Auto Insurance Coverage
What is Auto Insurance Coverage? I wish there was a legal text book covering this subject■
Due to the highly regulated nature of automobile insurance, several elements of the policy are standardized. The entire policy itself is known as the Ontario Automobile Policy (O.A.P. 1) Owner’s Policy (OAP 1). It is in a standard form that was developed and approved by the Financial Services Commission of Ontario (FSCO), and now by the Financial Services Regulatory Authority of Ontario (FSRA). This means that the elements of the auto policy, including the indemnity agreements, conditions, exclusions and definitions, will be the same across all auto policies in Ontario. The provisions are prescribed by the Insurance Act and incorporated into the OAP 1 as terms, conditions and statutory conditions. The OAP 1 is also written in plain, easy-to-understand English.
The OAP 1 contains three mandatory coverages:
- Third Party Liability
- Statutory Accident Benefits
- Uninsured/Unidentified Automobile
The OAP 1 also contains optional (opt-out) Direct Compensation – Property coverage. And let’s not forget optional property damage (specified perils, comprehensive, etc).
We act for insurers dealing with any type of coverage issues under the OAP 1. Our auto insurance coverage services include:
- Opinions on any coverage issues arising from the OAP 1 and endorsements, including:
- Is it an “automobile”?
- Is it an “accident”?
- Is the claimant an “insured person”
- Is the claimant a “dependent relative”?
- Is the person an “eligible claimant”?
- Exclusions and breaches of statutory conditions
- Investigations and examinations under oath.
- Reservations of rights and denial letters
- Coverage applications/actions and SABS adjudications
Ok … so …… we wrote a legal textbook on automobile insurance coverage in Ontario. It took about a year to write the content, and another year or two to come up with the catchy title.
The book is available in the LexisNexis store and online on Lexis+
Auto Insurance Coverage Cases
- Naim v Co-operators General Insurance Company (2024), Licence Appeal Tribunal (Coverage – Whether the claimant was an insured person under a policy as a ‘dependant’)
- Clarke v Coseco Insurance (2024), Licence Appeal Tribunal (Coverage – Whether the claimant was an insured person under a policy as a ‘dependant’)
- Pridmore v Drenth (2023), Superior Court (Coverage – Meaning of “authorized by law to drive” in Statutory Condition 4 in automobile policy, where insured was driving an ATV; Relief from Forfeiture)
- Beaudin v Travelers Insurance Company of Canada (2022), Court of Appeal (Coverage – Whether a dirt bike being driven in a race was an “automobile”)
- Rios v Chieftain Insurance (2024), Licence Appeal Tribunal (Coverage – Late application for benefits, contrary to section 32 of the Statutory Accident Benefits Schedule)
- Beaudin v Travelers Insurance Company of Canada (2021), Divisional Court (Coverage – Whether a dirt bike being driven in a race was an “automobile”)
- Lindo v Echelon Insurance (2021), Licence Appeal Tribunal (Coverage – Whether claimant who was victim of a drive-by shooting was involved in an “accident”)
- Perneroski v Echelon (2019), Court of Appeal (Coverage – Was the claimant’s uninsured dirt bike an “automobile” under the Statutory Accident Benefits Schedule while he was driving it in Georgia, USA?)
- Ayr Farmers Mutual v Wright (2016), Court of Appeal (Coverage – Can threshold issues of accident benefits coverage be decided at first instance in court?)
- Economical v Caughy (2016), Court of Appeal (Coverage – Whether tripping over a parked motorcycle was an “accident” under the Statutory Accident Benefits Schedule)
- Economical v Caughy (2014), Coverage (Whether tripping over a parked motorcycle was an “accident” under the Statutory Accident Benefits Schedule)
- K. (C.S.) v Economical (2010), FSCO Arbitration
- Poutney v Economical (2010), FSCO Arbitration (Coverage – Death benefits and financial dependency).\
- Valauskas v Motor Vehicle Accident Claims Fund (2009), FSCO Appeal (Nexus)
- Unifund v Danilov (2009), FSCO Arbitration (Nexus)
- MedCentra v Economical (2009), Superior Court (Coverage – Can a treatment provider/assessment centre pursue an accident benefits insurer directly for payments)
Auto Insurance Coverage Blog
A tale of two automobiles
"I know a lot about cars, man. I can look at any car's headlights and tell you exactly which way it's coming." - Mitch Hedberg, comedian The Financial Services Commission of Ontario (FSCO) has decided that 2011 will be the "Year of the Automobile." Herein is a tale of...