FSCO A12-001025, September 15, 2014). It has been argued this interpretation creates an absurdity not intended by the legislature, however, as a matter of statutory interpretation, the Court will not interfere and read-in more strict language or meaning to the statute - see Beattie v. National Frontier Insurance Co., 2003 CanLII 2715 (ON CA).
  4. Gipson v. Pilot Insurance Co., 2005 CanLII 1495 (ON SC).

Disclaimer

The contents of this blog are intended to provide general information on the law. It is not intended to form any solicitor-client relationship. Readers are encouraged to seek independent legal advice.  

Disclaimer: This article is intended to supply general information to the public. We make every effort to ensure the accuracy of this information. However, as laws change quickly, the reader should always ensure the accuracy and applicability of such information with respect to their particular case. The information contained in this article cannot replace a thorough and complete review of the reader's situation by competent legal counsel who has had an opportunity to review all of the facts.
Posted under Car Accidents, General Information
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