The Court of Appeal for Ontario has ruled drivers can still claim accident benefits on another driver’s policy, even if there are excluded from their own coverage. This is possible as long as they were not operating the vehicles from which they were secluded. The court came to the decision after assessing two separate incidents.
In The Dominion of Canada General Insurance Company v. State Farm Mutual Automobile Insurance Company, the court listened to two appeals in succession. Travelers Companies Inc. owns Dominion, the company at the centre of both appeals.
The first case involved Umberto Rupolo, who was a passenger when involved in a collision in his girlfriend’s car in February 2012. State Farm covered the policy of the vehicle owner (the girlfriend), but Rupolo claimed accident benefits from Dominion, who insured his parents car.
In the hearing, the arbitrator ruled for State Farm, saying Rupolo was eligible for accident benefits from The Dominion because he was not in his parents car. Under SABS regulation, “was to be given a broad and liberal interpretation, and that any ambiguity was to be resolved in favour of Umberto.” The arbitrator found that “there is sufficient ambiguity to an individual reading the OPCF 28A to think there would still be full accident benefits if not driving the excluded vehicle, and even limited accident benefits if driving the excluded vehicle.”
Ontario Superior Court of Justice Kelly Wright overruled this decision in 2015, but the case was appealed. On Feb. 2, 2018, the arbitrator’s original ruling was restored.
The Rupolo incident is similar to a case involving Matthew Bortulus, who was involved in an accident while driving his uninsured motorcycle in 2008. He applied for accident benefits through Belair, which was the insurance company of the other vehicle in the collision. Bortulus himself was excluded under his The Dominion policy, which was written for his parents’ vehicle. Belair argued it was up to The Dominion to cover the accident benefits claim.
Like the Rupolo case, the Court of Appeal of Ontario ruled against The Dominion and ordered the company to reimburse Belair.
As for the two people involved, neither were affected by the process thanks to Ontario’s pay first, dispute later system. This means an insurer must adjust a claim even if they believe another carrier should have covered the cost. Once the claim is adjusted, they can legally pursue the other carrier for reimbursement.