Wednesday, August 25, 2010

What amounts to an "application for benefits" sufficient to trigger access to statutory accident benefits?

ING Insurance Company of Canada v. TD Insurance Meloche Monnex, 2010 ONCA 559 deals with the insurance issue of what amounts to an "application for benefits" sufficient to trigger access to statutory accident benefits?

The Court holds the documentation need only provide sufficient particulars to reasonably assist the insurer with processing the application, identifying the benefits to which the applicant may be entitled, and assessing the claim.

The Court holds:


[1]               In Ontario, people injured in car accidents have immediate access to statutory accident benefits.  To ensure this result, the first insurer to receive a "completed application for benefits" is responsible for paying the benefits.  While that insurer may dispute its obligation to pay the benefits, such disputes are not to hold up benefit payments to the injured person.

[2]               In the present case, four people were injured in a car accident.  They went to a chiropractor for treatment.  The chiropractor sent ING Insurance Company of Canada ("ING") certain forms.  The question arose: did the forms amount to "completed applications for benefits", thereby triggering ING's obligation to pay benefits?  This appeal answers that question. 

...


[51]          I agree with the application judge, for the reasons that he gave, that the principle in Liberty Mutual applies.  Accordingly, an application for accident benefits need not be on a certain form in order to be valid – it need only provide sufficient particulars to reasonably assist the insurer with processing the application, identifying the benefits to which the applicant may be entitled, and assessing the claim: see paras. 41-42 of Liberty Mutual.  That is, the insurer only needs sufficient information to meaningfully move forward or commence the process of adjusting the claim: see Andriano v. Wawanesa Mutual Insurance Co., 2007 CarswellOnt 5669, at para. 36 (FSCO Arb.) and McIntosh v. Allstate Insurance Co. of Canada, 2004 CarswellOnt 2467, at paras. 32-33 (FSCO Arb.), both relying on Liberty Mutual.

1 comment:

chicago accident lawyer said...

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