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Insurance Act

R.S.O. 1990, CHAPTER I.8

Consolidation Period: From November 20, 2014 to the e-Laws currency date.

Last amendment: 2014, c. 9, Sched. 3.

CONTENTS

Definitions

1.

Definitions

PART I
GENERAL

Organization

5.1

Insurance Ombudsman

6.

Director of arbitrations

7.

Committees

8.

Arbitrators

9.

Mediators

11.

Evidence of mediation, evaluation, arbitration

11.

Evidence of persons who conducted certain proceedings

14.1

Assessment of health system costs

Decisions of Superintendent

15.

Orders

16.

Matters before the Superintendent

17.

Appeal of Superintendent’s decision

19.

Reference hearings

20.

Exclusive jurisdiction

21.

Rules

22.

Proceedings before Director or arbitrator

Administration

23.

Records of Superintendent

25.

Information about insurers, etc.

26.

Official documents as evidence

27.

Right to a licence

28.

Decision of Superintendent

33.

Service of documents

34.

Deemed service

35.

Service of notice or process on chief agent or Superintendent, insurers outside Ontario

36.

Annual report

PART II
GENERAL PROVISIONS APPLICABLE TO INSURERS

39.

Application of Part, insurance business in Ontario

Licences

40.

Necessity for licence

41.

Reinsurance with unlicensed insurer

42.

Authorized insurers and insurance

43.

Classes of insurance and licence conditions

44.

Membership in compensation association

45.

Conditions of automobile insurance licence

46.

Scope of life insurance licence

48.

Capital requirements, etc.

49.

Information preliminary to licence

50.

Documentary, etc., requirements

51.

Filing of changes in by-laws, etc.

52.

Corporate requirements

53.

Right to licence and insurer’s name

54.

Power of attorney of chief agent, insurers outside Ontario

55.

Form, term, conditions of licence

56.

Failure to pay claim, licence cancellation, etc.

57.

Suspension, cancellation of insurer’s licence for failure to pay administrative penalty

58.

Disciplinary action against insurers

62.

Superintendent takes control

63.

Appeal against Tribunal order to take control

64.

Revival of licence

65.

Notice of suspension or cancellation

Withdrawal from Automobile Insurance

65.1

Withdrawal procedure

Deposits

66.

Deposits

Records and Returns

100.

Report on share transfers

101.

Returns

101.1

Information on claims

102.

Business statements and capital or asset requirements

103.

Notice of returns

104.

Preparation of financial statements

105.

Published statements

106.

Statements that financial standing guaranteed by government prohibited

Real Property

107.

Powers of insurer to hold real property

Life Insurance

109.

Variable life insurance contracts based on segregated funds

110.

Variable life insurance contracts, forms and information folders

111.

Life insurers to separate business accounts

112.

Life insurance, distribution of parts of profits to participating policyholders

Insurance with Unlicensed Insurers

113.

Insurance with unlicensed insurers

General

115.

Trafficking in life insurance policies prohibited

115.1

Necessity for licence, long-term disability benefits

116.

Privileged information

117.

Form of insurance policy

118.

Violation of law, effect of, on claim for indemnity

119.

Reporting on applications to register

Agreements with Compensation Association

120.

Authority of Minister

Fees and Regulations

121.

Regulations

121.1

Fees

121.2

Forms

PART II.1
ACTUARY OF THE INSURER

121.3

Definition

121.4

Appointment of actuary

121.5

Notice of appointment

121.6

When officers not to be actuary

121.7

Chief financial officer

121.8

Revocation of appointment

121.9

Ceasing to hold office

121.10

Filling vacancy

121.11

Statement of actuary

121.12

Duty of replacement actuary

121.13

Actuary’s valuation

121.14

Superintendent may appoint actuary

121.15

Right to information

121.16

Actuary’s report

121.17

Report to directors

121.18

Report to officers

121.19

Qualified privilege

121.20

Non-application of this Part

121.21

Non-application of s. 121.17

121.22

Exemptions

PART II.2
DIRECTORS OF AN INSURER

121.23

Affiliated individuals

121.24

Directors’ duties

PART III
INSURANCE CONTRACTS IN ONTARIO

122.

Application of Part

123.

Contracts deemed made in Ontario

124.

Requirement for all terms to be set out in policy; relevance of proposal, etc.

125.

Copy of proposal to be furnished to insured

126.

No contract shall be inconsistent with Act

127.

Contents of policy

128.

Contracts providing for appraisals

129.

Relief from forfeiture

130.

How policy payable

131.

Waiver of term or condition

132.

Right of claimant against insurer where execution against insured returned unsatisfied

133.

Court actions for recovery of insurance money, special rules

134.

Non-payment of premium

135.

Insurer to furnish forms for proof of loss

136.

When action may be brought under contract

Insurance as Collateral Security

137.

Mortgagee not to receive commission from insurer

138.

Right to refund of premium on termination of contract

Contracts of Guarantee Insurance

139.

Contracts of title insurance

General

140.

No racial or religious discrimination permissible

141.

Payment into court

PART IV
FIRE INSURANCE

142.

Meaning of “agricultural property”, Part IV

143.

Application of Part

144.

Extent of coverage by contract

145.

Renewal of contract

146.

Form of contract

147.

Mortgagees and other payees

148.

Statutory conditions

149.

Limitation of liability clause

150.

Rateable contribution

151.

Special stipulations

152.

Subrogation

Fire Mutuals Guarantee Fund

153.

General reinsurance agreement

169.

Fire Mutuals Guarantee Fund

PART V
LIFE INSURANCE

Definitions

171.

Definitions, Part V

Application of Part

172.

Application of Part

173.

Group insurance

173.1

Application of ss. 126 and 131

Issuance of Policy and Contents Thereof

174.

Insurer to issue policy

175.

Contents of policy

176.

Contents of group policy

177.

Contents of group certificate

177.

Contents of group certificate

Conditions Governing Formation of Contract

178.

Insurable interest required

179.

Insurable interest, defined

179.

Insurable interest, defined

179.1

Termination of contract by court

180.

Contract taking effect

181.

Default in paying premium

182.

Payment of premium

183.

Duty to disclose

184.

Exceptions

185.

Non-disclosure by insurer

186.

Insurable age

187.

Misstatement of age in group insurance

188.

Effect of suicide

189.

Reinstatement

189.1

Termination and replacement of group contract

Designation of Beneficiaries

190.

Designation of beneficiary

191.

Designation of beneficiary irrevocably

192.

Designation in will, etc.

193.

Trustee for beneficiary

194.

Beneficiary’s share of insurance money

195.

Right to sue

196.

Insurance money free from other claims, etc.

Dealings with Contract During Lifetime of Insured

197.

Insured dealing with contract

198.

Insured entitled to dividends

199.

Transfer of ownership

199.

Transfer of ownership

200.

Effect of assignment

201.

Group life insured, enforcing rights

201.1

Enforcement of right re creditor’s group insurance

Minors

202.

Capacity of minors

Proceedings under Contract

203.

Proof of claim

204.

Payment of insurance money

205.

Action in Ontario

207.

Documents affecting right to insurance money

208.

Declaration as to sufficiency of proof

209.

Declaration as to presumption of death

210.

Court orders, application under s. 208 or 209

211.

Stay of proceedings

212.

Appeal, ss. 208 to 210

213.

Court orders, insufficient evidence, etc.

214.

Payment into court

215.

Simultaneous deaths

216.

Insurance money payable in instalments

217.

Insurer holding insurance money

218.

Court may order payment

219.

Costs, s. 214 or 218

220.

Minors

221.

Beneficiary under disability

221.

Beneficiary under legal incapacity

Miscellaneous Provisions

222.

Presumption against agency

222.

Presumption against agency

223.

Insurer giving information

PART VI
AUTOMOBILE INSURANCE

224.

Interpretation, Part VI

225.

Exception re insured

226.

Application of Part

226.1

Out-of-province insurers

Approval of Forms

227.

Approval of forms

228.

Application form

Other Information

229.

Information for applicants, etc.

230.

Information from brokers

Application and Policy

231.

Persons forbidden to act as agent

232.

Policy, formal requirements

232.1

Inspection requirements

233.

Misrepresentation or violation of conditions renders claim invalid

234.

Statutory conditions

236.

Notice of expiry or variation

237.

Limitation on termination

238.

Grounds to terminate

238.1

Affiliated automobile insurers, concurrent filing

Motor Vehicle Liability Policies

239.

Policy coverage

240.

Insurer not liable re excluded driver

241.

Coverage of non-owner’s policy

242.

Persons deemed not owners

243.

Territorial limits

244.

Rights of unnamed insured

245.

Additional agreements

246.

Liability for contamination

247.

Other liability, possible exclusions

248.

Liability for damage caused by machinery, etc.

249.

Excluded driver endorsement

250.

Liability, possible exclusions for other uses

251.

Minimum liability under policy

252.

Liability arising from use, etc., outside Ontario

253.

Excess insurance

254.

Agreement for partial payment of claim by insured

255.

Liability for nuclear energy hazard

256.

Advance payments and release by claimant

257.

Defence where more than one contract

258.

Application of insurance money, 3rd party claims, etc.

258.1

Notice of accident

258.2

Application of ss. 258.3 to 258.6

258.3

Notice and disclosure before action

258.4

Duty to disclose limits

258.5

Duty of insurer re settlement of claim

258.6

Mediation

259.

Notice of action and judgment against insured

259.1

Limitation period

Physical Damage Cover

260.

Physical damage cover, limitations and exclusions

261.

Partial payment of loss clause

262.

Claims under other contracts to be adjusted

Direct Compensation — Property Damage

263.

Accidents involving two or more insured automobiles

Limited Accident Insurances

265.

Uninsured automobile coverage

266.

Statutory accident principle established, automobile use, June 22, 1990 – Dec. 31, 1993

267.

Collateral source rule not to apply, automobile use, Oct. 24, 1989 – Dec. 31, 1993

267.1

Protection from liability, automobile use, Jan. 1, 1994 - Oct. 31, 1996

267.2

Publication of deductible amounts

Court Proceedings for Accidents on or after November 1, 1996

267.3

Definitions, ss. 267.4 to 267.12

267.4

Application of ss. 267.5 to 267.11, automobile use on or after Nov. 1, 1996

267.5

Protection from liability

267.6

No action by uninsured owner or lessee

267.7

Joint and several liability with other tortfeasors

267.8

Collateral benefits

267.9

Proceedings by action

267.10

Structured judgments

267.11

No gross-up for income tax

267.12

Liability of lessors

268.

Statutory accident benefits

268.0.1

Winding-up orders

268.1

Publication of indexation percentage

268.2

Rules of interpretation, Statutory Accident Benefits Schedule

268.3

Guidelines, Statutory Accident Benefits Schedule

268.4

Immunity

269.

Particulars of insurance

270.

Rights of unnamed insured

271.

Payment into court

273.

Claimant’s obligation to inform

273.1

Information to Ministry of Community and Social Services, etc.

274.

Release

275.

Indemnification in certain cases

276.

Terms of certain insurances, insurance under s. 265

Other Insurance

277.

Other insurance

Subrogation

278.

Subrogation

Dispute Resolution — Statutory Accident Benefits

279.

Dispute resolution

279.

Definitions

280.

Mediation

280.

Resolution of disputes

280.1

Neutral evaluation

281.

Litigation or arbitration

281.

Protection of benefits after Tribunal resolution

281.1

Limitation period

282.

Arbitration

282.

Assessment of dispute resolution costs

283.

Appeal against arbitration order

283.

Transition — regulations

284.

Application for variation, Director’s or arbitrator’s order

284.1

Restrictions on who may represent

285.

Stated case by Director

286.

When arbitrator cannot act

287.

Protection of benefits

288.

Finding of possible unfair or deceptive business practice

Insurers’ Payments for Listed Expenses — Statutory Accident Benefits

288.1

Listed expenses in connection with statutory accident benefits

288.2

Restrictions re payments for listed expenses

288.3

Public registry re service provider’s licences

288.4

Service provider’s licence — attributes and duties

288.5

Issuance of service provider’s licence

288.6

Revocation, suspension or surrender of service provider’s licence

288.7

Superintendent’s proposal to refuse application, etc.

Changes to Statutory Accident Benefits Schedule

289.

Review of this Part

PART VII
ACCIDENT AND SICKNESS INSURANCE

290.

Definitions, Part VII

291.

Application of Part

292.

Group insurance

292.1

Application of ss. 126 and 131

293.

Issue of policy

293.

Insurer to issue policy, furnish documents

294.

Contents of policy

295.

Confinement clauses void

296.

Contents of group policy

296.

Contents of group policy or creditor’s group policy

297.

Continuation of accident and sickness insurance where contract terminated

297.

Continuation of accident and sickness insurance where contract terminated

298.

Contents of group certificate

299.

Exceptions or reduction

300.

Statutory conditions

300.

Statutory conditions

301.

Omission or variation of statutory conditions

302.

Notice of statutory conditions

302.1

Declaration as to sufficiency of proof

302.2

Declaration of presumption of death

302.3

Court order re payment of insurance money

302.4

Order stays pending action

302.5

Order re furnishing of further evidence

303.

Termination for non-payment of initial or renewal premium

304.

Right where premium unpaid

305.

Insurable interest, defined

305.

Insurable interest, defined

306.

Insurable interest required

306.1

Termination of contract by court

Policies on Lives of Minors

307.

Capacity of minors

Misrepresentation and Non-Disclosure

308.

Duty to disclose

309.

Incontestability

309.

Failure to disclose

310.

Application of incontestability to reinstatement

311.

Pre-existing conditions

312.

Misstatement of age

Beneficiaries

313.

Designation of beneficiary

314.

Death of beneficiary or insured, etc.

314.1

Irrevocable designation

315.

Trustee for beneficiary

316.

Documents affecting title and assignment of contracts

317.

Insurance money free from other claims, etc.

317.1

Assignment of insurance

317.2

Entitlement to dividends

317.3

Transfer of ownership

318.

Group person insured enforcing rights

318.1

Enforcement of right re creditor’s group insurance

319.

Simultaneous deaths

320.

Payment into court

321.

Where beneficiary a minor

322.

Beneficiary under disability

322.

Beneficiary under legal incapacity

323.

Payments not exceeding $2,000

323.

Payments not exceeding $10,000

324.

Payment of insurance money

325.

Action in Ontario

326.

Insurer giving information

327.

Undue prominence

328.

Relief from forfeiture

328.

Relief from forfeiture

329.

Presumption against agency

329.

Presumption against agency

PART X
FRATERNAL SOCIETIES

339.

Definitions, Part X

340.

Application of Part

341.

What fraternal societies required to be licensed

342.

Cases in which societies not to be licensed

343.

Societies deemed not to be fraternal societies

344.

Guarantee and endowment insurance, exception to s. 342 (b)

345.

Central body for Ontario or representative may be dealt with

346.

By-laws and rules

347.

Amendment of rules, Superintendent’s direction

348.

Rules deliverable on demand

350.

Limitation of member’s liability in fraternal society

352.

Conditions of forfeiture restricted

353.

How notice may be given to members

354.

Head offices of Ontario societies

355.

Actuary’s report

356.

Where assets of society insufficient

357.

Reduction of benefits, or increase of rates

358.

Default of society in complying with request of Superintendent

359.

Separate accounts for each class of insurance

361.

Epidemic or unforeseen contingency

362.

General or expense fund

370.

Exception as to annual statement

371.

Policy disclosures

PART XIII
RECIPROCAL INSURANCE EXCHANGES

377.

Definitions, Part XIII

378.

Authority for exchange of reciprocal contracts of insurance

379.

Subscriber not to be deemed an insurer

380.

Contract executed on behalf of subscribers

380.1

Exchange agreement – required elements

381.

Filing by members of exchange

382.

Licence for exchange, approval of change

384.

Service of process

386.

Reserves to be held by exchange

387.

Investment of funds

388.

Other insurance or reinsurance

389.

Attorney not to act until licence granted

389.1

Divestment order

390.

Suspension or revocation of licence

392.

Fire insurance in unlicensed exchanges may be effected outside Ontario

PART XIV
AGENTS, BROKERS AND ADJUSTERS

Interpretation

392.1

Definition

Licences of Insurance Agents

392.2

Insurance agent’s licence, scope of authority

392.3

Application for agent’s licence

392.4

Issuance, amendment and renewal of agent’s licence

392.5

Revocation or suspension of agent’s licence

392.6

Automatic suspension of agent’s licence

392.7

Surrender of agent’s licence

392.8

Regulations re: agent’s licences

Licences of Insurance Agents

393.

Licensing of agents

Provisions Relating to Agents and Brokers Generally

394.

Agent or broker deemed to be insurer’s agent

395.

Fraudulent representations

396.

Personal liability of agent for unlawful contracts

Licences of Insurance Adjusters

397.

Licences of insurance adjusters

398.

Prohibition against public adjusters of motor accident claims

Partnership Licences of Agents and Adjusters

399.

Licences to partnerships

Corporation Licences of Agents and Adjusters

400.

Licences to corporations

Provisions Relating to Agents, Brokers and Adjusters Generally

401.

Acting as agent or adjuster without authority

402.

Money held in trust by agent

403.

No compensation to be paid by insurer not licensed

407.

Limited or conditional licence

407.1

Suspension, revocation of licence for failure to pay administrative penalty

Notice of Proposal by Superintendent

407.1

Superintendent’s proposal to refuse application, etc.

407.2

Transition

PART XV
RATES AND RATING BUREAUS

408.

Meaning of “rating bureau”, Part XV

409.

Duties of rating bureaus and insurers

410.

Application re risk classification system, rates

411.

Approval of expedited applications, s. 410

412.

Approval of other applications, s. 410

412.1

Hearing

413.

Exemptions from approval process

413.1

Risk classification and rate determination regulations

414.

Affiliated automobile insurers

415.

Reconsideration, systems and rates

416.

Ministerial policy, statements, systems and rates

417.

Automobile insurance, systems and rates

417.0.1

Risk classification systems, emergency vehicles

418.

Inquiry

PART XVI
AMALGAMATIONS AND TRANSFERS

419.

Meaning of “transfer”, Part XVI

420.

Application

421.

Transfer agreements, requirements

422.

Transfer agreements, application for approval

425.

Documents to be filed with Superintendent

426.

Approval or rejection of transfer

431.

Transfer of contracts where insurer leaves Ontario

PART XVII
INVESTMENTS

Transition to New Investment Rules

431.1

Interpretation

Interpretation and Application

432.

Interpretation

433.

Application

Investment Standards

434.

Investment standards

Acquiring, Holding or Increasing Substantial Investments

435.

General restriction on substantial investment

435.1

Substantial investment in permitted entity

435.2

Indirect substantial investment

Acquiring Shares or Ownership Interests Through Loan Workouts and Realization of Security Interests

435.3

Loan workouts

435.4

Acquisition of shares or ownership interests on realization of security interest

Acquiring Substantial Investments in other Specified Circumstances

435.5

Specialized financing

435.6

Authorized investments

Portfolio and Lending Limits

435.7

Restrictions on loans, etc.

435.8

Exclusion from portfolio limits

435.9

Lending limits

435.10

Limit on interests in real property

435.11

Limit on equity acquisitions

435.12

Aggregate investment limit

435.13

Divestment order

435.14

Limit on asset transactions

436.

Transitional provisions

437.

Investments, value and formal requirements

PART XVII.1
RELATED PARTY TRANSACTIONS

Interpretation and Application

437.12

Definitions

437.13

Related parties

437.14

Transactions

437.15

Application

Rules for Transactions with Related Parties

437.16

General rule re transactions with related party

437.17

Subsidiary’s transactions deemed to be those of insurer

437.18

Transactions permitted with related parties

437.19

Transactions with directors, senior officers, etc.

437.20

Transactions exempt under Superintendent’s order

437.21

Determining if related party involved

437.22

Contravention

PART XVIII
UNFAIR OR DECEPTIVE ACTS OR PRACTICES

438.

Definitions, Part XVIII

439.

Unfair or deceptive acts, etc., prohibited

440.

Superintendent may investigate

441.

Action on examination or investigation

PART XVIII.1
ADMINISTRATIVE PENALTIES

441.1

Definitions

441.2

Administrative penalties

441.3

General administrative penalties

441.4

Summary administrative penalties

441.5

Maximum administrative penalties

441.6

Enforcement of administrative penalties

PART XIX
EXAMINATION AND ENFORCEMENT

442.

Interpretation, Part XIX

442.1

Inquiries

442.2

Right of access to books, records, etc.

442.3

Duty to provide information

442.4

Annual, etc., examination of insurers

443.

Examinations, general

444.

Powers of examination, etc.

444.1

Power to summon persons, etc.

445.

Reports

446.

No liability

446.1

Prohibition re obstruction

447.

Offences, false information, etc.

448.

Order for compliance

449.

Limitation period

Definitions

Definitions

1.  In this Act, except where inconsistent with the definition sections of any Part,

“accountant” means a person who is licensed under the Public Accounting Act, 2004; (“comptable”)

“actuary” means a Fellow of the Canadian Institute of Actuaries; (“actuaire”)

“adjuster” means a person who,

(a) on behalf of an insurer or an insured, for compensation, directly or indirectly solicits the right to negotiate the settlement of or investigate a loss or claim under a contract or a fidelity, surety or guaranty bond issued by an insurer, or investigates, adjusts or settles any such loss or claim, or

(b) holds himself, herself or itself out as an adjuster, investigator, consultant or adviser with respect to the settlement of such losses or claims,

but does not include,

(c) a barrister or solicitor acting in the usual course of the practice of law,

(d) a trustee or agent of the property insured,

(e) a salaried employee of a licensed insurer while acting on behalf of such insurer in the adjustment of losses,

(f) a person who is employed as an appraiser, engineer or other expert solely for the purpose of giving expert advice or evidence, or

(g) a person who acts as an adjuster of marine losses only; (“expert d’assurance”)

“agent” means a person who, for compensation, commission or any other thing of value,

(a) solicits insurance on behalf of an insurer who has appointed the person to act as the agent of such insurer or on behalf of the Facility Association under the Compulsory Automobile Insurance Act, or

(b) solicits insurance on behalf of an insurer or transmits, for a person other than himself, herself or itself, an application for, or a policy of insurance to or from such insurer, or offers or assumes to act in the negotiation of such insurance or in negotiating its continuance or renewal with such insurer,

and who is not a member of the Registered Insurance Brokers of Ontario; (“agent”)

“automobile” includes a trolley bus and a self-propelled vehicle, and the trailers, accessories and equipment of automobiles, but does not include railway rolling stock that runs on rails, watercraft or aircraft; (“automobile”)

“broker” means an insurance broker within the meaning of the Registered Insurance Brokers Act; (“courtier”)

“cash-mutual corporation” means a corporation without share capital that is empowered to undertake insurance on both the cash plan and the mutual plan; (“société mutuelle au comptant”)

“chief agency” means the principal office or place of business in Ontario of any licensed insurer having its head office out of Ontario; (“agence principale”)

“Commission” means the Financial Services Commission of Ontario established under the Financial Services Commission of Ontario Act, 1997; (“Commission”)

“compensation association” means a body corporate or unincorporated association the purpose of which is to provide compensation to claimants and policyholders of insolvent insurers and that has been designated under the regulations as a compensation association; (“association d’indemnisation”)

“contract” means a contract of insurance, and includes a policy, certificate, interim receipt, renewal receipt, or writing evidencing the contract, whether sealed or not, and a binding oral agreement; (“contrat”)

“debt obligation” means a bond, debenture, note or other evidence of indebtedness, whether the debt is secured or unsecured; (“titre de créance”)

“Director” means the director of arbitrations appointed under section 6; (“directeur”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “Director” is repealed. (See: 2014, c. 9, Sched. 3, ss. 1, 22)

“due application” includes such information, evidence and material as the Superintendent requires to be furnished and the payment of the fees established by the Minister in respect of any application, certificate or document required or issued by virtue of this Act; (“demande régulière”)

“entity” includes a corporation, trust, partnership, fund, unincorporated association or organization, the Crown, a Crown agency, the government of a foreign country or of a political subdivision of a foreign country and any agency of that government; (“entité”)

“exchange” or “reciprocal insurance exchange” means a group of subscribers exchanging reciprocal contracts of indemnity or insurance with each other through the same attorney; (“bourse” ou “bourse d’assurance réciproque”)

“financial institution” means,

(a) an insurer that is incorporated or organized under the laws of Canada or of any province of Canada,

(b) a bank or authorized foreign bank within the meaning of section 2 of the Bank Act (Canada),

(c) a loan or trust corporation incorporated or organized under the laws of Canada or any province of Canada,

(d) an entity that,

(i) is incorporated or organized under the laws of Canada or of any province of Canada, and

(ii) primarily engages in dealing in securities, including portfolio management and investment counselling,

(e) a credit union or caisse populaire incorporated under the laws of any province of Canada or an association to which the Cooperative Credit Associations Act (Canada) applies,

(f) an entity that is prescribed or is a member of a class that is prescribed; (“institution financière”)

“foreign jurisdiction” means a jurisdiction other than Ontario; (“ressort étranger”)

“fraternal society” means a society, order or association incorporated for the purpose of making with its members only, and not for profit, contracts of life insurance or accident and sickness insurance in accordance with its constitution, by-laws and rules and this Act; (“société fraternelle”)

“governing executive authority” means the executive committee, executive board, management committee, grand executive committee or such other board, committee or body as is charged under the constitution and rules of a fraternal society with its general management between general meetings; (“organe de direction”)

“head office” means the place where the chief executive officer of an insurer transacts business; (“siège social”)

“industrial contract” means a contract of life insurance for an amount not exceeding $2,000, exclusive of any benefit, surplus, profit, dividend or bonus also payable under the contract, and that provides for payment of premiums once every two weeks or at shorter intervals, or, if the premiums are usually collected at the home of the insured, at monthly intervals; (“contrat populaire”)

“insurance” means the undertaking by one person to indemnify another person against loss or liability for loss in respect of a certain risk or peril to which the object of the insurance may be exposed, or to pay a sum of money or other thing of value upon the happening of a certain event, and includes life insurance; (“assurance”)

“insurance fund” or “insurance funds”, as applied to a fraternal society or as applied to a corporation not incorporated exclusively for the transaction of insurance, includes all money, securities for money and assets appropriated by the rules of the society or corporation to the payment of insurance liabilities or appropriated for the management of the insurance branch or department or division of the society, or otherwise legally available for insurance liabilities, but does not include funds of a trade union appropriated to or applicable for the voluntary assistance of wage earners unemployed or upon strike; (“fonds d’assurance”)

“insurance money” means the amount payable by an insurer under a contract, and includes all benefits, surplus, profits, dividends, bonuses, and annuities payable under the contract; (“sommes assurées”)

“insurance on the cash plan” means any insurance that is not mutual insurance; (“assurance au comptant”)

“insurer” means the person who undertakes or agrees or offers to undertake a contract; (“assureur”)

“lodge” includes a primary subordinate division, by whatever name known, of a fraternal society; (“loge”)

“Minister” means the Minister of Finance; (“ministre”)

“motor vehicle liability policy” means a policy or part of a policy evidencing a contract insuring,

(a) the owner or driver of an automobile, or

(b) a person who is not the owner or driver thereof where the automobile is being used or operated by that person’s employee or agent or any other person on that person’s behalf,

against liability arising out of bodily injury to or the death of a person or loss or damage to property caused by an automobile or the use or operation thereof; (“police de responsabilité automobile”)

“mutual benefit society” means a mutual corporation formed for the purpose of providing insurance against sickness, disability or death for its members, or for these and any other purposes necessary or incidental thereto except life insurance, but does not include a pension fund or employees’ mutual benefit society incorporated under or subject to the Corporations Act; (“société de secours mutuel”)

“mutual corporation” means a corporation without share capital that is empowered to undertake mutual insurance exclusively; (“société mutuelle”)

“mutual insurance” means a contract of insurance in which the consideration is not fixed or certain at the time the contract is made and is to be determined at the termination of the contract or at fixed periods during the term of the contract according to the experience of the insurer in respect of all similar contracts, whether or not the maximum amount of such consideration is predetermined; (“assurance mutuelle”)

“non-owner’s policy” means a motor vehicle liability policy insuring a person solely in respect of the use or operation by that person or on that person’s behalf of an automobile that is not owned by that person; (“police de non-propriétaire”)

“officer” includes a trustee, director, manager, treasurer, secretary or member of the board or committee of management of an insurer and a person appointed by the insurer to sue and be sued in its behalf; (“dirigeant”)

“owner’s policy” means a motor vehicle liability policy insuring a person in respect of the ownership, use or operation of an automobile owned by that person and within the description or definition thereof in the policy and, if the contract so provides, in respect of the use or operation of any other automobile; (“police de propriétaire”)

“paid in”, when applied to the capital stock of an insurer or to any shares thereof, means the amount paid to the insurer on its shares, not including the premium, if any, paid thereon, whether such shares are or are not fully paid; (“versé”)

“paid up”, when applied to the capital stock of an insurer or to any shares thereof, means the capital stock or shares on which there remains no liability, actual or contingent, to the issuing insurer; (“libéré”)

“participating share” means a share of a corporation that carries the right to participate in the earnings of the corporation to an unlimited degree and to participate in a distribution of the remaining property of the corporation on dissolution; (“action participante”)

“policy” means the instrument evidencing a contract; (“police”)

“premium” means the single or periodical payment under a contract for insurance, and includes dues, assessments, administration fees paid for the administration or servicing of such contract, and other considerations; (“prime”)

“premium note” means an instrument given as consideration for insurance whereby the maker undertakes to pay such sum or sums as may be legally demanded by the insurer, but the aggregate of which sums does not exceed an amount specified in the instrument; (“billet de souscription”)

“property” includes profits, earnings and other pecuniary interests, and expenditure for rents, interest, taxes and other outgoings and charges and in respect of inability to occupy the insured premises, but only to the extent of express provision in the contract; (“biens”)

“rate”, in relation to automobile insurance, means all amounts payable under contracts of automobile insurance for an identified risk whether expressed in dollar terms or in some other manner and includes commissions, surcharges, fees, discounts, rebates and dividends; (“taux”)

“regulations” means the regulations made under this Act; (“règlements”)

“risk classification system”, in relation to automobile insurance, means the elements used for the purpose of classifying risks in the determination of rates for a coverage or category of automobile insurance, including the variables, criteria, rules and procedures used for that purpose; (“système de classement des risques”)

“salesperson” means a person who is employed by a licensed insurance agent or broker on a stated salary that is not supplemented by commission, bonus or any other remuneration to solicit insurance or transact, for a person other than himself or herself, an application for a policy of insurance, or to act in the negotiation of such insurance or in negotiating its continuance or renewal, or collects and receives premiums on behalf of his or her employer only, but does not include a licensed insurance agent, broker or employee engaged solely in office duties for an agent or broker; (“vendeur”)

“security” means, when used to refer to a form of investment,

(a) a share of any class of shares of a corporation or a debt obligation of a corporation, and includes a warrant of a corporation, but does not include a deposit with a financial institution, any instrument evidencing a deposit with a financial institution or a policy, or

(b) any ownership interest in or debt obligation of an unincorporated entity, but does not include a policy; (“titre”or “valeur mobilière”)

“security interest” means an interest in or charge upon property by way of mortgage, hypothec, pledge or otherwise, to secure the payment of a debt or the performance of another obligation; (“sûreté”)

“spouse” means either of two persons who,

(a) are married to each other,

(b) have together entered into a marriage that is voidable or void, in good faith on the part of the person asserting a right under this Act, or

(c) are not married to each other and live together in a conjugal relationship outside marriage; (“conjoint”)

“Superintendent” means the Superintendent of Financial Services appointed under the Financial Services Commission of Ontario Act, 1997; (“surintendant”)

“Tribunal” means the Financial Services Tribunal established under the Financial Services Commission of Ontario Act, 1997; (“Tribunal”)

“upon proof”, as applied to any matter connected with the licensing of an insurer or other person, means upon proof to the satisfaction of the Superintendent; (“sur preuve”)

“voting share” means a share of a corporation carrying voting rights under all circumstances or by reason of an event that has occurred and is continuing or by reason of a condition that has been fulfilled. (“action avec droit de vote”) R.S.O. 1990, c. I.8, s. 1; 1993, c. 10, s. 2; 1994, c. 11, s. 336; 1996, c. 21, s. 1; 1997, c. 19, s. 10 (1); 1997, c. 28, s. 64; 1999, c. 6, s. 31 (1); 1999, c. 12, Sched. I, s. 4 (1, 2); 2002, c. 18, Sched. H, s. 4 (1-4); 2004, c. 8, s. 46; 2004, c. 31, Sched. 20, s. 1; 2005, c. 5, s. 35 (1, 2); 2006, c. 33, Sched. O, s. 1.

PART I
GENERAL

Organization

2.-5.  Repealed: 1997, c. 28, s. 66.

Insurance Ombudsman

5.1  (1)  The Superintendent shall appoint an employee of the Commission as Insurance Ombudsman. 1996, c. 21, s. 2; 1997, c. 28, s. 67.

Duties

(2)  The Insurance Ombudsman shall inquire into complaints about insurers’ business practices.

Complaints

(3)  A person may submit a written complaint about an insurer’s business practices to the Insurance Ombudsman if the person has submitted the complaint to the insurer and the complaint has not been resolved within a reasonable time.

Response

(4)  The Insurance Ombudsman shall give the insurer an opportunity to respond to any complaint submitted under subsection (3).

Authority of Insurance Ombudsman

(5)  After considering the complaint and any response, the Insurance Ombudsman may attempt to resolve the complaint or may recommend to the Superintendent that the Superintendent inquire into the complaint. 1996, c. 21, s. 2.

Director of arbitrations

6.  (1)  The Lieutenant Governor in Council shall appoint a director of arbitrations who shall carry out the duties and exercise the powers of the Director under this Act. R.S.O. 1990, c. I.8, s. 6 (1); 1996, c. 21, s. 3.

Acting Director

(2)  If the Director is absent or if there is a vacancy in the office of Director, such person as may be designated by the Director shall act as and have all the powers of the Director.

Delegation

(3)  The Director may delegate in writing any of his or her powers or duties to an employee of the Commission, subject to any limitation or condition set out in the delegation.

Idem

(4)  The Director may appoint employees of the Commission or other persons to hold hearings on his or her behalf and to exercise the powers and perform the duties of the Director relating to such hearings. R.S.O. 1990, c. I.8, s. 6 (2-4).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 6 of the Act is repealed. (See: 2014, c. 9, Sched. 3, ss. 2, 22)

Committees

7.  (1)  The Minister shall appoint one or more committees for the purposes of this Act.

Name

(2)  The Minister shall assign a name to each committee. 1996, c. 21, s. 4.

Duties

(3)  Each committee shall,

(a) perform such functions as are assigned to the committee by the Minister or the Superintendent; and

(b) perform such other functions as are prescribed by the regulations. 1996, c. 21, s. 4; 1997, c. 28, s. 67.

Same

(4)  The Minister shall assign to one of the committees the function of recommending persons to conduct arbitrations under this Act. 1996, c. 21, s. 4.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (4) is repealed. (See: 2014, c. 9, Sched. 3, ss. 3, 22)

Arbitrators

8.  (1)  The Superintendent shall establish and maintain a roster of candidates chosen by the Superintendent from the persons recommended to conduct arbitrations under this Act by the committee appointed under section 7. 1996, c. 21, s. 5; 1997, c. 28, s. 67.

Appointment

(2)  The Director shall appoint arbitrators only from the roster of candidates. R.S.O. 1990, c. I.8, s. 8 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 8 of the Act is repealed. (See: 2014, c. 9, Sched. 3, ss. 4, 22)

Mediators

9.  The Superintendent may appoint employees of the Commission or other persons to act as mediators. R.S.O. 1990, c. I.8, s. 9; 1997, c. 28, s. 67.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 9 of the Act is repealed. (See: 2014, c. 9, Sched. 3, ss. 5, 22)

10.  Repealed: 1996, c. 21, s. 6.

Evidence of mediation, evaluation, arbitration

11.  (1)-(4)  Repealed: 1997, c. 28, s. 68 (1).

Mediators

(5)  A mediator shall not be required to testify in a civil proceeding or in a proceeding before any tribunal respecting any mediation conducted under this Act or respecting information obtained in the discharge of the mediator’s duties under this Act. 1996, c. 21, s. 7.

Neutral evaluation

(6)  A person who performs an evaluation under section 280.1 shall not be required to testify in a civil proceeding or in a proceeding before any tribunal respecting the evaluation or respecting information obtained in the discharge of the person’s duties under this Act. 1996, c. 21, s. 7.

Arbitrators

(7)  A person who is appointed as an arbitrator for the purposes of an arbitration under this Act shall not be required to testify in a civil proceeding or in a proceeding before any tribunal respecting any arbitration performed under this Act or respecting information obtained in the discharge of the person’s duties under this Act. 1997, c. 28, s. 68 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 11 is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 6, 22)

Evidence of persons who conducted certain proceedings

11.  (1)  A person who conducted a proceeding described in subsection (2) shall not be required to testify in a civil proceeding or in a proceeding before any tribunal respecting the proceeding described in subsection (2) or respecting information obtained in the discharge of the person’s duties under this Act. 2014, c. 9, Sched. 3, s. 6.

Proceedings

(2)  The proceedings referred to in subsection (1) are mediations, evaluations and arbitrations under sections 279 to 287, as those sections read immediately before being repealed by section 14 of Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014. 2014, c. 9, Sched. 3, s. 6.

12.  Repealed: 1997, c. 28, s. 69.

12.1  Repealed: 1997, c. 28, s. 70.

12.2  Repealed: 1997, c. 28, s. 71.

13.  Repealed: 1997, c. 28, s. 72.

14.  Repealed: 1997, c. 28, s. 73.

Assessment of health system costs

14.1  (1)  The Lieutenant Governor in Council may, in accordance with the regulations, assess all insurers that have issued motor vehicle liability policies in Ontario for amounts prescribed by the regulations that are incurred by the Ministry of Health and Long-Term Care under an Act or program administered by that ministry. 1996, c. 21, s. 10; 2006, c. 19, Sched. L, s. 11 (3).

Same

(2)  If an assessment is made under subsection (1), the share of a particular insurer shall be determined in the manner prescribed by regulation. 1996, c. 21, s. 10.

Insurer’s duty to pay

(3)  An insurer shall pay the amount assessed against it. 1996, c. 21, s. 10.

Same

(4)  If an insurer fails to pay an assessment made under subsection (1), the Superintendent may suspend or cancel the insurer’s licence. 1996, c. 21, s. 10; 1997, c. 28, s. 74.

Same

(5)  The Superintendent may revive the licence of an insurer whose licence was suspended or cancelled under subsection (4) if the insurer pays all amounts owing by the insurer under this section. 1996, c. 21, s. 10; 1997, c. 28, s. 74.

Decisions of Superintendent

Orders

15.  (1)  The Superintendent shall determine matters before him or her by order and may make an order subject to such conditions as are set out in the order. R.S.O. 1990, c. I.8, s. 15 (1); 1997, c. 28, s. 75 (2).

Interim orders

(2)  The Superintendent may make interim orders pending the final order in a matter before him or her. R.S.O. 1990, c. I.8, s. 15 (2); 1997, c. 28, s. 75 (2).

Matters before the Superintendent

16.  (1)  The Superintendent is not required to hold a hearing when making a decision but shall allow the parties affected by a matter before him or her to make written submissions.

Variation of decisions

(2)  Subject to subsection (1), the Superintendent may reconsider and vary or revoke a decision or order made by him or her if the Superintendent considers it advisable to do so.

Making of rules

(3)  The Superintendent may make rules for the practice and procedure to be observed in determining matters before him or her.

Superintendent’s powers

(4)  In determining any matter, the Superintendent may,

(a) determine what constitutes adequate public notice;

(b) conduct any inquiry or inspection the Superintendent considers necessary;

(c) consider any relevant information obtained by the Superintendent in addition to information provided by the parties, if he or she first informs the parties of the additional information and gives them an opportunity to explain or refute it. 1997, c. 28, s. 76.

Appeal of Superintendent’s decision

17.  (1)  If an appeal is provided for, a person affected by a decision of the Superintendent may appeal the decision to the Tribunal.

Notice of appeal

(2)  A notice of appeal shall be in writing and shall be served on the Superintendent and filed with the Tribunal within 30 days after the date of the Superintendent’s decision or within such other time period that this Act specifies.

Hearing

(3)  The Tribunal shall hold a hearing of an appeal.

Parties

(4)  The parties to an appeal are the person who requests the appeal, the Superintendent and the other persons whom the Tribunal specifies.

Power of the Tribunal

(5)  Upon hearing an appeal, the Tribunal may, by order, confirm, vary or rescind the decision appealed from or substitute its decision for that of the Superintendent.

Stay of decision

(6)  The filing of a notice of appeal does not stay the decision of the Superintendent but the Tribunal may grant a stay until it disposes of the appeal. 1997, c. 28, s. 76.

18.  Repealed: 1997, c. 28, s. 76.

Reference hearings

19.  (1)  The Lieutenant Governor in Council may require the Tribunal to examine and report on any question related to insurance that, in the opinion of the Lieutenant Governor in Council, requires a public hearing. R.S.O. 1990, c. I.8, s. 19 (1); 1997, c. 28, s. 77.

Parties

(2)  The Tribunal shall determine who may be a party to a reference hearing. R.S.O. 1990, c. I.8, s. 19 (2); 1997, c. 28, s. 77.

Exclusive jurisdiction

20.  (1)  This section applies with respect to proceedings under this Act before the Tribunal, the Superintendent and the Director and before an arbitrator. R.S.O. 1990, c. I.8, s. 20 (1); 1997, c. 28, s. 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 7, 22)

Exclusive jurisdiction

(1)  This section applies with respect to proceedings under this Act before the Tribunal or the Superintendent. 2014, c. 9, Sched. 3, s. 7.

Idem

(2)  A person referred to in subsection (1) has exclusive jurisdiction to exercise the powers conferred upon him or her under this Act and to determine all questions of fact or law that arise in any proceeding before him or her and, unless an appeal is provided under this Act, his or her decision thereon is final and conclusive for all purposes.

Decisions, etc., not stayed

(3)  An application for judicial review and any appeal from an order of the court on the application does not stay the decision made under this Act.

Court may grant stay

(4)  Despite subsection (3), a judge of the court to which the application is made or a subsequent appeal is taken may grant a stay until the disposition of the judicial review or appeal. R.S.O. 1990, c. I.8, s. 20 (2-4).

Rules

21.  Subject to the regulations made under paragraph 25 of subsection 121 (1), the Director may make rules for the practice and procedure to be observed in mediations under section 280, in performing evaluations under section 280.1, and in proceedings under this Act before the Director or an arbitrator. 1996, c. 21, s. 11.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 21 is repealed. (See: 2014, c. 9, Sched. 3, ss. 8, 22)

Proceedings before Director or arbitrator

22.  (1)  For the purpose of exercising the powers and performing their duties under this Act, the Director and every arbitrator has the same power to summon and enforce the attendance of witnesses and compel them to give evidence on oath or otherwise, and to produce documents, records and things, as is vested in the Superior Court of Justice for the trial of civil actions. R.S.O. 1990, c. I.8, s. 22 (1); 1997, c. 28, s. 78; 2006, c. 19, Sched. C, s. 1 (1).

Power to require evidence

(2)  A person referred to in subsection (1) may require to be made or may take and receive affidavits or depositions and may examine witnesses upon oath. R.S.O. 1990, c. I.8, s. 22 (2).

Employment of stenographer

(3)  The evidence and proceedings in any matter before a person referred to in subsection (1) may be reported by a stenographer who has taken an oath before the person to report the evidence and proceedings faithfully. R.S.O. 1990, c. I.8, s. 22 (3).

Oaths

(4)  A person referred to in subsection (1) may administer and certify an oath required under this Act. R.S.O. 1990, c. I.8, s. 22 (4).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 22 is repealed. (See: 2014, c. 9, Sched. 3, ss. 9, 22)

Administration

Records of Superintendent

23.  (1)  The Superintendent shall keep the following books and records:

1. A register of all licences issued under this Act, in which shall appear the name of the insurer, the address of the head office, the address of the principal office in Canada, the name and address of the chief or general agent in Ontario, the number of the licence issued, particulars of the classes of insurance for which the insurer is licensed, and such other information as the Superintendent considers necessary.

2. A record of all securities deposited by each insurer with the Superintendent, naming in detail the several securities, their par value, their date of maturity and value at which they are received as deposit. R.S.O. 1990, c. I.8, s. 23 (1); 1997, c. 28, s. 79.

Inspection

(2)  The books and records required by this section to be kept shall be open to inspection at such times and upon payment of such fees as may be established by the Minister. R.S.O. 1990, c. I.8, s. 23 (2); 1997, c. 19, s. 10 (2); 2004, c. 31, Sched. 20, s. 2.

24.  Repealed: 1999, c. 12, Sched. I, s. 4 (3).

Information about insurers, etc.

Annual publication in The Ontario Gazette, notice of licence

25.  (1)  The Superintendent shall cause to be published in The Ontario Gazette in July of each year a list of the insurers licensed at the date of the list, and shall from time to time cause notice of the licence of an insurer not theretofore licensed and notice of suspension or cancellation or revivor of licence to be given by publication in The Ontario Gazette. R.S.O. 1990, c. I.8, s. 25 (1).

Certificates

(2)  The Superintendent may issue a certificate,

(a) Repealed: 1997, c. 28, s. 81 (2).

(b) stating that a copy of, or extract from, a document or thing in the custody of the Commission is a true copy of, or extract from, the original;

(c) stating the amount payable to the Minister of Finance under subsection 32 (3) or (4);

(d) stating the amount payable for an audit under subsection 101 (4);

(e) stating whether a document was served or delivered under this Act;

(f) stating whether any document required under this Act was filed;

(g) stating whether a document or notification was received or issued by the Superintendent, the Director, an arbitrator or a mediator under this Act.

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (g) is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 10, 22)

(g) stating whether a document or notification was received or issued by the Superintendent.

(h), (i) Repealed: 1997, c. 28, s. 81 (4).

R.S.O. 1990, c. I.8, s. 25 (2); 1997, c. 28, s. 81 (1-4); 2009, c. 33, Sched. 16, s. 7 (1).

(3)  Repealed: 1997, c. 28, s. 81 (5).

Official documents as evidence

26.  (1)  In this section,

“official document” means a certificate, licence, order, decision, direction, inquiry or notice under this Act. R.S.O. 1990, c. I.8, s. 26 (1).

Idem

(2)  An official document that purports to be signed on behalf of the Superintendent shall be received in evidence in any proceeding as proof, in the absence of evidence to the contrary, of the facts stated in the official document without proof of the signature or the position of the person appearing to have signed the official document. R.S.O. 1990, c. I.8, s. 26 (2); 1997, c. 28, s. 82.

True copies as evidence

(3)  A true copy certified by the Superintendent under clause 25 (2) (b) is admissible in evidence to the same extent as and has the same evidentiary value as the document or thing of which it is a copy. R.S.O. 1990, c. I.8, s. 26 (3); 1997, c. 28, s. 82.

Right to a licence

27.  It is the duty of the Superintendent to determine the right of an insurer in Ontario to be licensed under this Act. 1997, c. 28, s. 83.

Decision of Superintendent

28.  (1)  Every decision of the Superintendent upon an application for a licence shall be in writing and notice thereof shall be forthwith given to the insurer. R.S.O. 1990, c. I.8, s. 28 (1).

Certified copy

(2)  The insurer, or any person interested, is entitled, upon payment of the fee established by the Minister, to a certified copy of the decision. R.S.O. 1990, c. I.8, s. 28 (2); 2004, c. 31, Sched. 20, s. 3.

Appeal

(3)  The insurer or any person affected by a decision of the Superintendent made under subsection (1) may appeal the decision to the Tribunal. 1997, c. 28, s. 84.

29.  Repealed: 2013, c. 2, Sched. 8, s. 1.

30.  Repealed: 2013, c. 2, Sched. 8, s. 2.

31.  Repealed: 2013, c. 2, Sched. 8, s. 3.

32.  Repealed: 2013, c. 2, Sched. 8, s. 4.

Service of documents

33.  (1)  Unless otherwise provided in this Act or in the rules made by the Superintendent under subsection 16 (3) or by the Tribunal, service of any document for the purpose of a matter to be determined by the Superintendent or a proceeding before the Tribunal that may result in an order or decision affecting the rights or obligations of a person required to be licensed under this Act may be made,

(a) on any person, by personal service on the person to be served;

(b) on an insurer, by first class registered mail addressed to the insurer or its chief executive officer at the insurer’s head office in Ontario as identified in the records of the Superintendent;

(c) on a person who is not an insurer, by first class registered mail addressed to the person’s last known address;

(d) on any person, by leaving a copy of the document with the solicitor, if any, of the person to be served, or with an employee in the solicitor’s office; or

(e) on any person, by telephone transmission of a facsimile of the document in accordance with subsection (7). R.S.O. 1990, c. I.8, s. 33 (1); 1993, c. 10, s. 5 (1); 1997, c. 28, s. 86; 1999, c. 12, Sched. I, s. 4 (5).

Service at place of residence

(2)  Where an attempt is made to effect personal service at a person’s place of residence and for any reason personal service cannot be effected, the document may be served by,

(a) leaving a copy, in a sealed envelope addressed to the person, at the place of residence with anyone who appears to be an adult member of the same household; and

(b) on the same day or the following day, mailing another copy of the document to the person at the place of residence. R.S.O. 1990, c. I.8, s. 33 (2).

Effective date of service

(3)  Service by first class registered mail under subsection (1) and service at a person’s place of residence under subsection (2) is effective on the seventh day after the document is mailed in accordance with subsection (1) or (2). 1993, c. 10, s. 5 (2).

(4), (5)  Repealed: 1993, c. 10, s. 5 (2).

Acceptance of service by a solicitor

(6)  Service on a solicitor is not effective unless the solicitor endorses on the document or a copy of it an acceptance of service on behalf of his or her client and the date of the acceptance. R.S.O. 1990, c. I.8, s. 33 (6).

Requirements for service by facsimile

(7)  A document that is served by telephone transmission shall include a cover page indicating,

(a) the sender’s name, address and telephone number;

(b) the name of the person to be served;

(c) the date and time of transmission;

(d) the total number of pages transmitted, including the cover page;

(e) the telephone number from which the document is transmitted; and

(f) the name and telephone number of a person to contact in the event of transmission problems. R.S.O. 1990, c. I.8, s. 33 (7).

Deemed service

34.  (1)  Where an attempt is made to effect service under subsection 33 (1) on an insurer or an agent, and for any reason service cannot be effected, the document may be served on the Superintendent and such service shall be deemed to be service on the insurer or agent.

Method of service

(2)  Service may be made on the Superintendent under subsection (1) by first class registered mail addressed to the Superintendent at the Superintendent’s office, or by personal service on the Superintendent.

Superintendent to forward document

(3)  Where a document is served on the Superintendent under subsection (1), the Superintendent shall forthwith mail the document to the insurer or agent at the address for the insurer or agent contained in the records of the Superintendent. R.S.O. 1990, c. I.8, s. 34.

Service of notice or process on chief agent or Superintendent, insurers outside Ontario

35.  (1)  Where the head office of a licensed insurer is situate out of Ontario, notice or process in any action or proceeding in Ontario may be served upon the chief agent of the insurer in Ontario or, where no appointment of a chief agent is then in effect, upon the Superintendent and such service shall be deemed service upon the insurer in the case of a corporation and upon members of the insurer in the case of an unincorporated body or association.

Insurer to file address

(2)  Every licensed insurer shall file in the office of the Superintendent notice of a post office address to which any such notice or process may be forwarded by the Superintendent and shall from time to time notify the Superintendent of any change in the address so filed.

Superintendent to forward notice or process

(3)  The Superintendent shall forthwith after the receipt of any such notice or process forward it to the insurer by registered mail addressed in the manner last notified to him or her for this purpose by the insurer. R.S.O. 1990, c. I.8, s. 35.

Annual report

36.  (1)  The Superintendent shall prepare for the Minister, from the statements filed by the insurers and from any inspection or inquiries made, an annual report, showing particulars of the business of each insurer as ascertained from such statement, inspection and inquiries, and such report shall be printed and published forthwith after completion. R.S.O. 1990, c. I.8, s. 36 (1).

Permissible investments

(2)  In his or her annual report the Superintendent shall allow as assets only such of the investments of the several insurers as are authorized by this Act, or by their Acts or instruments of incorporation, or by the general Acts applicable to such investments. R.S.O. 1990, c. I.8, s. 36 (2).

Superintendent’s corrections of annual statements

(3)  In his or her annual report the Superintendent shall make all necessary corrections in the annual statements made by all licensed insurers as provided in this Act, and the Superintendent is at liberty to increase or diminish the liabilities of such insurers to the true and correct amounts thereof as ascertained by him or her in the examination of their affairs at the head office thereof in Ontario, or otherwise. R.S.O. 1990, c. I.8, s. 36 (3).

Appraisement of real property owned by insurer

(4)  If it appears to the Superintendent, or if he or she has any reason to suppose, from the annual statements prepared and delivered to him or her by all insurers, that the value placed by any insurer, incorporated and licensed in Ontario, upon the real property owned by it or any parcel thereof is too great, the Superintendent may require such insurer to secure an appraisement of such real property by one or more competent valuators or the Superintendent may procure such appraisement at the expense of the insurer, and the appraised value, if it varies materially from the statement or return made by the insurer, may be substituted in the annual report of the Superintendent. R.S.O. 1990, c. I.8, s. 36 (4); 2006, c. 33, Sched. O, s. 2.

Appraisement of real property held as security for loans

(5)  In like manner, if it appears to the Superintendent, or if he or she has any reason to suppose, that the amount secured by mortgage or hypothec upon any parcel of real property, together with the interest due and accrued thereon, is greater than the value of the parcel, or that the parcel is not sufficient for the loan and interest, the Superintendent may procure an appraisement thereof and, if from the appraised value it appears that the parcel is not adequate security for the loan and interest, he or she may write off the loan and interest a sum sufficient to reduce the loan to such an amount as may fairly be realizable from the security, in no case to exceed the appraised value, and the Superintendent may insert the reduced amount in his or her annual report. R.S.O. 1990, c. I.8, s. 36 (5); 2006, c. 33, Sched. O, s. 2.

Appraisement of other investments

(6)  In like manner, if it appears to the Superintendent, or if he or she has any reason to suppose, that the value of any other investment of the funds of the insurer is less than the amount of the value of the investments shown in the books of the insurer, the Superintendent may make or cause to be made an appraisal of the security, and, if from the appraised value it appears that the value of the security as shown on the books of the insurer is greater than its true value as shown by the appraisal, he or she may reduce the book value of the security to such amount as may fairly be realizable from the security, in no case to exceed the appraised value, and the Superintendent may insert the reduced amount in his or her annual report. R.S.O. 1990, c. I.8, s. 36 (6).

37.  Repealed: 1997, c. 28, s. 87.

38.  Repealed: 1997, c. 19, s. 10 (3).

PART II
GENERAL PROVISIONS APPLICABLE TO INSURERS

Application of Part, insurance business in Ontario

39.  (1)  This Part applies to insurance undertaken in Ontario and to all insurers carrying on business in Ontario.

Undertaking insurance

(2)  An insurer undertaking a contract of insurance that under this Act is deemed to be made in Ontario, whether the contract is original or renewed, except the renewal from time to time of life insurance policies, shall be deemed to be undertaking insurance in Ontario within the meaning of this Part.

Carrying on business

(3)  An insurer undertaking insurance in Ontario or that in Ontario sets up or causes to be set up a sign containing the name of an insurer, or that in Ontario maintains or operates, either in its own name or in the name of its agent or other representative, an office for the transaction of the business of insurance either in or out of Ontario, or that in Ontario distributes or publishes or causes to be distributed or published any proposal, circular, card, advertisement, printed form or like document, or that in Ontario makes or causes to be made any written or oral solicitation for insurance, or that in Ontario issues or delivers any policy of insurance or interim receipt or collects or receives or negotiates for or causes to be collected or received or negotiated for any premium for a contract of insurance or inspects any risk or adjusts any loss under a contract of insurance, or that prosecutes or maintains in Ontario an action or proceeding in respect of a contract of insurance, or a club, society or association incorporated or unincorporated that receives, either as trustees or otherwise, contributions or money from its members out of which gratuities or benefits are paid directly or indirectly upon the death of its members, or any of them, shall be deemed to be an insurer carrying on business in Ontario within the meaning of this Act. R.S.O. 1990, c. I.8, s. 39.

Licences

Necessity for licence

40.  (1)  Every insurer undertaking insurance in Ontario or carrying on business in Ontario shall obtain from the Superintendent and hold a licence under this Act. R.S.O. 1990, c. I.8, s. 40 (1); 1997, c. 28, s. 88.

Prohibition re: licence

(2)  No person shall carry on business as an insurer or engage in an act constituting the business of insurance in Ontario without a licence under this Act.

Idem

(3)  No insurer shall carry on business in Ontario as an insurer of a class of insurance that is not authorized by its licence under this Act.

Prohibition against acting on behalf of unlicensed insurer

(4)  No person in Ontario shall do or cause to be done any act or thing mentioned in subsection 39 (3) on behalf of or as agent of an insurer that is not licensed under this Act. R.S.O. 1990, c. I.8, s. 40 (2-4).

Exception

(5)  The following shall not be deemed insurers within the meaning of this Act or required or entitled to be licensed as such:

1. Pension fund societies incorporated under the Corporations Act.

2. Corporations mentioned in paragraphs 3 and 4 of section 343.

3. A trade union in Ontario that under the authority of its incorporating Act or charter has an assurance or benefit fund for the benefit of its own members exclusively.

4. Mutual benefit societies. R.S.O. 1990, c. I.8, s. 40 (5); 1997, c. 19, s. 10 (4).

Unauthorized insurance

(6)  No insurer that is incorporated in Ontario and licensed under this Act shall carry on or solicit business as an insurer in another jurisdiction unless it is authorized to do so under the laws of that jurisdiction. R.S.O. 1990, c. I.8, s. 40 (6).

Prohibited benefits

(7)  No mutual benefit society shall offer or pay a benefit that would have been prohibited under this Act on January 1, 1996. 1997, c. 19, s. 10 (5).

Reinsurance with unlicensed insurer

41.  Subject to the regulations, nothing in this Act prevents a licensed insurer who has lawfully effected a contract of insurance in Ontario from reinsuring the risk or part thereof with an insurer transacting business out of Ontario and not licensed under this Act. R.S.O. 1990, c. I.8, s. 41.

Authorized insurers and insurance

What insurers may be licensed

42.  (1)  Upon due application and upon proof of compliance with this Act, the Superintendent may issue a licence to undertake contracts of insurance and carry on business in Ontario to any insurer coming within one of the following classes:

1. Joint stock insurance companies.

2. Mutual insurance corporations.

3. Cash-mutual insurance corporations.

4. Fraternal societies.

5. Repealed: 1997, c. 19, s. 10 (6).

6. Companies duly incorporated to undertake insurance contracts and not within classes 1 to 5.

7. Reciprocal insurance exchanges.

8. Underwriters or syndicates of underwriters operating on the plan known as Lloyds.

9. Repealed: 1997, c. 19, s. 10 (6).

R.S.O. 1990, c. I.8, s. 42 (1); 1997, c. 19, s. 10 (6); 1997, c. 28, s. 88; 1999, c. 12, Sched. I, s. 4 (6).

Authorized insurance

(2)  A licence issued under this Act authorizes the insurer named therein to exercise in Ontario all rights and powers reasonably incidental to the carrying on of the business of insurance named therein that are not inconsistent with this Act or with its Act or instrument of incorporation or organization. R.S.O. 1990, c. I.8, s. 42 (2).

Classes of insurance and licence conditions

43.  (1)  The Superintendent may by order determine and define classes of insurance for the purposes of this Act and of licences granted to insurers under this Act. 1997, c. 28, c. 89 (1).

Note: Despite the re-enactment of subsection 43 (1) by the Statutes of Ontario, 1997, chapter 28, subsection 89 (1), regulations made under subsection 43 (1) of this Act, as it read immediately before July 1, 1998, continue until the Superintendent makes an order under subsection 43 (1), as re-enacted by the Statutes of Ontario, 1997, chapter 28, subsection 89 (1), that is inconsistent with those regulations. See: 1997, c. 28, s. 89 (2).

Not a regulation

(1.1)  An order made by the Superintendent under subsection (1) is not a regulation within the meaning of Part III (Regulations) of the Legislation Act, 2006. 1997, c. 28, c. 89 (1); 2006, c. 21, Sched. F, s. 136 (1).

Publication of list

(1.2)  The Superintendent shall publish in The Ontario Gazette in July of each year a list of the classes of insurance authorized under subsection (1) and shall publish in The Ontario Gazette notice of all additions to or deletions from the list as soon as practicable after making them. 1997, c. 28, c. 89 (1).

Licence to carry on insurance business

(2)  Subject to the provisions of the Parts of this Act that particularly relate to the classes of insurers mentioned in section 42, a licence may be granted to an insurer to carry on any one or more of the classes of insurance defined under subsection (1). R.S.O. 1990, c. I.8, s. 43 (2); 2002, c. 18, Sched. H, s. 4 (5).

Determination of classes of insurance by Superintendent

(3)  For the purposes of this Act, the Superintendent may determine the class or classes of insurance into which the circumstances or conditions in any case may bring any insurance granted or that may be granted in respect thereto, and the policy form for the class of insurance to be used thereunder. R.S.O. 1990, c. I.8, s. 43 (3).

Conditions

(4)  A licence may be issued subject to such limitations and conditions as may be prescribed by regulation. R.S.O. 1990, c. I.8, s. 43 (4).

Membership in compensation association

44.  (1)  Where a compensation association has been designated by the regulations as a compensation association for a class of insurers, every insurer in that class shall be deemed to be a member of the compensation association and shall be bound by the by-laws and memorandum of operation of the compensation association. 2002, c. 18, Sched. H, s. 4 (6).

Assessments and levies

(2)  A member of a compensation association shall pay to the compensation association all assessments and levies made against the member by the compensation association, and, where the member fails to pay the assessment or levy within thirty days of the day the notice of the assessment or levy is mailed to the member,

(a) the compensation association may claim the amount of the assessment or levy, with interest, as a debt due from the member or if the insurer has ceased to be a member, from the former member; and

(b) the licence of the member to carry on insurance may be cancelled. R.S.O. 1990, c. I.8, s. 44 (2).

Non-application

(3)  Subsections (1) and (2) do not apply to,

(a) a mutual insurance corporation that is a member of the Fire Mutuals Guarantee Fund or such other insurers designated under the regulations as being adequately covered by some other plan of compensation;

(b) an insurer whose business is limited to that of reinsurance;

(c) an insurer named in an agreement entered into under section 120 as an insurer to whom subsections (1) and (2) do not apply;

(d) a reciprocal insurance exchange; or

(e) a class of insurer designated by the regulations. R.S.O. 1990, c. I.8, s. 44 (3); 1997, c. 19, s. 10 (8); 1999, c. 12, Sched. I, s. 4 (8).

Conditions of automobile insurance licence

45.  (1)  A licence to carry on automobile insurance in Ontario is subject to the following conditions:

1. In any action in Ontario against the licensed insurer or its insured arising out of an automobile accident in Ontario, the insurer shall appear and shall not set up any defence to a claim under a contract made outside Ontario, including any defence as to the limit or limits of liability under the contract, that might not be set up if the contract were evidenced by a motor vehicle liability policy issued in Ontario and such contract made outside Ontario shall be deemed to include the statutory accident benefits referred to in subsection 268 (1).

2. In any action in another province or territory of Canada, a jurisdiction in the United States of America or a jurisdiction designated in the Statutory Accident Benefits Schedule against the licensed insurer, or its insured, arising out of an automobile accident in that jurisdiction, the insurer shall appear and shall not set up any defence to a claim under a contract evidenced by a motor vehicle liability policy issued in Ontario, including any defence as to the limit or limits of liability under the contract, that might not be set up if the contract were evidenced by a motor vehicle liability policy issued in that jurisdiction. R.S.O. 1990, c. I.8, s. 45 (1); 1993, c. 10, s. 6; 1996, c. 21, s. 12.

Penalty for breach

(2)  A licence may be cancelled when the holder commits a breach of condition as set out in subsection (1). R.S.O. 1990, c. I.8, s. 45 (2).

Scope of life insurance licence

46.  Every insurer licensed for the transaction of life insurance may, under the authority of its licence, unless the licence expressly provides otherwise,

(a) Repealed: 2002, c. 18, Sched. H, s. 4 (7).

(b) transact annuities of all kinds and insurance providing for the establishment of accumulation or endowment funds. R.S.O. 1990, c. I.8, s. 46; 2002, c. 18, Sched. H, s. 4 (7).

47.  Repealed: 2002, c. 18, Sched. H, s. 4 (8).

Capital requirements, etc.

Capital requirements for joint stock Co. — life insurance

48.  (1)  A licence shall not be granted to a joint stock insurance company not licensed before the 1st day of January, 1971 unless the company furnishes to the Superintendent satisfactory evidence that if the company is applying for a licence to transact the business of life insurance, the company has paid up capital and surplus of not less than $2,000,000, or such greater amount as the Superintendent in the circumstances may require, of which at least $1,000,000 is paid up capital and at least $500,000 is unimpaired surplus. R.S.O. 1990, c. I.8, s. 48 (1); 1997, c. 28, s. 90.

Capital requirements for joint stock Co. — insurance other than life

(2)  A licence shall not be granted to a joint stock insurance company unless the company furnishes to the Superintendent satisfactory evidence that if the company is applying for a licence to transact any insurance other than life insurance, the company has, in aggregate, a paid up capital and unimpaired surplus of not less than $3,000,000 or such greater amount as the Superintendent in the circumstances may require. R.S.O. 1990, c. I.8, s. 48 (2); 1997, c. 28, s. 90.

Capital requirements for other insurers — insurance other than life

(3)  A licence shall not be granted to a mutual insurance corporation, a cash-mutual insurance corporation, an insurance company mentioned in paragraph 6 of subsection 42 (1), or to an underwriter or syndicate of underwriters operating on the plan known as Lloyds, except upon proof that the net surplus of assets over all liabilities exceeds the amount fixed by subsection (2) for the paid in capital stock of joint stock insurance companies, and that such net surplus of assets over all liabilities together with the contingent liability of members, if any, exceeds the amount fixed by subsection (2) for the paid up capital and surplus of joint stock insurance companies for the respective classes of insurance mentioned therein. R.S.O. 1990, c. I.8, s. 48 (3).

Exemption orders

(4)  On the report of the Superintendent, the Lieutenant Governor in Council may by order exempt an insurer from the minimum capital requirements set out in subsection (2) or (3), as the case may be, if the insurer is offering its services only within Ontario or if the insurer is offering a specialized or limited service that in the opinion of the Lieutenant Governor in Council does not require the support of higher capital requirements. R.S.O. 1990, c. I.8, s. 48 (4).

Idem

(5)  An exemption under subsection (4) may be made subject to such conditions as the Lieutenant Governor in Council may impose. R.S.O. 1990, c. I.8, s. 48 (5).

Capital requirements for other insurers — life insurance

(6)  A licence shall not be granted to a mutual insurance corporation, a cash-mutual insurance corporation, an insurance company mentioned in paragraph 6 of subsection 42 (1), a reciprocal insurance exchange, or to an underwriter or syndicate of underwriters operating on the plan known as Lloyds, not licensed on the 30th day of June, 1971, except upon proof that the net surplus of assets over all liabilities exceeds the amount fixed by subsection (1) for the paid in capital stock of joint stock insurance companies, and that such net surplus of assets over all liabilities together with the contingent liability of members, if any, exceeds the amount fixed by subsection (1) for the paid up capital and surplus of joint stock insurance companies for the respective classes of insurance mentioned therein. R.S.O. 1990, c. I.8, s. 48 (6); 1999, c. 12, Sched. I, s. 4 (9).

Application of subs. (3)

(7)  Subsection (3) does not apply to a mutual insurance corporation incorporated under the laws of Ontario that is a member of the Fire Mutuals Guarantee Fund. 1999, c. 12, Sched. I, s. 4 (10).

Restriction, premium note plan

(7.1)  No mutual insurance corporation that is incorporated in Ontario to undertake contracts on a premium note plan may be licensed under this Act unless it is a member of the Fire Mutuals Guarantee Fund. 1999, c. 12, Sched. I, s. 4 (10).

Application of other Parts

(8)  A licence shall not be granted to an insurer except upon proof that it has complied with the provisions of this Act and the regulations applicable to it. R.S.O. 1990, c. I.8, s. 48 (8).

Licence for both fire and life

(9)  A licence shall not be granted to an insurer for the transaction of both property and life insurance unless it maintains separate and distinct accounts, funds and securities in respect of its business of life insurance, and those funds and securities are available only for the protection of the holders of its policies of life insurance and are not liable for the payment of claims arising from any other class of insurance that it undertakes, and it complies with such other requirements as the Superintendent may impose for the purposes of this subsection. R.S.O. 1990, c. I.8, s. 48 (9); 2002, c. 18, Sched. H, s. 4 (9).

Evidence by insurer when head office is outside Ontario

(10)  Where the head office of an applicant for a licence under this Act is situate out of Ontario, a licence shall not be granted except upon proof of its ability to provide for the payment at maturity of all its contracts, but the Superintendent may accept as sufficient the fact that it is licensed by any other government in Canada. R.S.O. 1990, c. I.8, s. 48 (10).

Licence of extra-provincial corporation

(11)  A licence shall not be granted to a corporation that is incorporated under the law of a province other than Ontario unless its head office and chief place of business is situate in that province. R.S.O. 1990, c. I.8, s. 48 (11).

Information preliminary to licence

49.  The Superintendent may require such notice of the application for a licence to be given by publication in The Ontario Gazette and elsewhere as he or she considers necessary. R.S.O. 1990, c. I.8, s. 49.

Documentary, etc., requirements

Documents to be filed by applicants for licence

50.  (1)  Before the issue of a licence to an insurer, such insurer shall file in the office of the Superintendent the following documents:

1. A certified copy of its Act or other instrument of incorporation or association and of its constitution and by-laws and regulations verified in a manner satisfactory to the Superintendent.

2. A certified copy of its last balance sheet and auditor’s report thereon.

3. If the head office of the insurer is out of Ontario, notice of the place where the chief office of the insurer in Ontario is to be situate.

4. If the head office of the insurer is out of Ontario, a power of attorney from the insurer to an agent resident in Ontario.

5. Copies of all policy forms and forms of application for insurance proposed to be used by the insurer in Ontario.

6. Any evidence or documents required by other Parts of this Act.

Evidence

(2)  The applicant for a licence shall furnish such evidence as the Superintendent considers necessary that the requirements of this Act have been complied with and that the applicant is entitled to the licence applied for.

Paying cost of examination

(3)  When the Superintendent considers it necessary to conduct an examination of the affairs of an applicant for a licence, the applicant shall pay the costs of the examination upon receiving a statement thereof certified by the Superintendent. R.S.O. 1990, c. I.8, s. 50.

Filing of changes in by-laws, etc.

51.  Every licensed insurer shall file in the office of the Superintendent certified copies of every amendment, revision or consolidation of its Act or other instrument of incorporation or association and of its constitution, by-laws and regulations verified in a manner satisfactory to the Superintendent within thirty days after the passing or adoption of the amendment, revision or consolidation. R.S.O. 1990, c. I.8, s. 51.

Corporate requirements

Statement of expenses of organization

52.  (1)  Upon application being made for a licence under this Act by an insurer incorporated after the 1st day of January, 1925 under any general or special Act of Ontario, there shall be submitted to the Superintendent a sworn statement setting forth the several sums of money paid in connection with the incorporation and organization of the insurer, and such statement shall, in addition, include a list of all unpaid liabilities, if any, in connection with or arising out of the incorporation and organization.

To what limited

(2)  Until the licence is granted, no payments on account of expenses of incorporation and organization shall be made out of the money paid in by shareholders, except reasonable sums for the payment of clerical assistance, legal services, office rental, advertising, stationery, postage and expense of travel, if any. R.S.O. 1990, c. I.8, s. 52 (1, 2).

Conditions precedent to issue of licence

(3)  The Superintendent shall not issue the licence until he or she is satisfied that all the requirements of this Act and of the Corporations Act as to the subscriptions for shares in the capital of the insurer, the payment of money by shareholders on account of their subscriptions, the election of directors and other preliminaries have been complied with, and unless he or she is satisfied that the expenses of incorporation and organization, including any commission payable in connection with subscriptions for shares in the capital of the insurer, are reasonable. R.S.O. 1990, c. I.8, s. 52 (3); 1997, c. 28, s. 90.

Right to licence and insurer’s name

Right to licence

53.  (1)  An insurer that has applied for a licence and has complied with this Act and the Corporations Act is entitled to the licence. R.S.O. 1990, c. I.8, s. 53 (1).

Name of insurer

(2)  The Superintendent may refuse to licence an insurer where the name of the insurer is,

(a) the same as or similar to the name of another insurer and the assumption or use of the name in Ontario would be likely to deceive or mislead the public; or

(b) if the name of the insurer is objectionable on any public grounds. R.S.O. 1990, c. I.8, s. 53 (2); 1997, c. 28, s. 90.

Power of attorney of chief agent, insurers outside Ontario

54.  (1)  Every licensed insurer that has its head office outside Ontario shall file with the Superintendent an executed copy of a power of attorney from the insurer to a chief agent resident in Ontario.

Execution of power of attorney

(2)  The power of attorney shall be under the seal of the insurer, and shall be signed by the president and secretary or other proper officers of the insurer in the presence of a witness who shall make oath as to its due execution.

Authentication

(3)  The official positions held by the officers signing the power of attorney shall be verified by an oath of a person cognizant of the fact.

Contents of power of attorney

(4)  The power of attorney shall declare at what place in Ontario the chief agency of the corporation is and shall expressly authorize the chief agent to receive service of process in all actions and proceedings against the insurer in Ontario for any liability incurred by the insurer therein, and also to receive from the Superintendent all notices that the law requires to be given, or that it is thought advisable to give, and shall declare that service of process for or in respect of such liability on the chief agent is legal and binding on the insurer.

Authority conferred

(5)  The power of attorney may confer upon the chief agent any further or other powers that the insurer considers advisable.

Effect of copy as evidence

(6)  The production of a copy of the power of attorney certified by the Superintendent is sufficient evidence for all purposes of the power and authority of the person therein named to act on behalf of the insurer in the manner and for the purposes set forth in the certified copy.

Changes in chief agent

(7)  Where the insurer changes its chief agent in Ontario, it shall, within seven days of the appointment, file with the Superintendent a similar power of attorney, stating the change and containing a similar declaration as to service of process and notices.

Service of process thereafter

(8)  After the power of attorney is filed, any process in any action or proceeding against the insurer for liability incurred in Ontario may be validly served on the insurer upon its chief agent, but nothing in this section renders invalid service in any other mode in which the corporation may be lawfully served. R.S.O. 1990, c. I.8, s. 54.

Form, term, conditions of licence

Form

55.  (1)  Subject to section 382, the licence shall be in such form or forms for the different classes of insurers as may be from time to time determined by the Superintendent, and shall specify the business to be carried on by the insurer. R.S.O. 1990, c. I.8, s. 55 (1); 1997, c. 28, s. 90.

Conditions

(2)  The Superintendent may, at any time and in respect of any licence of an insurer,

(a) set a term for the licence;

(b) impose any conditions or limitations that the Superintendent considers appropriate relating to the carrying on of the insurer’s business; or

(c) vary, amend or revoke any condition or limitation to which the licence is subject.

Notice

(3)  The Superintendent shall not exercise any power under subsection (2) until he or she has given the insurer notice of intention to exercise the power and has afforded the insurer a reasonable opportunity to make written submissions.

Application

(4)  Subsections (2) and (3) apply in respect of licences in force on the date this section comes into force and in respect of licenses issued after the date this section comes into force.

Appeal to Tribunal

(5)  The insurer may appeal the decision of the Superintendent to the Tribunal. 1997, c. 28, s. 91 (1).

Failure to pay claim, licence cancellation, etc.

56.  (1)  Where written notice has been served on the Superintendent and upon proof of an undisputed claim arising from loss insured against in Ontario remaining unpaid for the space of sixty days after being due or of a disputed claim after final judgment in the regular course of law and tender of a legal, valid discharge being unpaid, the Superintendent may suspend or cancel the licence. R.S.O. 1990, c. I.8, s. 56 (1); 1997, c. 28, s. 92.

Revival of licence

(2)  The licence may be revived and the insurer may again transact business if, within six months after notice to the Superintendent of the failure of the insurer to pay an undisputed claim or the amount of a final judgment as provided in this section, such undisputed claim or final judgment upon or against the insurer in Ontario is paid and satisfied. R.S.O. 1990, c. I.8, s. 56 (2).

Suspension, cancellation of insurer’s licence for failure to pay administrative penalty

57.  (1)  The Superintendent may suspend or cancel an insurer’s licence if the insurer fails to pay an administrative penalty as required under this Act. 2012, c. 8, Sched. 23, s. 2.

Notice

(2)  The Superintendent shall give written notice to the insurer before exercising the Superintendent’s authority under subsection (1). 2012, c. 8, Sched. 23, s. 2.

Procedural steps not required

(3)  Section 58 does not apply to the exercise of the Superintendent’s authority under subsection (1). 2012, c. 8, Sched. 23, s. 2.

Revival of licence

(4)  If a licence is suspended or cancelled under subsection (1), the Superintendent may revive the licence if the insurer pays the administrative penalty. 2012, c. 8, Sched. 23, s. 2.

Disciplinary action against insurers

Superintendent’s report

58.  (1)  Upon examination, from annual statements, or upon any other evidence, the Superintendent shall make a report if he or she,

(a) finds, with respect to an insurer incorporated or organized under the laws of Ontario, that the assets of the insurer are insufficient to justify its continuance in business or to provide for its obligations;

(b) is of the opinion that there exists a state of affairs that is or may be prejudicial to the interests of persons who have contracts of insurance with an insurer licensed in Ontario;

(c) finds that an insurer licensed in Ontario has failed to comply with any provision of law or with its Act or instrument of incorporation or association; or

(d) becomes aware that the licence of an insurer licensed in Ontario has been suspended or cancelled by any government in Canada.

Notice to insurer

(2)  The Superintendent may give notice in writing, which shall include a copy of the report made under subsection (1), to the insurer stating that the Superintendent intends,

(a) to suspend or cancel the insurer’s licence; or

(b) to take possession and control of the assets of the insurer if incorporated or organized under the laws of Ontario.

Request for hearing

(3)  Within 15 days after receiving the notice, the insurer may request in writing that the Tribunal hold a hearing before the Superintendent takes any action described in the notice.

Hearing

(4)  If, within the time period allowed, the insurer requests a hearing, the Tribunal shall hold a hearing.

No request for hearing

(5)  If, within the time period allowed, the insurer does not request a hearing, the Superintendent may, by order,

(a) suspend or cancel the licence of the insurer; or

(b) take possession and control of the assets of the insurer if incorporated or organized under the laws of Ontario.

Interim order

(6)  If the Superintendent is of the opinion that the interests of the public may be adversely affected by any delay in making an order mentioned in subsection (5), the Superintendent may make an interim order before the expiry of the time period for the insurer to request a hearing or, if the Tribunal holds a hearing, before the final determination of the hearing.

Interim order in force

(7)  Unless the Superintendent revokes an interim order,

(a) the interim order remains in force indefinitely if, within the time allowed, the insurer does not request a hearing;

(b) the interim order remains in force until the final determination of the hearing if, within the time period allowed, the insurer requests a hearing.

Powers of Tribunal

(8)  At a hearing, if the Tribunal finds that one or more of the circumstances described in clauses (1) (a), (b), (c) and (d) exist, it may,

(a) suspend or cancel the licence of the insurer; or

(b) order the Superintendent to take possession and control of the assets of the insurer if incorporated or organized under the laws of Ontario.

Copy of order to insurer

(9)  If the Tribunal makes an order described in clause (8) (b), the Superintendent shall deliver a copy of the order to an officer of the insurer. 1997, c. 28, s. 94.

59.  Repealed: 1997, c. 28, s. 94.

60.  Repealed: 1997, c. 19, s. 10 (11).

61.  Repealed: 1997, c. 28, s. 95.

Superintendent takes control

Power of Superintendent upon taking control

62.  (1)  If the Superintendent has taken possession and control of the assets of the insurer, he or she shall thereafter conduct its business and take such steps as in his or her opinion should be taken toward its rehabilitation, and for such purposes the Superintendent has all the powers of the board of directors of the insurer, and, without limiting the generality of the foregoing, the Superintendent may,

(a) exclude the directors, officers, employees and agents of the insurer from the premises, property and business of the insurer; and

(b) carry on, manage and conduct the operations of the insurer and in the name of the insurer preserve, maintain, realize, dispose of and add to the property of the insurer, receive the incomes and revenues of the insurer and exercise all the powers of the insurer. R.S.O. 1990, c. I.8, s. 62 (1); 1993, c. 10, s. 9; 1997, c. 28, s. 96 (1).

Application to court

(2)  While the Superintendent has possession and control of the assets of an insurer under this section, the Superintendent may apply to the court for an order for the winding up of the insurer under Part VI of the Corporations Act. R.S.O. 1990, c. I.8, s. 62 (2); 1997, c. 28, s. 96 (2).

Appointment of managers

(3)  Where the Superintendent is in possession and control of the assets of an insurer and is conducting its business, he or she may appoint one or more persons to manage and operate the business of the insurer and,

(a) each person so appointed is a representative of the Superintendent; and

(b) the remuneration of any such person, other than an employee of the office of the Superintendent, shall be fixed by the Superintendent. R.S.O. 1990, c. I.8, s. 62 (3); 1997, c. 28, s. 96 (3).

Relinquishing control

(4)  Whenever the Superintendent believes that an insurer whose assets are in the possession and control of the Superintendent meets all the requirements of this Act and that it is otherwise proper for the insurer to resume possession and control of its assets and the conduct of its business, the Superintendent may relinquish to the insurer the possession and control of its assets, and after that time the powers of the Superintendent under this section cease.

Rehabilitation efforts futile

(5)  If the Superintendent considers that further efforts to rehabilitate an insurer whose assets are in the possession and control of the Superintendent would be futile, the Superintendent may relinquish to the insurer the possession and control of its assets, and after that time the powers of the Superintendent under this section cease. 1997, c. 28, s. 96 (4).

Expenses of proceedings

(6)  The expenses of the Superintendent incurred in rehabilitation proceedings under this section and section 58 shall be paid by all insurers licensed under this Act to carry on business of the same class or classes as the insurer who is the subject of the proceedings, and the share of each shall be the proportion of the expenses that the net premium income received from the insurer’s policyholders in Ontario in its last preceding fiscal year bears to the total net premium income received from the policyholders in Ontario by all insurers of that class in their respective last preceding fiscal years. R.S.O. 1990, c. I.8, s. 62 (6); 1997, c. 28, s. 96 (5).

Advisory committee

(7)  The insurers required to bear the said expenses of the Superintendent may appoint a committee of not more than six members to advise the Superintendent in respect of all matters pertinent to the rehabilitation of the insurer whose assets are in the possession and control of the Superintendent. R.S.O. 1990, c. I.8, s. 62 (7).

Appeal against Tribunal order to take control

63.  (1)  Despite section 62, an insurer may appeal to the Divisional Court from any order made by the Tribunal under clause 58 (8) (b) within thirty days after the delivery of a copy of the order to an officer of the insurer. 1993, c. 10, s. 10 (1); 1997, c. 28, s. 97 (1).

Stay

(2)  An order of the Tribunal under clause 58 (8) (b) shall take effect immediately, but where there is an appeal, a judge of the Divisional Court may grant a stay until any appeal is disposed of. R.S.O. 1990, c. I.8, s. 63 (2); 1993, c. 10, s. 10 (2); 1997, c. 28, s. 97 (2).

Documents to be filed

(3)  The Tribunal shall file with the Divisional Court,

(a) the decision of the Tribunal;

(b) the report of the Superintendent;

(c) the record of the hearing; and

(d) all written submissions by the appellant to the Tribunal. 1997, c. 28, s. 97 (3).

(4)  Repealed: 1993, c. 10, s. 10 (3).

Order

(5)  Where an appeal is taken under this section, the court may by order direct the Superintendent to take such action as the court considers proper or refrain from taking any action specified in the order and the Superintendent shall act accordingly. R.S.O. 1990, c. I.8, s. 63 (5).

Further decision

(6)  Despite the determination of the appeal under this section, the Superintendent and the Tribunal have power to make any further reports and orders on new material or where there is a material change in the circumstances, and any such further order is subject to appeal under this section. 1993, c. 10, s. 10 (4); 1997, c. 28, s. 97 (4).

Revival of licence

64.  Where the licence of an insurer is suspended or cancelled under this Act, it may be revived if the insurer makes good the deposit, or the deficiency, as the case may be, to the satisfaction of the Superintendent. R.S.O. 1990, c. I.8, s. 64; 1997, c. 28, s. 98.

Notice of suspension or cancellation

65.  If a licence of an insurer is suspended or cancelled, notice of such suspension or cancellation shall be published in The Ontario Gazette and elsewhere as the Superintendent directs, and thereafter any person transacting business on behalf of the insurer except for winding-up purposes is guilty of an offence. 1997, c. 28, s. 99.

Withdrawal from Automobile Insurance

Withdrawal procedure

65.1  (1)  For the purpose of this section, an insurer is withdrawing from the business of automobile insurance if the insurer does anything that results or is likely to result in a significant reduction in the amount of gross premiums written by the insurer for automobile insurance in any part of Ontario, including any of the following things that have or are likely to have that result:

1. Refusing to process applications for automobile insurance.

2. Declining to issue, terminating or refusing to renew contracts of automobile insurance.

3. Refusing to provide or continue coverages or endorsements in respect of contracts of automobile insurance.

4. Taking actions that directly or indirectly result in termination of contracts between the insurer and the agents and brokers who solicit or negotiate contracts of automobile insurance on behalf of the insurer.

5. Reducing the ability of the agents or brokers to solicit or negotiate contracts of automobile insurance on behalf of the insurer.

6. Reducing the insurer’s ability to act as a servicing carrier or ceasing to act as a servicing carrier under the Plan of Operation of the Facility Association.

7. Taking actions that directly or indirectly result in the termination of any contract between the insurer and the Facility Association.

8. Engaging in any activity or failure to act that is prescribed by the regulations.

Withdrawal from automobile insurance

(2)  An insurer shall not withdraw from the business of automobile insurance except in accordance with this section. 1993, c. 10, s. 11.

Procedure for withdrawal

(3)  An insurer that intends to withdraw from the business of automobile insurance shall file with the Superintendent a notice in the form provided by the Superintendent. 1993, c. 10, s. 11; 1997, c. 28, s. 100.

Time for notice

(4)  The notice shall specify the date that the insurer intends to begin to withdraw from the business of automobile insurance and shall be filed at least 180 days before that date. 1993, c. 10, s. 11.

Additional information

(5)  The Superintendent may require the insurer to provide such information, material and evidence as the Superintendent considers necessary in addition to the information, material and evidence required to be provided in the notice. 1993, c. 10, s. 11; 1997, c. 28, s. 100.

Authority to withdraw

(6)  The insurer may withdraw from the business of automobile insurance on or after the date specified in the notice under subsection (4). 1993, c. 10, s. 11.

Superintendent’s powers

(7)  Despite subsection (6), the Superintendent may,

(a) authorize the insurer to withdraw from the business of automobile insurance before the date specified in the notice under subsection (4); or

(b) prohibit the insurer from withdrawing from the business of automobile insurance until a date specified by the Superintendent that is not later than ninety days after the date specified in the notice under subsection (4). 1993, c. 10, s. 11; 1997, c. 28, s. 100.

Application of regulations under subs. 121 (1), par. 16

(8)  The Superintendent may order that the regulations made under paragraph 16 of subsection 121 (1) do not apply to a class of contracts, coverages or endorsements specified by the Superintendent to which an insurer is a party. 1993, c. 10, s. 11; 1997, c. 28, s. 100.

Deposits

Deposits

66.  (1)  At any time, the Superintendent may require an insurer to deposit, in any amount the Superintendent considers necessary, securities acceptable to the Superintendent and on such conditions as the Superintendent considers proper.

When to be made

(2)  The securities shall be deposited with the Superintendent within 30 days of the date that the requirement is made or within such longer period of time as is agreed to by the Superintendent. 1997, c. 19, s. 10 (14).

Appeal

(2.1)  An insurer may appeal to the Tribunal the decision of the Superintendent to require a deposit. 1997, c. 28, s. 101 (2).

Withdrawal of deposit

(3)  No part of a deposit shall be withdrawn without the approval of the Superintendent. 1997, c. 19, s. 10 (14).

Failure to comply

(4)  The Superintendent may suspend the licence of an insurer that fails to deposit securities in the amount and within the time required by,

(a) the Superintendent under subsection (1) if the insurer has not appealed the Superintendent’s decision; or

(b) the Tribunal under subsection (2.1) if the insurer has appealed the Superintendent’s decision. 1997, c. 28, s. 101 (3).

Vesting

(5)  Securities deposited with the Superintendent are vested in the Superintendent without any formal transfer.

Interest

(6)  The insurer is entitled to the interest and dividends paid on securities while the securities are on deposit with the Superintendent, if the insurer is in compliance with this Act.

Substitution

(7)  The Superintendent may permit an insurer to substitute other securities for those deposited by the insurer.

Reciprocal deposits

(8)  If an insurer incorporated under the laws of Ontario or a reciprocal insurance exchange provided for in Part XIII wants to be licensed by another province that requires a deposit, the Superintendent may hold securities as a deposit on a reciprocal basis for the other province.

Purpose of deposits

(9)  The Superintendent shall hold and administer a deposit as security for the Ontario contracts of the insurer and for any contracts in a reciprocating province.

Order to fix amount

(10)  If a reciprocating province requires that the amount of a deposit be in a fixed amount, the Lieutenant Governor in Council may, by order, fix the required amount of the deposit and list the reciprocating provinces with respect to the deposit.

Claims

(11)  If an insurer that has deposited securities with the Superintendent under this section ceases to carry on the business of insurance in Ontario or if its licence is suspended or cancelled under this Act, the Superintendent shall notify each reciprocating province of the cessation, suspension or cancellation.The notice shall state that the reciprocating province is entitled to submit to the Superintendent an accounting of all claims and liabilities outstanding in the reciprocating province in respect of the insurer before the deposit is released to the insurer.

Out-of-province insurer

(12)  If the Superintendent is notified that an insurer that has deposited securities with the Superintendent has ceased to transact business in a reciprocating province or that the insurer’s licence to transact the business of insurance has been suspended or cancelled in that province, the Superintendent may, at the request of the reciprocating province, take any action that the Superintendent could take if the insurer ceased to carry on the business of insurance in Ontario or could take if the licence of the insurer were suspended or cancelled in Ontario.

Notice to insured

(13)  If the Superintendent receives notice that an order has been made in another province for the administration of a deposit of an insurer in respect of which Ontario is a reciprocating province and that a date has been fixed by the trustee in the other province for the termination of the administration of the deposit, the Superintendent shall give notice of the termination date to persons insured under Ontario policies issued by the insurer.

Application to court

(14)  The Superintendent may, at any time, make application to a court of competent jurisdiction for directions regarding the administration of securities deposited by an insurer under this section. 1997, c. 19, s. 10 (14).

67.-99.  Repealed: 1997, c. 19, s. 10 (14).

Records and Returns

Report on share transfers

100.  No transfers of shares of an insurer shall be entered in the book or books maintained for that purpose until thirty days after notice thereof has been deposited with the Superintendent if,

(a) the transfer relates to 10 per cent or more of the issued shares of the insurer for the time being enjoying voting rights; or

(b) the directors have reason to believe that the transfer would result in a majority of the issued shares of the insurer for the time being enjoying voting rights being beneficially owned by any one person. R.S.O. 1990, c. I.8, s. 100; 1997, c. 28, s. 102.

Returns

101.  (1)  When required by the Superintendent, licensed insurers shall prepare and file with the Superintendent or with an agency designated by the Superintendent a return respecting the experience of the insurer’s business in a form approved by the Superintendent containing such information as the Superintendent may require. R.S.O. 1990, c. I.8, s. 101 (1); 1997, c. 28, s. 102.

Compilation of data

(2)  The Superintendent may require any agency so designated to compile the data so filed in such form as he or she may approve, and the expense of making the compilation shall be apportioned among the insurers whose data is compiled by such agency by the Superintendent, who shall certify in writing the amount due from each insurer, and it is payable by the insurer to such agency forthwith. R.S.O. 1990, c. I.8, s. 101 (2).

Audit and direction

(3)  If it appears to the Superintendent that the insurer’s records of premium income and claims paid are not kept in such a manner as to show correctly the experience of the insurer for the purposes of the return, the Superintendent may nominate an accountant to proceed under his or her direction to audit the books and records of the insurer and to give such instructions as will enable the officers of the insurer to keep the records correctly after the audit. R.S.O. 1990, c. I.8, s. 101 (3); 1997, c. 28, s. 102.

Expenses of audit

(4)  The insurer shall pay the accountant for an audit under subsection (3) forthwith upon receiving a certificate of the Superintendent stating the amount payable. R.S.O. 1990, c. I.8, s. 101 (4); 1997, c. 28, s. 102.

Debt to the Crown

(5)  Any amount payable to an accountant under subsection (3) that is not paid within thirty days from the date on which the insurer receives the Superintendent’s certificate becomes a debt owing to the Crown. R.S.O. 1990, c. I.8, s. 101 (5); 1997, c. 28, s. 102.

Information on claims

101.1  Every insurer shall provide the Superintendent or an agency designated by the Superintendent with information prescribed by the regulations about applications for insurance and claims made to the insurer at such times and subject to such conditions as are prescribed by the regulations. 1996, c. 21, s. 13; 1997, c. 28, s. 102.

Business statements and capital or asset requirements

Annual and interim statements

102.  (1)  Subject to section 370, every licensed insurer shall,

(a) prepare annually and deliver to the Superintendent or his or her designate, on or before the prescribed date for the prescribed category of insurer, a statement of the condition of affairs of the insurer for the year that ended, at the election of the company in its by-laws, on the 31st day of October or the 31st day of December next preceding the delivery of the statement; and

(b) prepare and deliver to the Superintendent or his or her designate when required by the Superintendent, for the prescribed category of insurer, an interim statement for the period specified by the Superintendent containing such information as the Superintendent considers necessary to assess the insurer’s condition of affairs. R.S.O. 1990, c. I.8, s. 102 (1); 1994, c. 11, s. 337; 1997, c. 19, s. 10 (15, 16); 2004, c. 31, Sched. 20, s. 4.

Contents of annual statement

(2)  A statement of the condition of affairs of an insurer under clause (1) (a) shall be in a form approved by the Superintendent, and shall set out,

(a) the assets, liabilities, revenues and expenses of the insurer for the year;

(b) particulars of the business done by the insurer in Ontario during the year; and

(c) such other information as the Superintendent considers necessary to assess an insurer’s condition of affairs. R.S.O. 1990, c. I.8, s. 102 (2).

Auditor’s report

(3)  A statement of the condition of affairs of an insurer under clause (1) (a) shall be accompanied by a report of an auditor prepared in the manner required by the Superintendent. R.S.O. 1990, c. I.8, s. 102 (3).

Modified statement

(4)  The Superintendent may, in writing, direct an insurer to prepare and file a modified statement respecting the business of the insurer in Ontario only, in lieu of filing the annual statement that the insurer is required to file under clause (1) (a). 1997, c. 28, s. 103.

Who may verify statement

(5)  In the case of a corporation, such statement shall be verified by the president, vice-president or managing director, or other director appointed for the purpose by the board of directors, and by the secretary or manager of the corporation. R.S.O. 1990, c. I.8, s. 102 (5).

Indirect collection of personal information

(6)  The Superintendent is authorized to obtain from insurers personal information about identifiable individuals where the collection of the information is required to monitor the condition of affairs of the insurer and the information is collected on a statement made under subsection (1). R.S.O. 1990, c. I.8, s. 102 (6).

(7)  Repealed: 2002, c. 18, Sched. H, s. 4 (10).

Required level of capital or assets

(8)  Every insurer licensed under this Act shall maintain capital or assets (in compliance with such requirements as may be prescribed by regulation governing the level of capital or assets to be maintained) in an amount that bears not less than a reasonable relationship to the outstanding liabilities, premiums and loss experience of the insurer. 1999, c. 12, Sched. I, s. 4 (11).

Same

(8.1)  The amount required by subsection (8) shall be calculated in accordance with such requirements as may be prescribed by regulation, and the calculation shall exclude any investments of the insurer that are not authorized by this Act or that were not authorized by law at the time they were acquired. 1999, c. 12, Sched. I, s. 4 (11).

Exception

(9)  Subsection (8) does not apply to a mutual insurance corporation that is a member of the Fire Mutuals Guarantee Fund or to an insurer licensed to transact only,

(a) the business of life insurance;

(b) the business of accident and sickness insurance; or

(c) the business of life insurance and the business of accident and sickness insurance. 2002, c. 18, Sched. H, s. 4 (11).

Contributions to the Fire Mutuals Guarantee Fund

(10)  The contribution by a member of the Fire Mutuals Guarantee Fund to the Fund shall be treated as if it were an asset of the member for the purposes of the statements required under this section and shall be subject to examination by the Superintendent in the same manner as the other assets and property of a licensed insurer. 2006, c. 33, Sched. O, s. 3.

Life insurance policies

(11)  No insurer incorporated and licensed under the laws of Ontario to transact life insurance shall issue a policy that does not appear to be self-supporting upon reasonable assumptions as to interest, mortality and expenses. 1997, c. 19, s. 10 (17).

Exemption from filing requirements

(12)  The Superintendent may, in writing, exempt completely or in part any insurer or any category of insurer from any or all of the filing requirements imposed under this section for the period of time specified in the exemption. 1997, c. 19, s. 10 (17).

Notice of returns

103.  Notice of the requirements for returns under section 101 or 102 is sufficient if it is sent by first class ordinary mail addressed to the insurer at the insurer’s address for service of notice or process as identified in the records of the Superintendent. R.S.O. 1990, c. I.8, s. 103.

Preparation of financial statements

104.  The financial statements required under this Act shall be prepared in accordance with this Act and the regulations. R.S.O. 1990, c. I.8, s. 104.

Published statements

105.  A statement purporting to show the financial condition of an insurer differing from the financial condition shown by the statement filed with the Superintendent, or a balance sheet or other statement in form differing from the form approved by the Superintendent, shall not be published or circulated, and every insurer publishing such a statement is guilty of an offence. R.S.O. 1990, c. I.8, s. 105; 2004, c. 31, Sched. 20, s. 5.

Statements that financial standing guaranteed by government prohibited

106.  Every person who represents orally or in writing that the issue of a licence to an insurer or the printing or publication of an annual statement in the report of the Superintendent or in any other publication of the Superintendent or any other circumstance of the supervision or regulation of the business of the insurer by law or the Superintendent is a warranty or guarantee of the financial standing of the insurer or of its ability to provide for the payment of its contracts at maturity is guilty of an offence. R.S.O. 1990, c. I.8, s. 106.

Real Property

Powers of insurer to hold real property

107.  An insurer incorporated and licensed under the laws of Ontario may hold, manage and otherwise deal with real property, subject to any restrictions on doing so under Parts XVII and XVII.1 or the regulations. 2006, c. 33, Sched. O, s. 4.

108.  Repealed: 1997, c. 19, s. 10 (21).

Life Insurance

Variable life insurance contracts based on segregated funds

109.  (1)  Any insurer incorporated and licensed under the laws of Ontario to transact the business of life insurance may,

(a) issue policies for which the reserves vary in amount with the market value of a specified group of assets; and

(b) retain for investment,

(i) policy dividends,

(ii) policy proceeds that become payable on surrender or maturity of the policy not less than five years from the date of its issue if the policyholder so directs, and

(iii) policy proceeds that become payable on the death of the policyholder if the policyholder or beneficiary so directs,

on the basis that the liability of the insurer in respect thereof varies in amount with the market value of a specified group of assets,

and the insurer shall maintain in respect of such policies, dividends and proceeds, as the case may be, one or more separate and distinct funds with separate assets for each such fund. R.S.O. 1990, c. I.8, s. 109 (1).

How fund created

(2)  For the purpose of creating a separate and distinct fund under subsection (1), an insurer may, if duly authorized by by-law,

(a) make a transfer from the shareholders’ fund but the amounts so transferred shall not exceed the surplus in the shareholders’ fund; and

(b) make a transfer of assets from one or more life insurance funds, but,

(i) the maximum amount that may be transferred from any life insurance fund is the amount by which 25 per cent of the surplus in that fund exceeds the aggregate of all prior transfers from that fund to all such separate and distinct funds under this subsection and clause (3) (b) less the aggregate of all prior transfers to that fund pursuant to clause (5) (a), and

(ii) the maximum amount that may be transferred from all life insurance funds is the amount by which 10 per cent of the surplus in those funds or $2,000,000, whichever is the lesser, exceeds the aggregate of all prior transfers from those funds to all such separate and distinct funds pursuant to this subsection and clause (3) (b) less the aggregate of all prior transfers to all life insurance funds pursuant to clause (5) (a). R.S.O. 1990, c. I.8, s. 109 (2).

Transfers to fund

(3)  For the purpose of maintaining a separate and distinct fund under subsection (1), an insurer may from time to time make transfers from a life insurance fund,

(a) to the extent that the assets of the separate and distinct fund are not sufficient to provide for any benefits guaranteed under the terms of the policies for which the separate fund is held; or

(b) in any case other than that mentioned in clause (a), if the insurer provides evidence satisfactory to the Superintendent that such transfers are necessary for the proper administration of the policies or deposits for which the separate fund is held. R.S.O. 1990, c. I.8, s. 109 (3).

Surplus

(4)  Where for the purposes of subsection (2) the surplus in any fund is required to be determined, the surplus shall be taken as shown in the most recent annual statement filed with the Superintendent. R.S.O. 1990, c. I.8, s. 109 (4).

Segregation of assets for policies

(5)  Where a separate and distinct fund is maintained under subsection (1), the assets of such fund shall, subject to subsection (3), be available only to meet the liabilities arising under the policies or deposits in respect of which such fund is maintained, except that,

(a) any amount representing the value of a transfer, or any part thereof, to such separate and distinct fund under subsection (2) or clause (3) (b), may, with the approval of the Superintendent, be transferred back to the fund or funds from which such transfer was made, and, where there is more than one such fund, the amount transferred back to each shall be that proportion of the whole amount that the amount transferred from that fund to the separate and distinct fund was to the total amount so transferred from all the funds; and

(b) any assets, other than assets in respect of a transfer to the separate and distinct fund under subsection (2) or clause (3) (b), remaining in the separate and distinct fund after the discharge of all the insurer’s liabilities in respect of the policies or deposits for which the fund is maintained, may be transferred to such other fund as the directors may determine. R.S.O. 1990, c. I.8, s. 109 (5).

Value of transfers

(6)  For the purposes of clause (2) (b), the value of any assets transferred to or from a separate and distinct fund shall be taken as the value thereof at the time of transfer to that fund and, for all other purposes, the value from time to time of any assets that have been transferred to a separate and distinct fund maintained under subsection (1) shall be the market value of such assets. R.S.O. 1990, c. I.8, s. 109 (6).

(7)  Repealed: 2006, c. 33, Sched. O, s. 5.

Variable life insurance contracts, forms and information folders

110.  (1)  In this section,

“variable insurance contract” means an annuity or life insurance contract for which the reserves or a part thereof vary in amount with the market value of a specified group of assets held in a separate and distinct fund and includes a provision in a life insurance contract under which policy dividends or policy proceeds may be retained for investment in such a fund.

Prohibition

(2)  No insurer shall issue a variable insurance contract or offer to enter into a variable insurance contract that under this Act would be deemed to be made in Ontario until there has been filed with the Superintendent a specimen form of such variable insurance contract, an information folder pertaining thereto and such other material as may be required under the regulations and a receipt therefor has been obtained from the Superintendent.

Form of contract

(3)  The forms of variable insurance contracts and information folders with respect thereto shall comply with the requirements of Part V of this Act and the regulations.

Form of information folder

(4)  The information folder shall provide brief and plain disclosure of all material facts relating to the variable insurance contract and shall contain a certificate to that effect signed by the chief executive officer and the chief financial officer of the insurer or such other persons as the regulations may prescribe.

Delivery of information folder

(5)  No application for a variable insurance contract shall be accepted by an insurer until the insurer has delivered to the applicant therefor a copy of the latest information folder relating thereto that is on file with the Superintendent.

New information folders

(6)  So long as an insurer continues to issue a variable insurance contract in respect of which it has filed an information folder, it shall,

(a) forthwith after the occurrence of any material change in the contract or in any other facts set out in the latest information folder so filed; and

(b) within thirteen months after the date of filing of the latest information folder so filed, or such other period of time as may be provided by the regulations,

file with the Superintendent a new information folder in respect thereof. R.S.O. 1990, c. I.8, s. 110 (1-6).

Prohibition order

(7)  Where it appears to the Superintendent that,

(a) an information folder or any other document filed with the Superintendent by an insurer with respect to a variable insurance contract,

(i) fails to comply in any substantial respect with the requirements of this Act or the regulations,

(ii) contains any promise, estimate, illustration or forecast that is misleading, false or deceptive, or

(iii) conceals or omits to state any material fact necessary in order to make any statement contained therein not misleading in the light of the circumstances in which it was made; or

(b) the financial condition of the insurer or its method of operation in connection with the issuance of its variable insurance contracts will not afford sufficient protection to prospective purchasers of such variable insurance contracts in Ontario,

the Superintendent may prohibit the insurer from continuing to issue such variable insurance contracts in Ontario. R.S.O. 1990, c. I.8, s. 110 (7); 1997, c. 28, s. 105 (1).

Appeal

(7.1)  The insurer may appeal the decision of the Superintendent under subsection (7) to the Tribunal. 1997, c. 28, s. 105 (2).

Regulations

(8)  The Lieutenant Governor in Council may make regulations,

(a) prescribing the form and content of variable insurance contracts;

(b) prescribing the form, content, time of filing and delivery of information folders and the persons to whom information folders shall be delivered;

(c) for the furnishing of information by an insurer or an agent thereof to prospective purchasers of variable insurance contracts;

(d) prescribing the documents, reports, statements, agreements and other information required to be filed, furnished or delivered under this section, and the form and content thereof. R.S.O. 1990, c. I.8, s. 110 (8).

Life insurers to separate business accounts

111.  Every insurer licensed to transact life insurance shall keep separate and distinct accounts of participating and non-participating business. R.S.O. 1990, c. I.8, s. 111.

Life insurance, distribution of parts of profits to participating policyholders

112.  (1)  The directors of an insurer incorporated and licensed under the laws of Ontario to transact the business of life insurance as a joint stock insurance company may from time to time set apart such portion of the net profits as they consider safe and proper for distribution as dividends or bonuses to shareholders and holders of participating policies, ascertaining the part thereof that has been derived from participating policies and distinguishing that part from the profits derived from other sources.

Idem

(2)  Despite anything to the contrary in any letters patent of incorporation or contract, the holders of participating policies are entitled to share in that portion of the profits that has been distinguished as having been derived from participating policies (including a share of the profits arising from the sale of securities in the proportion of the mean participating fund to the mean total funds) to the extent of at least 90 per cent thereof in any year.

Interest on unimpaired paid up capital stock

(3)  In fixing or arriving at the amount of divisible profits, there may be included interest on the amount of the unimpaired paid up capital stock and on any other sum or sums from time to time standing to the credit of the shareholders after deducting any amounts expended in the establishment, prosecution or extension of the company’s business or applied to making good any impairment of capital, and such interest may be allowed or credited to the shareholders at the average net rate of interest earned in the preceding year or other period under consideration upon the mean total funds of the company, but the shareholders are to be charged with a fair proportion of all losses incurred upon investments or other losses of a similar character in the proportion of the mean shareholders’ funds to the mean total funds.

Rights of participating policyholders

(4)  This section does not interfere with the rights of the participating policyholders of an insurer referred to in subsection (1) to share in the profits realized from the non-participating branch of its business in any case to which the policyholders are so entitled. R.S.O. 1990, c. I.8, s. 112.

Insurance with Unlicensed Insurers

Insurance with unlicensed insurers

113.  Despite anything in this Act, any person may insure property situated in Ontario against fire with an unlicensed insurer, and any property insured or to be insured under this section may be inspected and any loss incurred in respect thereof adjusted, if such insurance is effected outside Ontario and without any solicitation whatsoever directly or indirectly on the part of the insurer. R.S.O. 1990, c. I.8, s. 113.

114.  Repealed: 1999, c. 12, Sched. I, s. 4 (13).

General

Trafficking in life insurance policies prohibited

115.  Any person, other than an insurer or its duly authorized agent, who advertises or holds himself, herself or itself out as a purchaser of life insurance policies or of benefits thereunder, or who trafficks or trades in life insurance policies for the purpose of procuring the sale, surrender, transfer, assignment, pledge or hypothecation thereof to himself, herself or itself or any other person, is guilty of an offence. R.S.O. 1990, c. I.8, s. 115.

Note: On a day to be named by proclamation of the Lieutenant Governor, the Act is amended by adding the following section: (See: 2014, c. 7, Sched. 14, ss. 1, 8 (1))

Necessity for licence, long-term disability benefits

115.1  (1)  Except as provided in the regulations, no person shall provide long-term disability benefits in Ontario unless the benefits are payable under a contract of insurance undertaken by a licensed insurer. 2014, c. 7, Sched. 14, s. 1.

Exception

(2)  Subsection (1) does not apply in respect of any benefit provided under a registered pension plan within the meaning of subsection 248 (1) of the Income Tax Act (Canada). 2014, c. 7, Sched. 14, s. 1.

Definition

(3)  In this section,

“long-term disability benefits” means benefits under a benefit plan under which payments or benefits are payable to an individual for a period of not less than 52 weeks or until recovery, retirement or death, whichever period is shorter. 2014, c. 7, Sched. 14, s. 1.

Privileged information

116.  Any information, document, record, statement or thing made or disclosed to the Commission concerning a person licensed or applying for licence under this Act is absolutely privileged and shall not be used as evidence in any action or proceeding in any court brought by or on behalf of such person. R.S.O. 1990, c. I.8, s. 116.

Form of insurance policy

117.  (1)  The Superintendent may require an insurer to file with him or her a copy of any form of policy or of the form of application for any policy issued or used by the insurer. R.S.O. 1990, c. I.8, s. 117 (1).

Prohibition of certain policies

(2)  If an insurer issues a policy or uses an application that, in the opinion of the Superintendent, is unfair, fraudulent, or not in the public interest, the Superintendent may prohibit the insurer from issuing or using the form of policy or application.

Appeal

(2.1)  The insurer may appeal the decision of the Superintendent under subsection (2) to the Tribunal. 1997, c. 28, s. 106.

Offence

(3)  An insurer that, after being so prohibited, issues any such policy or uses any such application is guilty of an offence. R.S.O. 1990, c. I.8, s. 117 (3).

Violation of law, effect of, on claim for indemnity

118.  Unless the contract otherwise provides, a contravention of any criminal or other law in force in Ontario or elsewhere does not, by that fact alone, render unenforceable a claim for indemnity under a contract of insurance except where the contravention is committed by the insured, or by another person with the consent of the insured, with intent to bring about loss or damage, but in the case of a contract of life insurance this section applies only to insurance undertaken as part of the contract whereby the insurer undertakes to pay insurance money or to provide other benefits in the event that the person whose life is insured becomes disabled as a result of bodily injury or disease. R.S.O. 1990, c. I.8, s. 118; 2002, c. 18, Sched. H, s. 4 (13).

Reporting on applications to register

119.  An insurer incorporated under the laws of Ontario shall notify the Superintendent fourteen days in advance of making application for registration under Part IX of the Canadian and British Insurance Companies Act (Canada) or any similar enactment or regulation of the Government of Canada. R.S.O. 1990, c. I.8, s. 119.

Agreements with Compensation Association

Authority of Minister

120.  The Minister, with the approval of the Lieutenant Governor in Council, may enter into agreements with a compensation association related to the conduct of a plan to compensate policyholders and eligible claimants of insolvent insurers. R.S.O. 1990, c. I.8, s. 120.

Fees and Regulations

Regulations

121.  (1)  The Lieutenant Governor in Council may make regulations,

1. prescribing limitations and conditions for the purpose of subsection 43 (4);

2. prescribing entities or classes of entities for the purposes of clause (f) of the definition of “financial institution” in section 1;

2.1 Repealed: 1997, c. 28, s. 107 (1).

3. designating one or more bodies corporate or associations as compensation associations and designating any such body corporate or association as a compensation association for one or more classes of insurers specified by the regulations;

4. Repealed: 2002, c. 18, Sched. H, s. 4 (14).

5. designating insurers for the purposes of clause 44 (3) (a) and designating classes of insurers for the purposes of clause 44 (3) (e);

6. prescribing ratios, percentages, amounts and calculations for the purposes of subsection 102 (8) and any such regulation may prescribe different ratios, percentages, amounts and calculations for one or more classes of insurance and for insurers whose business is limited to that of reinsurance;

7. exempting any insurer or class of insurers from any regulation made under paragraph 6 subject to such terms and conditions as may be set out in the regulations;

7.0.1 prescribing restrictions on insurers holding, managing or otherwise dealing with real property;

7.1 prescribing an activity or failure to act for the purpose of paragraph 8 of subsection 65.1 (1);

8. prescribing terms, conditions and limitations with respect to the reinsurance of risk;

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding the following paragraphs: (See: 2014, c. 7, Sched. 14, ss. 2, 8 (1))

8.1 exempting any person or class of persons from section 115.1 subject to such terms and conditions, including any limitations or restrictions, as may be set out in the regulations;

8.2 governing transitional matters which, in the opinion of the Lieutenant Governor in Council, are necessary or desirable to facilitate the implementation of section 115.1;

9. establishing benefits for the purposes of Part VI that must be provided under contracts evidenced by motor vehicle liability policies and establishing terms, conditions, provisions, exclusions and limits related to such benefits;

10. requiring insurers to offer optional benefits in excess of the benefits that must be provided under paragraph 9 prescribing the circumstances in which the optional benefits are to be offered and establishing terms, conditions, provisions, exclusions and limits related to such benefits;

10.1 prescribing coverages and endorsements in respect of contracts of automobile insurance that insurers or a class of insurers are required to offer, deeming the benefits provided by the coverages and endorsements not to be statutory accident benefits for the purpose of Part VI, and prescribing the circumstances in which the coverages and endorsements shall be offered;

10.2 prescribing rules for interpreting the regulations made under paragraphs 9 and 10 or any provision of those regulations;

10.3 prescribing functions to be performed by a committee appointed under section 7;

10.4 governing the procedure for determining who is liable to pay statutory accident benefits under section 268, including requiring insurers to resolve disputes about liability through an arbitration process established by the regulations and requiring the interim payment of benefits pending the determination of liability;

11. prescribing categories of insurers for the purpose of subsection 101 (1), requiring insurers to file a return under that subsection by category and prescribing the information that insurers may solicit from insured persons for purposes of such returns;

11.1 prescribing the information to be provided under section 101.1 and any conditions that apply to the provision of the information;

12. prescribing categories of insurers for the purpose of subsection 102 (1);

13. prescribing dates for the purpose of clause 102 (1) (a);

14. governing the preparation of financial statements required under this Act or the regulations;

14.0.1 governing the investment and valuation of the assets of the Fire Mutuals Guarantee Fund;

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding the following paragraphs:

14.0.2 exempting a contract or class of contracts from the application of Part V, any provision or requirement of Part V or any regulation or provision or requirement of a regulation made in respect of Part V, postponing, for any contract or class of contracts, the application of Part V or of any such provision or requirement to a specified date and applying a provision of Part V for a specified period on and after the date it was re-enacted, repealed or amended by Schedule 23 to the Strong Action for Ontario Act (Budget Measures), 2012, as it read immediately before that date, to a contract or class of contracts;

14.0.3 prescribing information for which access is limited under clause 174 (8) (b);

14.0.4 for the purpose of subsection 190 (4), respecting the circumstances under which an insurer may not restrict or exclude in a contract of life insurance the right of an insured to designate persons to whom or for whose benefit insurance money is to be payable and respecting the restriction or exclusion in a contract of such right;

14.0.5 prescribing the rights the insured may exercise under a contract of life insurance in the circumstances described in subsection 197 (2);

See: 2012, c. 8, Sched. 23, ss. 3 (1), 77.

14.1 for the purposes of Part VI or any provision of Part VI,

i. defining “automobile”,

ii. prescribing any vehicle or class of vehicles to be automobiles subject to any terms and conditions prescribed in the regulations,

iii. prescribing any vehicle or class of vehicles not to be automobiles, subject to any terms and conditions prescribed in the regulations,

iv. prescribing any service or class of services to be public transit, in the circumstances, if any, prescribed in the regulations and subject to any terms, conditions, provisions, exclusions and limits prescribed in the regulations,

v. prescribing any service or class of services not to be public transit, in the circumstances, if any, prescribed in the regulations and subject to any terms, conditions, provisions, exclusions and limits prescribed in the regulations;

15. prescribing the information to be given to applicants or to insured persons under subsection 229 (1) and the circumstances in which it is to be given;

15.0.1 governing the inspection of automobiles for the purpose of section 232.1;

15.1 for the purpose of section 234, prescribing statutory conditions and the types of contracts of automobile insurance to which the statutory conditions apply;

16. establishing requirements that must be met, in circumstances specified by the regulations, before an insurer declines to issue, terminates or refuses to renew a contract of automobile insurance or refuses to provide or continue any coverage or endorsement in respect of a contract of automobile insurance;

17. prescribing grounds for which an insurer cannot, in circumstances specified by the regulations, decline to issue, terminate or refuse to renew a contract of automobile insurance or refuse to provide or continue any coverage or endorsement in respect of a contract of automobile insurance;

18. prescribing coverages and endorsements for the purposes of section 237;

19. governing the payment of premiums for automobile insurance in instalments and setting maximum rates of interest in relation to instalment payments;

19.1 prescribing types of contracts and circumstances in which section 236 does not apply;

20. exempting any insurer, and exempting any insurer in respect of certain types of contracts of automobile insurance, from section 236;

20.1 prescribing information to be provided under clause 258.3 (1) (c) and the time period within which the information must be provided for the purpose of that clause;

20.2 prescribing procedures and time limits applicable to mediations required by section 258.6;

20.3 prescribing circumstances in which a contract or part of a contract providing insurance against loss of or damage to an automobile and the loss of use thereof must contain a clause described in subsection 261 (1.1);

20.4 prescribing a minimum or maximum sum to be deducted under a clause described in clause 261 (1) (b) or subsection 261 (1.1);

21. prescribing rules for determining the degree of fault in various situations for loss or damage arising directly or indirectly from the use or operation of an automobile;

22. providing for and governing indemnification and subrogation where section 263 applies;

22.1 prescribing classes of contracts for the purpose of subsection 263 (5.1);

22.2 prescribing circumstances in which a contract belonging to a class prescribed under paragraph 22.1 must contain a provision described in subsection 263 (5.2.1);

22.3 prescribing the minimum or maximum amount of a reduction required by a provision described in clause 263 (5.1) (b) or subsection 263 (5.2.1);

23. prescribing any activity or failure to act that constitutes an unfair or deceptive act or practice under the definition of “unfair or deceptive acts or practices” in section 438, and prescribing requirements that, if not complied with, constitute an unfair or deceptive act or practice;

23.1 defining serious impairment of an important physical, mental or psychological function for the purpose of section 267.1 and defining permanent serious impairment of an important physical, mental or psychological function for the purpose of section 267.5;

23.2 respecting the evidence that must be adduced to prove that a person has sustained serious impairment of an important physical, mental or psychological function for the purposes of section 267.1 or permanent serious impairment of an important physical, mental or psychological function for the purposes of section 267.5;

23.3 prescribing the method for determining net income loss and net loss of earning capacity for the purpose of paragraphs 2 and 3 of subsection 267.5 (1);

23.4 defining catastrophic impairment for the purpose of subsection 267.5 (4);

23.5 prescribing amounts for the purpose of sub-subparagraph B of subparagraph i of paragraph 3 of subsection 267.5 (7) and sub-subparagraph B of subparagraph ii of paragraph 3 of subsection 267.5 (7);

23.6 prescribing circumstances in which the court shall order that an award for damages be paid periodically under section 267.10;

23.6.1 for the purpose of this Act or any provision of this Act, deeming payments for income loss or loss of earning capacity under an income continuation benefit plan to include payments prescribed by the regulations;

23.6.2 prescribing types of amounts and the manner of determining any type of amount for the purposes of clause 267.12 (2) (c);

23.6.3 prescribing types of amounts and the manner of determining any type of amount for the purposes of clause 267.12 (3) (c);

23.6.4 prescribing, for the purposes of subsection 267.12 (4),

i. circumstances in which subsection 267.12 (1) does not apply,

ii. persons or classes of persons to whom subsection 267.12 (1) does not apply,

iii. motor vehicles or classes of motor vehicles to which subsection 267.12 (1) does not apply,

iv. terms, conditions, provisions, exclusions and limits for the purposes of determining if subsection 267.12 (1) applies in particular circumstances or to a prescribed person, prescribed class of persons, prescribed motor vehicle or prescribed class of motor vehicles;

23.6.5 defining the terms “taxicab”, “livery vehicle” and “limousine for hire” for the purposes of clause 267.12 (4) (c);

23.7 prescribing the information to be provided under section 273.1 and the conditions governing the provision of the information;

24. prescribing classes of persons, classes of automobiles and terms, conditions, provisions, exclusions and limits for the purposes of subsection 275 (1);

25. prescribing rules of procedure and setting time limits in respect of mediation, arbitration, appeal and variation proceedings under sections 280 to 284 and in respect of evaluations under section 280.1;

Note: On a day to be named by proclamation of the Lieutenant Governor, paragraph 25 is repealed. (See: 2014, c. 9, Sched. 3, ss. 11 (1), 22)

25.1 governing agreements to settle claims and disputes in respect of statutory accident benefits under Part VI;

25.2 governing the assignment of statutory accident benefits under Part VI, including the application of sections 279 to 287 to persons to whom the benefits are assigned;

Note: On a day to be named by proclamation of the Lieutenant Governor, paragraph 25.2 is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 11 (2), 22)

25.2 governing the assignment of statutory accident benefits under Part VI, including the application of sections 279 to 282 to persons to whom the benefits are assigned;

26. prescribing expenses that may be awarded to insured persons and insurers under subsections 282 (11) and (11.1), prescribing criteria governing the awarding of the expenses, and setting maximum amounts that may be awarded for the expenses;

Note: On a day to be named by proclamation of the Lieutenant Governor, paragraph 26 is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 11 (3), 22)

26. governing proceedings before the Licence Appeal Tribunal under section 280, including imposing time limits or limitation periods;

26.0.0.1 prescribing anything that, in sections 288.1 to 288.7, is required or permitted to be prescribed or to be done in accordance with the regulations;

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding the following paragraph:

26.0.1 exempting a contract or class of contracts from the application of Part VII, any provision or requirement of Part VII or any regulation or provision or requirement of a regulation made in respect of Part VII, postponing, for any contract or class of contracts, the application of Part VII or any such provision or requirement to a specified date and applying a provision of Part VII for a specified period on and after the date it was re-enacted, repealed or amended by Schedule 23 to the Strong Action for Ontario Act (Budget Measures), 2012, as it read immediately before that date, to a contract or class of contracts;

See: 2012, c. 8, Sched. 23, ss. 3 (1), 77.

26.1 prescribing such matters as are required or permitted to be prescribed under sections 380.1 to 386 with respect to reciprocal insurance exchanges;

27. permitting the Director to vary or revoke orders and prescribing rules of procedure and setting conditions and setting time-limits in respect thereof and permitting the Director to proceed by way of a hearing or by way of written submissions;

Note: On a day to be named by proclamation of the Lieutenant Governor, paragraph 27 is repealed. (See: 2014, c. 9, Sched. 3, ss. 11 (4), 22)

28. extending the provisions of this Act or any of them to a system or class of insurance not particularly mentioned in this Act;

28.1 exempting a person or class of persons from section 393 and sections 397 to 401, or from any provision of those sections, subject to such terms and conditions, including any limitations or restrictions, as may be specified in the regulations;

Note: On a day to be named by proclamation of the Lieutenant Governor, paragraph 28.1 is amended by striking out “section 393 and sections 397 to 401 or from any provision of those sections” and substituting “subsection 392.2 (6) or 397 (7) or section 401”. (See: 2014, c. 9, Sched. 3, ss. 11 (5), 22)

28.2 governing the sale and marketing of prescribed classes of insurance to members of a group, including prescribing and regulating qualifications for membership in groups;

28.3 for the purposes of section 284.1, specifying terms and conditions governing the representation of a party to a proceeding under sections 279 to 284;

Note: On a day to be named by proclamation of the Lieutenant Governor, paragraph 28.3 is repealed. (See: 2014, c. 9, Sched. 3, ss. 11 (6), 22)

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding the following paragraphs:

28.3.1 respecting the application of Part VII to insurance described in clause 291 (3) (c);

28.3.2 prescribing information for which access is limited under clause 293 (8) (b);

28.3.3 for the purpose of subsection 313 (1.2), respecting the circumstances under which an insurer may not restrict or exclude in a contract of accident and sickness insurance the right of an insured to designate persons to whom or for whose benefit insurance money is to be payable and respecting the restriction or exclusion in a contract of such right;

28.3.4 prescribing the rights the insured may exercise under a contract of accident and sickness insurance in the circumstances described in subsection 317.1 (2);

See: 2012, c. 8, Sched. 23, ss. 3 (1), 77.

28.4 prescribing persons or classes of persons for the purposes of subsection 398 (3) and prescribing terms and conditions governing persons engaged in an activity set out in subsection 398 (1);

29. governing group insurance contracts or schemes, or any class thereof including prescribing and regulating their terms and conditions, qualifications for membership in groups and regulating the marketing of group insurance contracts or schemes;

30.-32. Repealed: 2006, c. 33, Sched. O, s. 6 (5).

33. governing the advertising of insurance contracts or any class thereof including prescribing and regulating the form and content of advertisements and requiring their filing;

33.1 governing the collection, use and disclosure of personal information by insurers or a class of insurers and, for that purpose, defining personal information;

34. prescribing types of contracts of automobile insurance and types of endorsements to contracts of automobile insurance in respect of which sections 410 to 417 apply;

34.1 prescribing percentages, criteria and elements of risk classification systems for the purposes of subsection 411 (1);

34.2 prescribing circumstances in which the Tribunal is required to hold a hearing on an application under section 410 to which section 411 does not apply;

35. prescribing coverages and categories of automobile insurance that may be provided by insurers and prescribing coverages and categories of automobile insurance that insurers are prohibited from providing;

36. prescribing a risk classification system or elements of a risk classification system that must be used by insurers or a class of insurers in classifying risks for a coverage or category of automobile insurance;

36.1 prescribing elements of a risk classification system that insurers or a class of insurers are prohibited from using in classifying risks for a coverage or category of automobile insurance;

36.2 prescribing, for the purpose of section 413.1, maximum monetary amounts and percentages by which the rate for a class of risks in respect of a coverage or category of automobile insurance may increase or decrease as a result of the application of a regulation made under paragraph 36 or 36.1;

37. Repealed: 1997, c. 28, s. 107 (3).

37.0.1 prescribing amounts incurred by the Ministry of Health and Long-Term Care that may be subject to an assessment under section 14.1 and governing assessments under that section;

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding the following paragraph: (See: 2014, c. 9, Sched. 3, ss. 11 (7), 22)

37.0.2 governing assessments under section 282;

37.1 respecting the relations between insurers, agents or brokers and,

i. entities that undertake the business of financial services,

ii. financial services intermediaries, and

iii. customers of persons and entities referred to in subparagraphs i and ii;

37.2 respecting networking arrangements between insurers and other persons providing products or services to the insurer or its customers;

37.3 prohibiting or restricting networking arrangements;

37.4 governing the conduct of insurers, agents and brokers in networking arrangements;

38. generally for the better administration of this Act. R.S.O. 1990, c. I.8, s. 121 (1); 1993, c. 10, s. 12 (1-13); 1994, c. 11, s. 338; 1996, c. 21, s. 14 (1-8); 1997, c. 19, s. 10 (22-24); 1997, c. 28, s. 107 (1-3); 1999, c. 12, Sched. I, s. 4 (14, 15); 2002, c. 18, Sched. H, s. 4 (14); 2002, c. 22, s. 114; 2004, c. 31, Sched. 20, s. 6; 2005, c. 31, Sched. 12, s. 1; 2006, c. 19, Sched. L, s. 11 (3); 2006, c. 33, Sched. O, s. 6 (1-5); 2011, c. 9, Sched. 21, s. 1; 2013, c. 2, Sched. 8, s. 5 (1).

Effective date of regulations

(2)  A regulation made under paragraph 6 of subsection (1) does not come into force until the day thirty days after it is filed with the Registrar of Regulations or such later day as may be set out in the regulation. R.S.O. 1990, c. I.8, s. 121 (2).

General or particular

(2.1)  A regulation made under subsection (1) may be general or particular. 1996, c. 21, s. 14 (9).

Adoption by reference

(2.2)  A regulation made under subsection (1) may adopt by reference, in whole or in part, with such changes as the Lieutenant Governor in Council considers necessary, any code, standard or guideline, as it reads at the time the regulation is made or as amended from time to time, whether before or after the regulation is made. 1996, c. 21, s. 14 (9).

(3)  Repealed: 1996, c. 21, s. 14 (10).

Same

(4)  The regulations made under paragraphs 9 and 10 of subsection (1),

(a) may establish procedures applicable to benefits;

(b) may prescribe the burden of proof and standard of proof applicable in court proceedings related to benefits and in arbitrations under section 282;

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (b) is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 11 (8), 22)

(b) may prescribe the burden of proof and standard of proof applicable in a proceeding before the Licence Appeal Tribunal under section 280;

(c) may require that a person be examined or assessed,

(i) by an assessment centre designated by a committee appointed under section 7, in accordance with procedures, standards and guidelines established by that committee or by the Minister, or

(ii) by any other person specified by the regulations;

(d), (e) Repealed: 1996, c. 21, s. 14 (12).

Note: Clauses 121 (4) (c), (d) and (e), as they read immediately before November 1, 1996, continue to apply to regulations made under paragraphs 9 and 10 of subsection 121 (1) in respect of benefits arising from the use or operation, after December 31, 1993 and before November 1, 1996, of an automobile. See: 1996, c. 21, s. 14 (14), 52.

(f) may authorize the payment of a benefit directly to a minor for the purpose of subsection 271 (1.4);

(g) may provide for the use of forms prescribed by the regulations or approved by the Superintendent; and

(h) may designate jurisdictions for the purpose of any provision of this or any other Act that refers to jurisdictions designated in the Statutory Accident Benefits Schedule. 1993, c. 10, s. 12 (14); 1996, c. 21, s. 14 (11-14); 1997, c. 28, s. 107 (4).

Classes, service provider’s licences

(4.1)  For greater certainty, a regulation made under paragraph 26.0.0.1 of subsection (1) may create different classes of service provider’s licences and may establish different requirements, conditions and restrictions for each class. 2013, c. 2, Sched. 8, s. 5 (2).

Regulations, Part II.2

(5)  The Lieutenant Governor in Council may make regulations,

1. prescribing the circumstances in which an individual is affiliated with an insurer for the purposes of Part II.2;

2. governing the establishment and operation of committees of insurers, including setting out requirements respecting the composition, membership, quorum, powers and duties of committees established by the directors of insurers;

3. exempting any insurer or class of insurers from Part II.2 or from any provision of that Part or the regulations made for the purposes of that Part, subject to such conditions as may be set out in the exempting regulations;

4. prescribing anything that is referred to in Part II.2 as being prescribed by the regulations or determined under the regulations. 2006, c. 33, Sched. O, s. 6 (6).

Regulations, Part XVII

(6)  The Lieutenant Governor in Council may make regulations,

1. with respect to the definition of “commercial loan” in subsection 432 (1),

i. prescribing an amount for the purposes of subclause (a) (i) of the definition,

ii. prescribing international agencies and other entities for the purposes of subclauses (a) (iii) and (b) (ii) of the definition,

iii. prescribing rules for determining amounts for the purposes of subclause (a) (v) and sub-subclauses (a) (vi) (A), (a) (vii) (A) and (a) (viii) (A) of the definition, and

iv. defining “widely distributed” for the purposes of subclauses (b) (iv) and (c) (i) of the definition;

2. prescribing classes of subsidiaries of insurers for the purposes of the definition of “prescribed subsidiary” in subsection 432 (1);

3. prescribing permitted entities and classes of permitted entities in which an insurer may acquire, hold or increase a substantial investment and prescribing any circumstances or conditions that must be satisfied for an entity to be a permitted entity for the purposes of Part XVII;

4. prescribing interests in real property for the purposes of Part XVII;

5. respecting the investment by insurers in permitted entities, including restrictions and limits on investments in permitted entities and rules relating to the form of the investments in permitted entities;

6. prescribing undertakings and information for the purposes of subsections 435.1 (4) and (5);

7. prescribing circumstances in which an insurer or a member of a class of insurers may acquire, hold or increase a substantial investment in an entity or a class of entities;

8. prescribing conditions for the purposes of clauses 435.3 (1) (c) and (d);

9. prescribing circumstances for the purposes of clause 435.3 (4) (a), 435.4 (4) (a) or 435.6 (4) (a);

10. for the purposes of section 435.5, prescribing rules for determining which investments are specialized financing, prescribing entities as specialized financing entities and governing an insurer’s specialized financing investments, including venture capital investments;

11. prescribing circumstances for the purposes of clause 435.6 (1) (f);

12. prescribing rules for determining the various financial limits referred to in Part XVII;

13. prescribing restrictions or conditions on the making of investments or loans or on acquiring an interest in property for the purposes of section 435.7;

14. prescribing circumstances for the purposes of subsection 435.8 (1);

15. prescribing requirements for the purposes of subsection 435.8 (3);

16. prescribing an amount or rules for determining an amount for the purposes of,

i. subsection 435.9 (1),

ii. subsection 435.9 (2),

iii. section 435.10,

iv. subsection 435.11 (2),

v. subsection 435.12 (2);

17. prescribing rules for determining the value of assets and an insurer’s total assets for the purposes of section 435.14;

18. prescribing rules and circumstances for the purposes of clause 435.14 (3) (c);

19. exempting any insurer or class of insurers from Part XVII or from any provision of that Part or the regulations made for the purposes of that Part, subject to such conditions as may be set out in the exempting regulations;

20. providing that one or more of the financial limits prescribed for the purposes of Part XVII do not apply in respect of an insurer or class of insurers or with respect to an investment or class of investments, or both, and prescribing when the financial limit does not apply and any conditions that must be satisfied for the financial limit not to apply;

21. prescribing criteria that the Superintendent shall consider in determining whether to give an approval for the purposes of any provision in Part XVII that refers to the approval of the Superintendent, other than subsection 435.1 (2);

22. prescribing anything that is referred to in Part XVII as being prescribed by the regulations or determined under the regulations. 2006, c. 33, Sched. O, s. 6 (6).

Regulations, Part XVII.1

(7)  The Lieutenant Governor in Council may make regulations,

1. exempting any insurer or class of insurers from Part XVII.1 or from any provision of Part XVII.1 or the regulations made for the purposes of that Part, subject to such conditions as may be set out in the exempting regulations;

2. prescribing holding companies and circumstances for the purposes of clause 437.13 (2) (c);

3. prescribing circumstances in which an insurer may enter into a transaction with a related party and setting out conditions respecting such transactions;

4. prescribing conditions and circumstances under which a transaction entered into by a subsidiary of an insurer will not be deemed to have been entered into by the insurer;

5. prescribing rules and conditions relating to transactions between insurers and related parties;

6. prescribing, for the purposes of paragraph 1 of subsection 437.18 (1),

i. a nominal amount or rules for determining what constitutes a nominal amount, and

ii. what constitutes a transaction that is immaterial to an insurer or rules for determining what constitutes an immaterial transaction;

7. prescribing conditions for the purposes of subparagraph 4 i and rules for the purposes of subparagraph 4 ii of subsection 437.18 (1);

8. prescribing permitted transactions for the purposes of paragraphs 10 and 16 of subsection 437.18 (1);

9. prescribing transactions between an insurer and a related party that are permitted for the purposes of subsection 437.18 (4) despite the fact that they are not on terms and conditions at least as favourable to the insurer as market terms and conditions;

10. prescribing an amount or rules for determining an amount for the purposes of subsection 437.19 (2);

11. prescribing for the purposes of subsection 437.19 (6),

i. types or classes of transactions,

ii. rules for determining the total value of transactions, and

iii. an amount or rules for determining an amount;

12. prescribing for the purposes of subsection 437.19 (7),

i. types or classes of transactions that require approval of the directors of an insurer,

ii. rules for determining the total value of transactions,

iii. an amount or rules for determining an amount, and

iv. what constitutes approval, including prescribing a minimum percentage of directors who must approve;

13. prescribing criteria that the Superintendent shall consider in determining whether to give an approval for the purposes of any provision in Part XVII.1 that refers to the approval of the Superintendent;

14. prescribing anything that is referred to in Part XVII.1 as being prescribed by the regulations or determined under the regulations. 2006, c. 33, Sched. O, s. 6 (6).

Regulations, Part XVIII.1

(7.1)  The Lieutenant Governor in Council may make regulations governing the administrative penalties that may be imposed under sections 441.3 and 441.4 and, without limiting the generality of the foregoing, may make regulations,

(a) prescribing provisions of this Act or the regulations for the purposes of sections 441.3 and 441.4;

(b) prescribing criteria the Superintendent is required or permitted to consider when imposing a penalty under section 441.3 or 441.4;

(c) prescribing the amount of a penalty, or the method for calculating the amount of a penalty, and prescribing different penalties or ranges of penalties for different types of contraventions or failures to comply and for different classes of persons;

(d) authorizing the Superintendent to determine the amount of a penalty, if the amount of the penalty or the method for calculating the amount of the penalty is not prescribed, and prescribing criteria the Superintendent is required or permitted to consider when determining this;

(e) authorizing a penalty to be imposed for each day or part of a day on which a contravention or failure to comply continues;

(f) authorizing higher penalties (not to exceed the maximum penalty established under section 441.5 or prescribed under clause (j)) for a second or subsequent contravention or failure to comply by a person;

(g) governing the manner of paying the penalties;

(h) requiring that a penalty be paid before a specified deadline or before a deadline specified by the Superintendent;

(i) authorizing the imposition of late payment fees respecting penalties that are not paid before the deadline, including graduated late payment fees;

(j) prescribing lesser maximum administrative penalties and the requirements established under this Act to which the lesser maximum penalties apply for the purpose of subsection 441.5 (1) or (2). 2012, c. 8, Sched. 23, s. 3 (2).

General or particular

(8)  A regulation made under subsection (5), (6), (7) or (7.1) may be general or particular. 2006, c. 33, Sched. O, s. 6 (6); 2012, c. 8, Sched. 23, s. 3 (3).

Same – classes

(9)  For greater certainty, a regulation made under subsection (5), (6), (7) or (7.1) with respect to a class of insurers may be made with respect to any class as described in the regulation and is not limited to the classes of insurers set out in subsection 42 (1). 2006, c. 33, Sched. O, s. 6 (6); 2012, c. 8, Sched. 23, s. 3 (4).

Fees

121.1  The Minister may establish fees in relation to any matter under this Act, including any services provided by or through the Ministry of Finance or the Commission. 1997, c. 19, s. 10 (25).

Forms

121.2  (1)  The Superintendent may approve forms for any purpose of this Act and the forms may provide for such information to be furnished as the Superintendent may require. 1997, c. 19, s. 10 (25); 1997, c. 28, c. 108 (2).

Electronic forms

(2)  The Superintendent may approve electronic forms for any purposes under this Act. 1997, c. 19, s. 10 (25); 1997, c. 28, s. 108 (2).

PART II.1
ACTUARY OF THE INSURER

Definition

121.3  In this Part,

“insurer” means an insurer incorporated and licensed under the laws of Ontario. 2002, c. 18, Sched. H, s. 4 (15).

Appointment of actuary

121.4  (1)  The directors of an insurer shall appoint an actuary of the insurer. 2002, c. 18, Sched. H, s. 4 (15).

Same

(2)  An insurer that is incorporated and licensed on the day this Part comes into force shall appoint an actuary of the insurer forthwith after that day. 2002, c. 18, Sched. H, s. 4 (15).

Notice of appointment

121.5  An insurer shall notify the Superintendent in writing of the appointment forthwith after the appointment of the actuary of the insurer. 2002, c. 18, Sched. H, s. 4 (15).

When officers not to be actuary

121.6  (1)  Neither the chief executive officer, the chief operating officer nor a person performing similar functions for an insurer shall be appointed as or hold the position of actuary of the insurer without the Superintendent’s written authorization. 2002, c. 18, Sched. H, s. 4 (15).

Duration of authorization

(2)  An authorization under subsection (1) expires on the earlier of the day specified in the authorization and the day that is six months after the authorization is issued. 2002, c. 18, Sched. H, s. 4 (15).

Chief financial officer

121.7  (1)  Neither the chief financial officer of an insurer nor a person performing similar functions for an insurer shall be appointed as or hold the position of actuary of the insurer unless,

(a) the Superintendent receives a written statement from the audit committee of the insurer indicating that it is satisfied that the duties of both positions will be adequately performed and that the actuarial duties will be performed in an independent manner; and

(b) the Superintendent authorizes the appointment or the holding of the position with or without conditions. 2002, c. 18, Sched. H, s. 4 (15).

Same

(2)  The conditions may limit the period of time that the officer or person may be the actuary of the insurer. 2002, c. 18, Sched. H, s. 4 (15).

Revocation of appointment

121.8  (1)  The directors of an insurer may revoke the appointment of the actuary of the insurer. 2002, c. 18, Sched. H, s. 4 (15).

Notice of revocation

(2)  An insurer shall give the Superintendent written notice of the revocation of an appointment forthwith after the revocation. 2002, c. 18, Sched. H, s. 4 (15).

Ceasing to hold office

121.9  (1)  A person shall cease to be the actuary of the insurer when,

(a) the person resigns as actuary of the insurer;

(b) the person ceases to be an actuary; or

(c) the directors of the insurer revoke the appointment. 2002, c. 18, Sched. H, s. 4 (15).

Effective date of resignation

(2)  The resignation of an actuary of the insurer takes effect on the later of the day that the insurer receives written notice of the resignation and the day specified in that notice. 2002, c. 18, Sched. H, s. 4 (15).

Filling vacancy

121.10  If the office of actuary of the insurer becomes vacant, the directors of the insurer shall immediately appoint a new actuary of the insurer and notify the Superintendent of the vacancy and the new appointment. 2002, c. 18, Sched. H, s. 4 (15).

Statement of actuary

121.11  If an actuary of the insurer resigns or his or her appointment is revoked, the actuary shall submit a written statement to the directors of the insurer and the Superintendent stating the circumstances and reasons why the actuary resigned or why, in the actuary’s opinion, the appointment was revoked. 2002, c. 18, Sched. H, s. 4 (15).

Duty of replacement actuary

121.12  If an actuary of the insurer resigns or the appointment of the actuary of the insurer is revoked, no person shall accept an appointment or consent to be appointed as the actuary of the insurer unless,

(a) the person has received the statement referred to in section 121.11; or

(b) the person has asked the former actuary for a copy of that statement and has not received a copy of it within 15 days after asking for it. 2002, c. 18, Sched. H, s. 4 (15).

Actuary’s valuation

121.13  (1)  An actuary of the insurer shall value,

(a) the actuarial and other policy liabilities of the insurer as at the end of a year covered by the annual statement required under subsection 102 (1); and

(b) any other matters the Superintendent directs. 2002, c. 18, Sched. H, s. 4 (15).

Same

(2)  The actuary’s valuation shall be in accordance with generally accepted actuarial practice with such changes as may be determined by the Superintendent and any additional directions that may be made by the Superintendent. 2002, c. 18, Sched. H, s. 4 (15).

Same

(3)  The insurer shall submit the actuary’s valuation report to the Superintendent with the statements required under subsection 102 (1). 2002, c. 18, Sched. H, s. 4 (15).

Superintendent may appoint actuary

121.14  (1)  The Superintendent may appoint an actuary to,

(a) conduct a review of the valuation of the actuary of the insurer completed under section 121.13; or

(b) conduct an independent valuation of matters referred to in section 121.13. 2002, c. 18, Sched. H, s. 4 (15).

Expenses payable by insurer

(2)  The expenses incurred in carrying out a review or a valuation under subsection (1) are payable by the insurer on being approved in writing by the Superintendent. 2002, c. 18, Sched. H, s. 4 (15).

Right to information

121.15  (1)  The actuary of the insurer may request information, explanations or access to any records of the insurer as are necessary to perform his or her duties. 2002, c. 18, Sched. H, s. 4 (15).

Same

(2)  The present or former directors, officers, employees or representatives of an insurer shall permit access to records and provide information or explanations requested by the actuary of the insurer, to the extent they are reasonably able to do so. 2002, c. 18, Sched. H, s. 4 (15).

No civil liability

(3)  A person who acts in good faith under subsection (2) shall not be liable in any civil proceeding arising from that action. 2002, c. 18, Sched. H, s. 4 (15).

Actuary’s report

121.16  (1)  An actuary of the insurer shall submit a report in a form approved by the Superintendent to shareholders and policyholders of the insurer on the valuation made under section 121.13 and on any other matter required by the Superintendent, at least 21 days before the date of the annual meeting. 2002, c. 18, Sched. H, s. 4 (15).

Same

(2)  The report shall include a statement by the actuary of the insurer as to whether, in the actuary’s opinion, the annual statement required under subsection 102 (1) presents fairly the results of the valuation made under section 121.13. 2002, c. 18, Sched. H, s. 4 (15).

Report to directors

121.17  (1)  An actuary of the insurer shall meet with the directors of the insurer or, if the directors so choose, with the audit committee of the insurer at least once during each fiscal year. 2002, c. 18, Sched. H, s. 4 (15).

Same

(2)  At the meeting referred to in subsection (1), the actuary of the insurer shall report, in accordance with generally accepted actuarial practice and any direction made by the Superintendent, on the financial position of the insurer and, if specified in a direction of the Superintendent, the expected future financial condition of the insurer. 2002, c. 18, Sched. H, s. 4 (15).

Report to officers

121.18  (1)  An actuary of the insurer shall report in writing to the chief executive officer and chief financial officer of the insurer any matters that have come to the actuary’s attention in the course of carrying out the actuary’s duties if, in the actuary’s opinion, they have material adverse effects on the financial condition of the insurer and those matters require rectification. 2002, c. 18, Sched. H, s. 4 (15).

Submission of report

(2)  An actuary of the insurer shall also provide a copy of the report referred to in subsection (1) to the directors of the insurer immediately after making it. 2002, c. 18, Sched. H, s. 4 (15).

Failure to take action

(3)  If, in the opinion of the actuary of the insurer, suitable action is not being taken to rectify the matters referred to in subsection (1), the actuary shall immediately send a copy of the report to the Superintendent and advise the directors of the insurer that he or she has done so. 2002, c. 18, Sched. H, s. 4 (15).

Qualified privilege

121.19  (1)  An oral or written statement or report made under this Act by an actuary or former actuary of the insurer has qualified privilege. 2002, c. 18, Sched. H, s. 4 (15).

Same

(2)  An actuary or former actuary of the insurer who in good faith makes an oral or written statement or report under section 121.11 or 121.18 is not liable in any civil proceeding seeking indemnification for damages attributable to the actuary or former actuary of the insurer having made the statement or report. 2002, c. 18, Sched. H, s. 4 (15).

Non-application of this Part

121.20  This Part does not apply to a mutual insurance corporation that is a member of the Fire Mutuals Guarantee Fund. 2002, c. 18, Sched. H, s. 4 (15).

Non-application of s. 121.17

121.21  Section 121.17 does not apply to reciprocal insurance exchanges. 2002, c. 18, Sched. H, s. 4 (15).

Exemptions

121.22  On written application by an insurer, the Superintendent may in special circumstances approve the exemption of the insurer from section 121.13 or 121.17, or both, on such terms and conditions as may be specified in the approval. 2002, c. 18, Sched. H, s. 4 (15).

PART II.2
DIRECTORS OF AN INSURER

Affiliated individuals

Definitions

121.23  (1)  In this Part,

“insurer” means an insurer that is incorporated and licensed under the laws of Ontario; (“assureur”)

“person” includes an entity; (“personne”)

“reporting issuer” means an insurer that is a reporting issuer under the Securities Act. (“émetteur assujetti”) 2006, c. 33, Sched. O, s. 7.

Affiliated individual

(2)  An individual is affiliated with an insurer for the purposes of this Part in the circumstances prescribed by the regulations. 2006, c. 33, Sched. O, s. 7.

Affiliate

(3)  An entity is an affiliate of an insurer for the purposes of this Part if it is an affiliate of the insurer for the purposes of Part XVII. 2006, c. 33, Sched. O, s. 7.

Superintendent may determine individual is affiliated

(4)  Despite subsection (2), the Superintendent may determine that an individual is affiliated with an insurer for the purposes of this Part if, in the opinion of the Superintendent, the individual has such a significant or sufficient commercial, business or financial relationship with the insurer or an affiliate of the insurer that the relationship can be construed as being material to the individual and can reasonably be expected to affect the exercise of the individual’s best judgment. 2006, c. 33, Sched. O, s. 7.

Appeal

(5)  The individual or the insurer may appeal a decision of the Superintendent to the Tribunal. 2006, c. 33, Sched. O, s. 7.

Duration of determination

(6)  A determination by the Superintendent under subsection (4),

(a) becomes effective on the day of the next annual meeting of the shareholders and policyholders unless a notice in writing by the Superintendent revoking the determination is received by the insurer before that day; and

(b) ceases to be in effect on the day of the next annual meeting of the shareholders and policyholders after a notice in writing by the Superintendent revoking the determination is received by the insurer. 2006, c. 33, Sched. O, s. 7.

Directors’ duties

121.24  (1)  Subject to this Act and the regulations, the directors of an insurer shall,

(a) establish an audit committee;

(b) establish a conduct review committee;

(c) establish such other committees as may be required by the regulations;

(d) establish procedures to resolve conflicts of interest, including procedures for the identification of potential conflict situations, and establish or designate a committee of the directors to monitor the application of the procedures and the results of their application. 2006, c. 33, Sched. O, s. 7.

Committees

(2)  In establishing a committee, the directors shall comply with any requirements prescribed by the regulations relating to the composition, membership, quorum, powers and duties of the committee. 2006, c. 33, Sched. O, s. 7.

Quorum of executive committee

(3)  Despite subsection 70 (3) of the Corporations Act, a quorum of the members of the executive committee must include at least one member of the executive committee who is not affiliated with the insurer. 2006, c. 33, Sched. O, s. 7.

PART III
INSURANCE CONTRACTS IN ONTARIO

Application of Part

122.  Except where otherwise provided and where not inconsistent with other provisions of this Act, this Part applies to every contract of insurance made in Ontario, other than contracts of,

(a) accident and sickness insurance;

(b) life insurance; and

(c) marine insurance. R.S.O. 1990, c. I.8, s. 122; 2002, c. 18, Sched. H, s. 4 (16).

Contracts deemed made in Ontario

123.  Where the subject-matter of a contract of insurance is property in Ontario or an insurable interest of a person resident in Ontario, the contract of insurance, if signed, countersigned, issued or delivered in Ontario or committed to the post office or to any carrier, messenger or agent to be delivered or handed over to the insured or the insured’s assign or agent in Ontario shall be deemed to evidence a contract made therein, and the contract shall be construed according to the law thereof, and all money payable under the contract shall be paid at the office of the chief officer or agent in Ontario of the insurer in lawful money of Canada. R.S.O. 1990, c. I.8, s. 123.

Requirement for all terms to be set out in policy; relevance of proposal, etc.

Terms, etc., of contracts invalid unless set out in full

124.  (1)  All the terms and conditions of the contract of insurance shall be set out in full in the policy or by writing securely attached to it when issued, and, unless so set out, no term of the contract or condition, stipulation, warranty or proviso modifying or impairing its effect is valid or admissible in evidence to the prejudice of the insured or beneficiary. R.S.O. 1990, c. I.8, s. 124 (1).

Exception

(2)  Subsection (1) does not apply to an alteration or modification of the contract agreed upon in writing by the insurer and the insured after the issue of the policy. R.S.O. 1990, c. I.8, s. 124 (2).

Contents of renewal receipt

(3)  Whether the contract does or does not provide for its renewal, but it is renewed by a renewal receipt, it is a sufficient compliance with subsection (1) if the terms and conditions of the contract are set out as provided by that subsection and the renewal receipt refers to the contract by its number or date. R.S.O. 1990, c. I.8, s. 124 (3).

What regard to be given to proposal

(4)  The proposal or application of the insured shall not as against the insured be deemed a part of or be considered with the contract of insurance except in so far as the court determines that it contains a material misrepresentation by which the insurer was induced to enter into the contract. R.S.O. 1990, c. I.8, s. 124 (4).

Contract not to be invalidated by erroneous statement in application unless material

(5)  No contract of insurance shall contain or have endorsed upon it, or be made subject to, any term, condition, stipulation, warranty or proviso providing that such contract shall be avoided by reason of any statement in the application therefor, or inducing the entering into of the contract by the insurer, unless such term, condition, stipulation, warranty or proviso is and is expressed to be limited to cases in which such statement is material to the contract, and no contract shall be avoided by reason of the inaccuracy of any such statement unless it is material to the contract. R.S.O. 1990, c. I.8, s. 124 (5).

Materiality, how decided

(6)  The question of materiality in a contract of insurance is a question of fact for the jury, or for the court if there is no jury, and no admission, term, condition, stipulation, warranty or proviso to the contrary contained in the application or proposal for insurance, or in the instrument of contract, or in any agreement or document relating thereto, has any force or validity. R.S.O. 1990, c. I.8, s. 124 (6).

Application

(7)  This section does not apply to,

(a) contracts of automobile insurance; or

(b) contracts of insurance to which Part IV applies. 2002, c. 18, Sched. H, s. 4 (17).

Copy of proposal to be furnished to insured

125.  An insurer shall upon request furnish to the insured a true copy of the insured’s application or proposal for insurance. R.S.O. 1990, c. I.8, s. 125.

No contract shall be inconsistent with Act

126.  (1)  No insurer shall make a contract of insurance inconsistent with this Act.

Rights of insured

(2)  An act or omission of the insurer resulting in imperfect compliance with any of the provisions of this Act does not render a contract invalid as against the insured. R.S.O. 1990, c. I.8, s. 126.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is repealed and the following substituted:

Rights of insured, beneficiary, etc.

(2)  A contract is not rendered void or voidable as against an insured, or a beneficiary or other person to whom insurance money is payable under the contract, by reason of a failure of the insurer to comply with a provision of this Act. 2012, c. 8, Sched. 23, s. 4.

See: 2012, c. 8, Sched. 23, ss. 4, 77.

Contents of policy

127.  (1)  Every policy shall contain the name of the insurer, the name of the insured, the name of the person or persons to whom the insurance money is payable, the amount, or the method of determining the amount, of the premium for the insurance, the subject-matter of the insurance, the indemnity for which the insurer may become liable, the event on the happening of which the liability is to accrue, the date upon which the insurance takes effect and the date it terminates or the method by which the latter is fixed or to be fixed. R.S.O. 1990, c. I.8, s. 127 (1).

Application of section

(2)  This section does not apply to contracts of surety insurance. R.S.O. 1990, c. I.8, s. 127 (2); 2002, c. 18, Sched. H, s. 4 (18).

Contracts providing for appraisals

128.  (1)  This section applies to a contract containing a condition, statutory or otherwise, providing for an appraisal to determine specified matters in the event of a disagreement between the insured and the insurer. R.S.O. 1990, c. I.8, s. 128 (1).

Appraisers, appointment

(2)  The insured and the insurer shall each appoint an appraiser, and the two appraisers so appointed shall appoint an umpire. R.S.O. 1990, c. I.8, s. 128 (2).

Appraisers, duties

(3)  The appraisers shall determine the matters in disagreement and, if they fail to agree, they shall submit their differences to the umpire, and the finding in writing of any two determines the matters. R.S.O. 1990, c. I.8, s. 128 (3).

Costs

(4)  Each party to the appraisal shall pay the appraiser appointed by the party and shall bear equally the expense of the appraisal and the umpire. R.S.O. 1990, c. I.8, s. 128 (4).

Appointment by judge

(5)  Where,

(a) a party fails to appoint an appraiser within seven clear days after being served with written notice to do so;

(b) the appraisers fail to agree upon an umpire within fifteen days after their appointment; or

(c) an appraiser or umpire refuses to act or is incapable of acting or dies,

a judge of the Superior Court of Justice may appoint an appraiser or umpire, as the case may be, upon the application of the insured or of the insurer. R.S.O. 1990, c. I.8, s. 128 (5); 2006, c. 19, Sched. C, s. 1 (1).

Relief from forfeiture

129.  Where there has been imperfect compliance with a statutory condition as to the proof of loss to be given by the insured or other matter or thing required to be done or omitted by the insured with respect to the loss and a consequent forfeiture or avoidance of the insurance in whole or in part and the court considers it inequitable that the insurance should be forfeited or avoided on that ground, the court may relieve against the forfeiture or avoidance on such terms as it considers just. R.S.O. 1990, c. I.8, s. 129.

How policy payable

130.  Insurance money is payable in Ontario in lawful money of Canada. R.S.O. 1990, c. I.8, s. 130.

Waiver of term or condition

131.  (1)  No term or condition of a contract shall be deemed to be waived by the insurer in whole or in part unless the waiver is stated in writing and signed by a person authorized for that purpose by the insurer.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is repealed and the following substituted:

Waiver and estoppel

(1)  The obligation of an insured to comply with a requirement under a contract is excused to the extent that,

(a) the insurer has given notice in writing that the insured’s compliance with the requirement is excused in whole or in part, subject to the terms specified in the notice, if any; or

(b) the insurer’s conduct reasonably causes the insured to believe that the insured’s compliance with the requirement is excused in whole or in part, and the insured acts on that belief to the insured’s detriment. 2012, c. 8, Sched. 23, s. 5.

See: 2012, c. 8, Sched. 23, ss. 5, 77.

Idem

(2)  Neither the insurer nor the insured shall be deemed to have waived any term or condition of a contract by any act relating to the appraisal of the amount of loss or to the delivery and completion of proofs or to the investigation or adjustment of any claim under the contract. R.S.O. 1990, c. I.8, s. 131.

Right of claimant against insurer where execution against insured returned unsatisfied

132.  (1)  Where a person incurs a liability for injury or damage to the person or property of another, and is insured against such liability, and fails to satisfy a judgment awarding damages against the person in respect of the person’s liability, and an execution against the person in respect thereof is returned unsatisfied, the person entitled to the damages may recover by action against the insurer the amount of the judgment up to the face value of the policy, but subject to the same equities as the insurer would have if the judgment had been satisfied.

Exception

(2)  This section does not apply to motor vehicle liability policies. R.S.O. 1990, c. I.8, s. 132.

Court actions for recovery of insurance money, special rules

Consolidation of actions

133.  (1)  Where several actions are brought for the recovery of money payable under a contract or contracts of insurance, the court may consolidate or otherwise deal therewith so that there is but one action for and in respect of all the claims made in such actions.

Where minors are entitled to insurance money

(2)  Where an action is brought to recover the share of one or more minors, all the other minors entitled, or the trustees, executors or guardians entitled to receive payment of the shares of such other minors, shall be made parties to the action, and the rights of all the minors shall be determined in one action.

Apportionment of sums directed to be paid

(3)  In all actions where several persons are interested in the insurance money, the court or judge may apportion among the persons entitled any sum directed to be paid, and may give all necessary directions and relief.

When payee is domiciled or resident abroad

(4)  Where the person entitled to receive money due and payable under a contract of insurance, except insurance of the person, is domiciled or resides in a foreign jurisdiction and payment, valid according to the law of such jurisdiction, is made to such person, such payment is valid and effectual for all purposes. R.S.O. 1990, c. I.8, s. 133.

Non-payment of premium

Effect of delivery of policy

134.  (1)  Where the policy has been delivered, the contract is as binding on the insurer as if the premium had been paid, although it has not in fact been paid, and although delivered by an officer or agent of the insurer who had not authority to deliver it.

Right of insurer in respect of unpaid premium

(2)  The insurer may sue for the unpaid premium and may deduct the amount thereof from the amount for which the insurer is liable under the contract of insurance.

Where note or cheque for premium not honoured

(3)  Where a cheque, bill of exchange or promissory note is given, whether originally or by way of renewal, for the whole or part of any premium and the cheque, bill of exchange or promissory note is not honoured according to its tenor, the insurer may terminate the contract forthwith by giving written notice by registered mail. R.S.O. 1990, c. I.8, s. 134.

Insurer to furnish forms for proof of loss

135.  (1)  An insurer, immediately upon receipt of a request, and in any event not later than sixty days after receipt of notice of loss, shall furnish to the insured or person to whom the insurance money is payable forms upon which to make the proof of loss required under the contract.

Offence

(2)  An insurer who neglects or refuses to comply with subsection (1) is guilty of an offence, and in addition section 136 is not available to the insurer as a defence to an action brought, after such neglect or refusal, for the recovery of money alleged to be payable under the contract of insurance.

Furnishing of forms not an admission

(3)  The furnishing by an insurer of forms to make proof of loss shall not be taken to constitute an admission by the insurer that a valid contract is in force or that the loss in question falls within the insurance provided by the contract. R.S.O. 1990, c. I.8, s. 135.

When action may be brought under contract

136.  No action shall be brought for the recovery of money payable under a contract of insurance until the expiration of sixty days after proof, in accordance with the provisions of the contract,

(a) of the loss; or

(b) of the happening of the event upon which the insurance money is to become payable,

or of such shorter period as is fixed by the contract of insurance. R.S.O. 1990, c. I.8, s. 136.

Insurance as Collateral Security

Mortgagee not to receive commission from insurer

137.  (1)  A mortgagee shall not accept or be entitled to receive either directly or through an agent or employee, and no officer or employee of such mortgagee shall accept or receive, any commission or other remuneration or benefit in consideration of effecting a contract of insurance or renewal thereof under which contract loss, if any, is payable to the mortgagee as mortgagee.

Payment of commission prohibited

(2)  No insurer or agent or broker shall pay, allow or give any commission or other remuneration or benefit to a mortgagee or to any person in the mortgagee’s employ or on the mortgagee’s behalf in consideration of effecting a contract of insurance or renewal thereof under which contract loss, if any, is payable to the mortgagee as mortgagee.

Offence

(3)  Any insurer or other person who contravenes this section is guilty of an offence. R.S.O. 1990, c. I.8, s. 137.

Right to refund of premium on termination of contract

138.  (1)  Where an insured assigns the right to refund of premium that may accrue by reason of the cancellation or termination of a contract of insurance under the terms thereof and notice of the assignment is given by the assignee to the insurer, the insurer shall pay any such refund to the assignee despite any condition in the contract, whether prescribed under this Act or not, requiring the refund to be paid to the insured or to accompany any notice of cancellation or termination to the insured.

Idem

(2)  Where the condition in the contract dealing with cancellation or termination by the insurer provides that the refund shall accompany the notice of cancellation or termination, the insurer shall include in the notice a statement that in lieu of payment of the refund in accordance with the condition the refund is being paid to the assignee under this section. R.S.O. 1990, c. I.8, s. 138.

Contracts of Guarantee Insurance

Contracts of title insurance

139.  (1)  Every contract of title insurance shall be in writing, and, in addition to the other requirements prescribed by this Act, shall expressly limit the liability of the insurer to a sum stated in the contract.

Questions as to validity of title

(2)  If a question arises as to the validity of the title insured, or as to the liability of the insurer, the insurer or the insured or any person entitled to proceed in right of either may by application have such question determined as provided in the Vendors and Purchasers Act in the case of vendors and purchasers. R.S.O. 1990, c. I.8, s. 139.

General

No racial or religious discrimination permissible

140.  Any licensed insurer that discriminates unfairly between risks in Ontario because of the race or religion of the insured is guilty of an offence. R.S.O. 1990, c. I.8, s. 140.

Payment into court

141.  (1)  Where an insurer cannot obtain a sufficient discharge for insurance money for which it admits liability, the insurer may apply to the court without notice for an order for the payment thereof into court, and the court may order the payment into court to be made upon such terms as to costs and otherwise as the court may direct, and may provide to what fund or name the amount shall be credited.

Discharge to insurer

(2)  The receipt of the registrar or other proper officer of the court is sufficient discharge to the insurer for the insurance money so paid into court, and the insurance money shall be dealt with according to the orders of the court. R.S.O. 1990, c. I.8, s. 141.

PART IV
FIRE INSURANCE

Meaning of “agricultural property”, Part IV

142.  In this Part, unless the context otherwise requires,

“agricultural property” includes dwelling-houses, stables, barns, sheds and outbuildings and their contents, wagons, carriages, and other vehicles, saddles and harness, agricultural engines, implements, tools, instruments, appliances and machinery, household goods, wearing apparel, provisions, musical instruments, libraries, livestock, growing crops, and crops severed from the land, fruit and ornamental trees, shrubs and plants, and live or standing timber, being upon farms as farm property, and owned by members of the insurer in which the property is insured. R.S.O. 1990, c. I.8, s. 142.

Application of Part

143.  (1)  This Part applies to insurance against loss of or damage to property arising from the peril of fire in any contract made in Ontario except,

(a) insurance within the class of aircraft insurance;

(a.1) insurance within the class of automobile insurance;

(a.2) insurance within the class of boiler and machinery insurance;

(a.3) insurance (other than marine insurance) against loss of or damage to property,

(i) while in transit or during delay incidental to transit, or

(ii) where, in the opinion of the Superintendent, the risk is substantially a transit risk;

(a.4) insurance within the class of marine insurance;

(a.5) insurance against loss of or damage to plate, sheet or window glass, whether in place or in transit;

(a.6) insurance against loss of or damage to property through the breakage or leakage of sprinkler equipment or other fire protection system, or of pumps, water pipes or plumbing and its fixtures;

(a.7) insurance against loss or damage through theft, wrongful conversion, burglary, house-breaking, robbery or forgery;

(b) where the subject-matter of the insurance is rents, charges or loss of profits;

(c) where the peril of fire is an incidental peril to the coverage provided; or

(d) where the subject-matter of the insurance is property that is insured by an insurer or group of insurers primarily as a nuclear risk under a policy covering against loss of or damage to the property resulting from nuclear reaction or nuclear radiation and from other perils. R.S.O. 1990, c. I.8, s. 143 (1); 2002, c. 18, Sched. H, s. 4 (19).

Automobiles

(2)  Despite subsection (1), this Part applies to insurance of an automobile as provided in subsection 47 (2). R.S.O. 1990, c. I.8, s. 143 (2).

Extent of coverage by contract

144.  (1)  Subject to subsection (4) of this section and to clause 151 (a), in any contract to which this Part applies the contract shall be deemed to cover the insured property,

(a) against fire (whether resulting from explosion or otherwise) not occasioned by or happening through,

(i) in the case of goods, their undergoing any process involving the application of heat,

(ii) riot, civil commotion, war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military power;

(b) against lightning, but excluding destruction or loss to electrical devices or appliances caused by lightning or other electrical currents unless fire originates outside the article itself and only for such destruction or damage as occurs from such fire;

(c) against explosion (not occasioned by or happening through any of the perils specified in subclause (a) (ii)) of natural, coal or manufactured gas in a building not forming part of a gas works, whether fire ensues therefrom or not. R.S.O. 1990, c. I.8, s. 144 (1).

Radioactive contamination

(2)  Unless a contract to which this Part applies otherwise specifically provides, it does not cover the insured property against loss or damage caused by contamination by radio-active material directly or indirectly resulting from fire, lightning or explosion within the meaning of subsection (1). R.S.O. 1990, c. I.8, s. 144 (2).

Coverage where property removed

(3)  Where property insured under a contract covering it at a specified location is necessarily removed to prevent loss or damage or further loss or damage thereto, that part of the insurance under the contract that exceeds the amount of the insurer’s liability for any loss incurred covers, for seven days only or for the unexpired term of the contract if less than seven days, the property removed and any property remaining in the original location in the proportions that the value of the property in each of the respective locations bears to the value of the property in them all. R.S.O. 1990, c. I.8, s. 144 (3).

Extended insurance

(4)  Nothing in subsection (1) precludes an insurer giving more extended insurance against the perils mentioned therein, but in that case this Part does not apply to the extended insurance. R.S.O. 1990, c. I.8, s. 144 (4).

Power to extend meaning of “lightning” in livestock contracts

(5)  An insurer licensed to carry on property insurance may include in its insurance contracts a clause or endorsement providing that, in the case of livestock insured against death or injury caused by fire or lightning, the word “lightning” is deemed to include other electrical currents. R.S.O. 1990, c. I.8, s. 144 (5); 2002, c. 18, Sched. H, s. 4 (20).

Renewal of contract

145.  A contract may be renewed by the delivery of a renewal receipt identifying the policy by number, date or otherwise. R.S.O. 1990, c. I.8, s. 145; 1999, c. 12, Sched. I, s. 4 (16).

Form of contract

146.  After an application for insurance is made, if it is in writing, any policy sent to the insured shall be deemed to be intended to be in accordance with the terms of the application, unless the insurer points out in writing the particulars wherein it differs from the application, in which case the insured may, within two weeks from the receipt of the notification, reject the policy. R.S.O. 1990, c. I.8, s. 146.

Mortgagees and other payees

147.  (1)  Where the loss, if any, under a contract has, with the consent of the insurer, been made payable to a person other than the insured, the insurer shall not cancel or alter the policy to the prejudice of that person without notice to that person. R.S.O. 1990, c. I.8, s. 147 (1).

Form of notice

(2)  Subject to subsection (3), the length of and manner of giving the notice under subsection (1) is the same as notice of cancellation to the insured under the statutory conditions in the contract. R.S.O. 1990, c. I.8, s. 147 (2); 1997, c. 19, s. 10 (26).

Alternate notice

(3)  If the loss under a contract has, with the consent of the insurer, been made payable to a person other than the insured, the insurer and the person may enter into a written agreement to provide for alternate notice. 1997, c. 19, s. 10 (27).

Statutory conditions

148.  (1)  The conditions set forth in this section shall be deemed to be part of every contract in force in Ontario and shall be printed in English or French in every policy with the heading “Statutory Conditions” or “Conditions légales”, as may be appropriate, and no variation or omission of or addition to any statutory condition is binding on the insured.

Definition

(2)  In this section,

“policy” does not include interim receipts or binders.

STATUTORY CONDITIONS

Misrepresentation

1.  If a person applying for insurance falsely describes the property to the prejudice of the insurer, or misrepresents or fraudulently omits to communicate any circumstance that is material to be made known to the insurer in order to enable it to judge of the risk to be undertaken, the contract is void as to any property in relation to which the misrepresentation or omission is material.

Property of Others

2.  Unless otherwise specifically stated in the contract, the insurer is not liable for loss or damage to property owned by any person other than the insured, unless the interest of the insured therein is stated in the contract.

Change of Interest

3.  The insurer is liable for loss or damage occurring after an authorized assignment under the Bankruptcy Act (Canada) or change of title by succession, by operation of law, or by death.

Material Change

4.  Any change material to the risk and within the control and knowledge of the insured avoids the contract as to the part affected thereby, unless the change is promptly notified in writing to the insurer or its local agent, and the insurer when so notified may return the unearned portion, if any, of the premium paid and cancel the contract, or may notify the insured in writing that, if the insured desires the contract to continue in force, the insured must, within fifteen days of the receipt of the notice, pay to the insurer an additional premium, and in default of such payment the contract is no longer in force and the insurer shall return the unearned portion, if any, of the premium paid.

Termination

5.  (1)  This contract may be terminated,

(a) by the insurer giving to the insured fifteen days’ notice of termination by registered mail or five days’ written notice of termination personally delivered;

(b) by the insured at any time on request.

(2)  Where this contract is terminated by the insurer,

(a) the insurer shall refund the excess of premium actually paid by the insured over the proportionate premium for the expired time, but, in no event, shall the proportionate premium for the expired time be deemed to be less than any minimum retained premium specified; and

(b) the refund shall accompany the notice unless the premium is subject to adjustment or determination as to amount, in which case the refund shall be made as soon as practicable.

(3)  Where this contract is terminated by the insured, the insurer shall refund as soon as practicable the excess of premium actually paid by the insured over the short rate premium for the expired time, but in no event shall the short rate premium for the expired time be deemed to be less than any minimum retained premium specified.

(4)  The refund may be made by money, postal or express company money order or cheque payable at par.

(5)  The fifteen days mentioned in clause (1) (a) of this condition commences to run on the day following the receipt of the registered letter at the post office to which it is addressed.

Requirements After Loss

6.  (1)  Upon the occurrence of any loss of or damage to the insured property, the insured shall, if the loss or damage is covered by the contract, in addition to observing the requirements of conditions 9, 10 and 11,

(a) forthwith give notice thereof in writing to the insurer;

(b) deliver as soon as practicable to the insurer a proof of loss verified by a statutory declaration,

(i) giving a complete inventory of the destroyed and damaged property and showing in detail quantities, costs, actual cash value and particulars of amount of loss claimed,

(ii) stating when and how the loss occurred, and if caused by fire or explosion due to ignition, how the fire or explosion originated, so far as the insured knows or believes,

(iii) stating that the loss did not occur through any wilful act or neglect or the procurement, means or connivance of the insured,

(iv) showing the amount of other insurances and the names of other insurers,

(v) showing the interest of the insured and of all others in the property with particulars of all liens, encumbrances and other charges upon the property,

(vi) showing any changes in title, use, occupation, location, possession or exposures of the property since the issue of the contract,

(vii) showing the place where the property insured was at the time of loss;

(c) if required, give a complete inventory of undamaged property and showing in detail quantities, cost, actual cash value;

(d) if required and if practicable, produce books of account, warehouse receipts and stock lists, and furnish invoices and other vouchers verified by statutory declaration, and furnish a copy of the written portion of any other contract.

(2)  The evidence furnished under clauses (1) (c) and (d) of this condition shall not be considered proofs of loss within the meaning of conditions 12 and 13.

Fraud

7.  Any fraud or wilfully false statement in a statutory declaration in relation to any of the above particulars, vitiates the claim of the person making the declaration.

Who may give notice and proof

8.  Notice of loss may be given and proof of loss may be made by the agent of the insured named in the contract in case of absence or inability of the insured to give the notice or make the proof, and absence or inability being satisfactorily accounted for, or in the like case, or if the insured refuses to do so, by a person to whom any part of the insurance money is payable.

Salvage

9.  (1)  The insured, in the event of any loss or damage to any property insured under the contract, shall take all reasonable steps to prevent further damage to such property so damaged and to prevent damage to other property insured hereunder including, if necessary, its removal to prevent damage or further damage thereto.

(2)  The insurer shall contribute proportionately towards any reasonable and proper expenses in connection with steps taken by the insured and required under subcondition (1) of this condition according to the respective interests of the parties.

Entry, Control, Abandonment

10.  After loss or damage to insured property, the insurer has an immediate right of access and entry by accredited agents sufficient to enable them to survey and examine the property, and to make an estimate of the loss or damage, and, after the insured has secured the property, a further right of access and entry sufficient to enable them to make appraisement or particular estimate of the loss or damage, but the insurer is not entitled to the control or possession of the insured property, and without the consent of the insurer there can be no abandonment to it of insured property.

Appraisal

11.  In the event of disagreement as to the value of the property insured, the property saved or the amount of the loss, those questions shall be determined by appraisal as provided under the Insurance Act before there can be any recovery under this contract whether the right to recover on the contract is disputed or not, and independently of all other questions. There shall be no right to an appraisal until a specific demand therefor is made in writing and until after proof of loss has been delivered.

When Loss Payable

12.  The loss is payable within sixty days after completion of the proof of loss, unless the contract provides for a shorter period.

Replacement

13.  (1)  The insurer, instead of making payment, may repair, rebuild, or replace the property damaged or lost, giving written notice of its intention so to do within thirty days after receipt of the proofs of loss.

(2)  In that event the insurer shall commence to so repair, rebuild, or replace the property within forty-five days after receipt of the proofs of loss, and shall thereafter proceed with all due diligence to the completion thereof.

Action

14.  Every action or proceeding against the insurer for the recovery of a claim under or by virtue of this contract is absolutely barred unless commenced within one year next after the loss or damage occurs.

Notice

15.  Any written notice to the insurer may be delivered at, or sent by registered mail to, the chief agency or head office of the insurer in the Province. Written notice may be given to the insured named in the contract by letter personally delivered to the insured or by registered mail addressed to the insured at the insured’s latest post office address as notified to the insurer. In this condition, the expression “registered” means registered in or outside Canada.

R.S.O. 1990, c. I.8, s. 148.

Limitation of liability clause

149.  A contract containing,

(a) a deductible clause;

(b) a co-insurance, average or similar clause; or

(c) a clause limiting recovery by the insured to a specified percentage of the value of any property insured at the time of loss, whether or not that clause is conditional or unconditional,

shall have printed or stamped upon its face in red ink or bold type the words “The policy contains a clause that may limit the amount payable”, or the French equivalent failing which the clause is not binding upon the insured. R.S.O. 1990, c. I.8, s. 149; 1997, c. 19, s. 10 (28).

Rateable contribution

150.  (1)  Where on the happening of any loss or damage to property insured there is in force more than one contract covering the same interest, each of the insurers under the respective contracts is liable to the insured for its rateable proportion of the loss, unless it is otherwise expressly agreed in writing between the insurers.

Effect of policy may not be postponed

(2)  For the purpose of subsection (1), a contract shall be deemed to be in force despite any term thereof that the policy will not cover, come into force, attach or become insurance with respect to the property until after full or partial payment of any loss under any other policy.

Certain restrictions valid

(3)  Nothing in subsection (1) affects the validity of any divisions of the sum insured into separate items, or any limits of insurance on specified property, or any clause referred to in section 149 or any contract condition limiting or prohibiting the having or placing of other insurance.

Ascertainment of rateable proportions

(4)  Nothing in subsection (1) affects the operation of any deductible clause and,

(a) where one contract contains a deductible, the proportion of the insurer under that contract shall be first ascertained without regard to the clause and then the clause shall be applied only to affect the amount of recovery under that contract; and

(b) where more than one contract contains a deductible, the proportions of the insurers under those contracts shall be first ascertained without regard to the deductible clauses and then the highest deductible shall be pro rated among the insurers with deductibles and these pro rated amounts shall affect the amount of recovery under those contracts.

Idem

(5)  Nothing in subsection (4) shall be construed to have the effect of increasing the proportional contribution of an insurer under a contract that is not subject to a deductible clause.

Insurance on identified articles

(6)  Despite subsection (1), insurance on identified articles is a first loss insurance as against all other insurance. R.S.O. 1990, c. I.8, s. 150.

Special stipulations

151.  Where a contract,

(a) excludes any loss that would otherwise fall within the coverage prescribed by section 144; or

(b) contains any stipulation, condition or warranty that is or may be material to the risk including, but not restricted to, a provision in respect to the use, condition, location or maintenance of the insured property,

the exclusion, stipulation, condition or warranty is not binding upon the insured, if it is held to be unjust or unreasonable by the court before which a question relating thereto is tried. R.S.O. 1990, c. I.8, s. 151.

Subrogation

152.  (1)  The insurer, upon making a payment or assuming liability therefor under a contract to which this Part applies, is subrogated to all rights of recovery of the insured against any person, and may bring action in the name of the insured to enforce such rights. R.S.O. 1990, c. I.8, s. 152 (1); 2002, c. 18, Sched. H, s. 4 (21).

Where amount recovered is not sufficient to indemnify

(2)  Where the net amount recovered, after deducting the costs of recovery, is not sufficient to provide a complete indemnity for the loss or damage suffered, that amount shall be divided between the insurer and the insured in the proportions in which the loss or damage has been borne by them respectively. R.S.O. 1990, c. I.8, s. 152 (2).

Fire Mutuals Guarantee Fund

General reinsurance agreement

153.  An insurer that is a member of the Fire Mutuals Guarantee Fund shall enter into and remain a party to a general reinsurance agreement with a mutual insurance corporation incorporated under subsection 148 (3) of the Corporations Act. 1999, c. 12, Sched. I, s. 4 (17).

154.-168.  Repealed: 1999, c. 12, Sched. I, s. 4 (17).

Fire Mutuals Guarantee Fund

169.  (1)  The agreement establishing the Fire Mutuals Guarantee Fund is continued and may be amended with the approval of the Superintendent. 1999, c. 12, Sched. I, s. 4 (18).

Members

(2)  The following persons may be members of the Fund, with the approval of the Superintendent:

1. Mutual insurance corporations including those that are incorporated under subsection 148 (3) of the Corporations Act.

2. Joint stock insurance companies, all the shares of which are owned by one or more mutual insurance corporations that are members of the Fund. 1999, c. 12, Sched. I, s. 4 (18).

Purposes

(3)  The Fund has the following purposes, and such additional purposes as may be set out in the agreement:

1. To pay the insurance claims and repay the unearned premiums of policyholders who are members of the Fund, if a member is unable to meet its obligations.

2. To pay the insurance claims of third parties against policyholders who are members of the Fund, if a member is unable to meet its obligations. 1999, c. 12, Sched. I, s. 4 (18).

Same

(3.1)  With the approval of the Superintendent, the assets of the Fund may be used for the purposes of the Fund. 1999, c. 12, Sched. I, s. 4 (18).

Powers

(3.2)  If the Fund is authorized to do so by the agreement, the Fund may,

(a) assess its members in respect of any payments that the Fund has authorized in respect of a member who is unable to meet its obligations; and

(b) until the assessments are paid, borrow money or establish lines of credit for the purposes of making payments in respect of the member who is unable to meet its obligations. 1999, c. 12, Sched. I, s. 4 (18).

Administration

(3.3)  The assets of the Fund shall be held in trust by a trust corporation registered under the Loan and Trust Corporations Act. 1999, c. 12, Sched. I, s. 4 (18).

Assets of Fund

(4)  The assets of the Fund shall,

(a) be maintained at no less than a book value of $1,000,000 including the value of any assessments made to restore the book value of $1,000,000, or such further amount as may be specified from time to time by the Superintendent;

(b) be maintained or increased by assessments on parties to the agreement on the basis set out in the agreement referred to in subsection (1);

(c) Repealed: 2006, c. 33, Sched. O, s. 8 (1).

(d) be invested and valued in accordance with the regulations. R.S.O. 1990, c. I.8, s. 169 (4); 1999, c. 12, Sched. I, s. 4 (19); 2006, c. 33, Sched. O, s. 8.

Relief from assessment

(5)  No assessment referred to in clause (3.2) (a) or (4) (b) shall be paid by an insurer if its effect would be to reduce the surplus of that insurer below the minimum amount specified by the Superintendent, and such a waiver of an assessment shall not be cause for the insurer’s expulsion from the Fund. R.S.O. 1990, c. I.8, s. 169 (5); 1999, c. 12, Sched. I, s. 4 (20).

Interest of Superintendent in Fund

(6)  The Superintendent shall be deemed to have an interest in the Fund as representative of all persons who may be claimants against insurers that are parties to the agreement and the trustees shall from time to time furnish the Superintendent with such information and accounts with respect to the Fund as the Superintendent may require. R.S.O. 1990, c. I.8, s. 169 (6).

Cessation of membership

(7)  The Superintendent may permit an insurer to cease to be a member of the Fund and may impose such terms and conditions respecting the cessation as the Superintendent considers appropriate. 1999, c. 12, Sched. I, s. 4 (21).

Withdrawal of approval

(7.1)  The Superintendent may withdraw his or her approval under subsection (2) when an insurer is in default of payment of its assessment under the agreement. 1999, c. 12, Sched. I, s. 4 (21).

Ceasing to issue contracts on premium note plan

(8)  An insurer who becomes a member of the Fund shall cease to undertake contracts of insurance or to renew existing contracts of insurance on the premium note plan. 1999, c. 12, Sched. I, s. 4 (21).

Application of Act

(9)  All parties to the agreement and their officers and directors shall be deemed to be persons engaged in the business of insurance for the purposes of this Act and the regulations and any contravention of the trust agreement constitutes an offence. R.S.O. 1990, c. I.8, s. 169 (9).

Passing of accounts

(10)  An account filed with the Superintendent under subsection (6), except so far as mistake or fraud is shown, is binding and conclusive upon all interested persons as to all matters shown in the account and the trustees’ administration thereof, unless the Superintendent, within six months of the date upon which the account is filed with him or her, requires in writing that such account be filed and passed before a judge of the Superior Court of Justice. R.S.O. 1990, c. I.8, s. 169 (10); 2006, c. 19, Sched. C, s. 1 (1).

Idem

(11)  The provisions of the Estates Act and the rules made thereunder and of the Trustee Act with respect to the passing of accounts of the trustees apply, with necessary modifications, to the passing of accounts under subsection (10). R.S.O. 1990, c. I.8, s. 169 (11).

170.  Repealed: 1999, c. 12, Sched. I, s. 4 (22).

PART V
LIFE INSURANCE

Definitions

Definitions, Part V

171.  (1)  In this Part,

“application” means an application for insurance or for the reinstatement of insurance; (“proposition”)

“beneficiary” means a person, other than the insured or the insured’s personal representative, to whom or for whose benefit insurance money is made payable in a contract or by a declaration; (“bénéficiaire”)

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding the following definition:

“blanket insurance” means group insurance that covers loss,

(a) arising from specific hazards incidental to or defined by reference to a particular activity or activities, and

(b) occurring during a limited or specified period not exceeding 30 days in duration; (“assurance globale”)

See: 2012, c. 8, Sched. 23, ss. 6 (1), 77.

“contract” means a contract of life insurance; (“contrat”)

“court” means the Superior Court of Justice or a judge thereof; (“tribunal”)

“creditor’s group insurance” means insurance effected by a creditor in respect of the lives of the creditor’s debtors whereby the lives of the debtors are insured severally under a single contract; (“assurance collective de créancier”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “creditor’s group insurance” is repealed and the following substituted:

“creditor’s group insurance” means insurance effected by a creditor whereby the lives of a number of the creditor’s debtors are insured severally under a single contract; (“assurance collective de créancier”)

See: 2012, c. 8, Sched. 23, ss. 6 (2), 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding the following definition:

“debtor insured” means a debtor whose life is insured under a contract of creditor’s group insurance; (“débiteur assuré”)

See: 2012, c. 8, Sched. 23, ss. 6 (3), 77.

“declaration” means an instrument signed by the insured,

(a) with respect to which an endorsement is made on the policy,

(b) that identifies the contract, or

(c) that describes the insurance or insurance fund or a part thereof,

in which the insured designates, or alters or revokes the designation of, the insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable; (“déclaration”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “declaration” is repealed and the following substituted:

“declaration”, except in sections 207 to 210, means an instrument signed by the insured,

(a) with respect to which an endorsement is made on the policy,

(b) that identifies the contract, or

(c) that describes the insurance or insurance fund or a part thereof,

in which the insured,

(d) designates, or alters or revokes the designation of, the insured, the insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable, or

(e) makes, alters or revokes an appointment under subsection 193 (1) or a nomination referred to in section 199; (“déclaration”)

See: 2012, c. 8, Sched. 23, ss. 6 (4), 77.

“family insurance” means insurance whereby the lives of the insured and one or more persons related to the insured by blood, marriage or adoption are insured under a single contract between an insurer and the insured; (“assurance familiale”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “family insurance” is amended by striking out “blood, marriage or adoption” and substituting “blood, marriage, conjugal relationship outside marriage or adoption”. See: 2012, c. 8, Sched. 23, ss. 6 (5), 77.

“group insurance” means insurance, other than creditor’s group insurance and family insurance, whereby the lives of a number of persons are insured severally under a single contract between an insurer and an employer or other person; (“assurance collective”)

“group life insured” means a person whose life is insured by a contract of group insurance but does not include a person whose life is insured under the contract as a person dependent upon, or related to, him or her; (“personne assurée par une assurance-vie collective”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “group life insured” is repealed and the following substituted:

“group life insured” means a person (the “primary person”) whose life is insured under a contract of group insurance but does not include a person whose life is insured under the contract as a person dependent upon, or related to, the primary person; (“personne assurée par une assurance-vie collective”)

See: 2012, c. 8, Sched. 23, ss. 6 (6), 77.

“instrument” includes a will; (“acte”)

“insurance” means life insurance; (“assurance”)

“insured”,

(a) in the case of group insurance, means, in the provisions of this Part relating to the designation of beneficiaries and the rights and status of beneficiaries, the group life insured, and

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (a) is repealed and the following substituted:

(a) in the case of group insurance, means, in the provisions of this Part relating to the designation of beneficiaries or personal representatives as recipients of insurance money and their rights and status, the group life insured, and

See: 2012, c. 8, Sched. 23, ss. 6 (7), 77.

(b) in all other cases, means the person who makes a contract with an insurer; (“assuré”)

“will” includes a codicil. (“testament”) R.S.O. 1990, c. I.8, s. 171; 2006, c. 19, Sched. C, s. 1 (1).

Annuity deemed life insurance

(2)  For the purposes of this Part, an undertaking entered into by an insurer to provide an annuity, or what would be an annuity except that the periodic payments may be unequal in amount, shall be deemed to be and always to have been life insurance whether the annuity is for,

(a) a term certain; or

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is amended by striking out “or” at the end of clause (a) and by adding the following clause:

(a.1) a term dependent either solely or partly on a human life; or

See: 2012, c. 8, Sched. 23, ss. 6 (8), 77.

(b) a term dependent solely or partly on the happening of an event not related to a human life. 2002, c. 18, Sched. H, s. 4 (22).

Application of Part

Application of Part

172.  (1)  Despite any agreement, condition or stipulation to the contrary, this Part applies to a contract made in Ontario on or after the 1st day of July, 1962, and, subject to subsections (2) and (3), applies to a contract made in Ontario before that day.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding “but subject to a regulation made under paragraph 14.0.2 of subsection 121 (1)” after “Despite any agreement, condition or stipulation to the contrary”. See: 2012, c. 8, Sched. 23, ss. 7, 77.

Beneficiary for value

(2)  The rights and interests of a beneficiary for value under a contract that was in force immediately before the 1st day of July, 1962 are those provided in Part V of The Insurance Act, being chapter 190 of the Revised Statutes of Ontario, 1960, as it existed immediately before that day.

Preferred beneficiary

(3)  Where the person who would have been entitled to the payment of insurance money, if the money had become payable immediately before the 1st day of July, 1962, was a preferred beneficiary within the meaning of Part V of The Insurance Act, being chapter 190 of the Revised Statutes of Ontario, 1960, as it existed immediately before that day, the insured may not, except in accordance with that Part,

(a) alter or revoke the designation of a beneficiary; or

(b) assign, exercise rights under or in respect of, surrender or otherwise deal with the contract,

but this subsection does not apply after a time at which the insurance money, if it were then payable, would be payable wholly to a person other than a preferred beneficiary within the meaning of that Part. R.S.O. 1990, c. I.8, s. 172.

Group insurance

173.  In the case of a contract of group insurance made with an insurer authorized to transact insurance in Ontario at the time the contract was made, this Part applies in determining,

(a) the rights and status of beneficiaries if the group life insured was resident in Ontario at the time he or she became insured; and

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (a) is amended by adding “and personal representatives as recipients of insurance money” after “the rights and status of beneficiaries” at the beginning. See: 2012, c. 8, Sched. 23, ss. 8, 77.

(b) the rights and obligations of the group life insured if he or she was resident in Ontario at the time he or she became insured. R.S.O. 1990, c. I.8, s. 173.

Note: On a day to be named by proclamation of the Lieutenant Governor, Part V is amended by adding the following section:

Application of ss. 126 and 131

173.1  Sections 126 and 131 apply to a contract of life insurance. 2012, c. 8, Sched. 23, s. 9.

See: 2012, c. 8, Sched. 23, ss. 9, 77.

Issuance of Policy and Contents Thereof

Insurer to issue policy

174.  (1)  An insurer entering into a contract shall issue a policy.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is repealed and the following substituted:

Insurer to issue policy, furnish documents

(1)  An insurer entering into a contract shall,

(a) issue a policy; and

(b) furnish to the insured the policy and a copy of the insured’s application. 2012, c. 8, Sched. 23, s. 10 (1).

See: 2012, c. 8, Sched. 23, ss. 10 (1), 77.

Documents forming contract

(2)  Subject to subsection (3), the provisions in,

(a) the application;

(b) the policy;

(c) any document attached to the policy when issued; and

(d) any amendment to the contract agreed upon in writing after the policy is issued,

constitute the entire contract.

Contract of fraternal society

(3)  In the case of a contract made by a fraternal society, the policy, the Act or instrument of incorporation of the society, its constitution, by-laws and rules, and the amendments made from time to time to any of them, the application for the contract and the medical statement of the applicant constitute the entire contract.

Copy of application

(4)  An insurer shall, upon request, furnish to the insured or to a claimant under the contract a copy of the application. R.S.O. 1990, c. I.8, s. 174.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (4) is repealed and the following substituted:

Copy of contract, etc.

(4)  Except in the case of a contract of group insurance or of creditor’s group insurance, an insurer, on request, shall furnish to the insured or a claimant under the contract a copy of,

(a) the entire contract as set out in subsection (2) or (3), as applicable; and

(b) any written statement or other record provided to the insurer as evidence of insurability under the contract. 2012, c. 8, Sched. 23, s. 10 (2).

Copy of application, policy, etc. — group insurance

(5)  In the case of a contract of group insurance, an insurer,

(a) on request, shall furnish to a group life insured or claimant under the contract a copy of,

(i) the group life insured’s application, and

(ii) any written statement or other record, not otherwise part of the application, provided to the insurer as evidence of the insurability of the group life insured under the contract;

(b) on request and reasonable notice, shall permit a group life insured or claimant under the contract to examine, and shall furnish to that person, a copy of the policy of group insurance. 2012, c. 8, Sched. 23, s. 10 (2).

Same — creditor’s group insurance

(6)  In the case of a contract of creditor’s group insurance, an insurer,

(a) on request, shall furnish to a debtor insured or claimant under the contract a copy of,

(i) the debtor insured’s application, and

(ii) any written statement or other record, not otherwise part of the application, provided to the insurer as evidence of the insurability of the debtor insured under the contract;

(b) on request and reasonable notice, shall permit a debtor insured or claimant under the contract to examine, and shall furnish to that person, a copy of the policy of creditor’s group insurance. 2012, c. 8, Sched. 23, s. 10 (2).

Reasonable fee

(7)  An insurer may charge a reasonable fee to cover its expenses in furnishing copies of documents under subsection (4), (5) or (6), other than the first copy furnished to each person. 2012, c. 8, Sched. 23, s. 10 (2).

Access to information restricted

(8)  Access to the documents described in clauses (5) (b) and (6) (b) does not extend,

(a) to information contained in those documents that would reveal personal information as defined in the Personal Information Protection and Electronic Documents Act (Canada) or personal health information as defined in the Personal Health Information Protection Act, 2004 about a person without that person’s consent, other than information about,

(i) the group life insured or debtor insured in respect of whom the claim is made, or

(ii) the person who requests the information; or

(b) to information prescribed by the regulations. 2012, c. 8, Sched. 23, s. 10 (2).

Claimant’s access to documents restricted

(9)  A claimant’s access to documents under subsections (4) to (6) extends only to information that is relevant to,

(a) a claim under the contract; or

(b) a denial of such a claim. 2012, c. 8, Sched. 23, s. 10 (2).

See: 2012, c. 8, Sched. 23, ss. 10 (2), 77.

Contents of policy

175.  (1)  This section does not apply to,

(a) a contract of group insurance;

(b) a contract of creditor’s group insurance; or

(c) a contract made by a fraternal society. R.S.O. 1990, c. I.8, s. 175 (1).

Same

(2)  An insurer shall set forth the following particulars in the policy:

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is amended by striking out the portion before paragraph 1 and substituting the following: (See: 2013, c. 2, Sched. 8, ss. 6 (1), 40)

Same

(2)  An insurer shall include the following information in the policy:

1. The name or a sufficient description of the insured and of the person whose life is insured.

2. The amount, or the method of determining the amount, of the insurance money payable, and the conditions under which it becomes payable.

3. The amount, or the method of determining the amount, of the premium and the period of grace, if any, within which it may be paid.

4. Whether the contract provides for participation in a distribution of surplus or profits that may be declared by the insurer.

5. The conditions upon which the contract may be reinstated if it lapses.

6. The options, if any,

(a) of surrendering the contract for cash;

(b) of obtaining a loan or an advance payment of the insurance money; and

(c) of obtaining paid-up or extended insurance. R.S.O. 1990, c. I.8, s. 175 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is amended by adding the following paragraph: (See: 2013, c. 2, Sched. 8, ss. 6 (2), 40)

7. The following statement:

Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 175 is amended by adding the following subsection:

Notice re restriction on designations

(3)  If a policy contains a provision removing or restricting the right of the insured to designate persons to whom or for whose benefit insurance money is to be payable, the front page of the policy must include the following statement in conspicuous bold type:

This policy contains a provision removing or restricting the right of the insured to designate persons to whom or for whose benefit insurance money is to be payable.

2012, c. 8, Sched. 23, s. 11.

See: 2012, c. 8, Sched. 23, ss. 11, 77.

Contents of group policy

176.  In the case of a contract of group insurance or of creditor’s group insurance, an insurer shall set forth the following particulars in the policy:

Note: On On a day to be named by proclamation of the Lieutenant Governor, section 176 is amended by striking out “an insurer shall set forth the following particulars in the policy” in the portion before paragraph 1 and substituting “an insurer shall include the following information in the policy”. (See: 2013, c. 2, Sched. 8, ss. 7, 40)

1. The name or a sufficient description of the insured.

2. The method of determining the persons whose lives are insured.

3. The amount, or the method of determining the amount, of the insurance money payable, and the conditions under which it becomes payable.

4. The period of grace, if any, within which the premium may be paid.

5. Whether the contract provides for participation in a distribution of surplus or profits that may be declared by the insurer. R.S.O. 1990, c. I.8, s. 176.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 176 is amended by adding the following paragraphs:

6. In the case of a contract of group insurance, any provision removing or restricting the right of a group life insured to designate persons to whom or for whose benefit insurance money is to be payable.

7. In the case of a contract of group insurance that replaces another contract of group insurance on some or all of the group life insured under the replaced contract, whether a designation of a group life insured, a group life insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable under the replaced contract applies to the replacement contract.

8. The following statement:

Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002.

See: 2012, c. 8, Sched. 23, ss. 12, 77.

Contents of group certificate

177.  In the case of a contract of group insurance, an insurer shall issue, for delivery by the insured to each group life insured, a certificate or other document in which are set forth the following particulars:

1. The name of the insurer and an identification of the contract.

2. The amount, or the method of determining the amount, of insurance on the group life insured and on any person whose life is insured under the contract as a person dependent upon, or related to, him or her.

3. The circumstances in which the insurance terminates and the rights, if any, upon such termination, of the group life insured or of any person whose life is insured under the contract as a person dependent upon, or related to, him or her. R.S.O. 1990, c. I.8, s. 177.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 177 is repealed and the following substituted:

Contents of group certificate

177.  (1)  In the case of a contract of group insurance or of creditor’s group insurance, an insurer shall issue, for delivery by the insured to each group life insured or debtor insured, a certificate or other document in which are set forth the following particulars:

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1), as re-enacted by section 13 of Schedule 23 to the Strong Action for Ontario Act (Budget Measures), 2012, is amended by striking out “in which are set forth the following particulars” in the portion before paragraph 1 and substituting “which shall include the following information”. (See: 2013, c. 2, Sched. 8, ss. 8, 40)

1. The name of the insurer and a sufficient identification of the contract.

2. The amount, or the method of determining the amount, of insurance on,

i. the group life insured and on any person whose life is insured under the contract as a person dependent upon or related to the group life insured, or

ii. the debtor insured.

3. The circumstances in which the insurance terminates and the rights, if any, upon such termination, of,

i. the group life insured and of any person whose life is insured under the contract as a person dependent upon or related to the group life insured, or

ii. the debtor insured.

4. In the case of a contract of group insurance that contains a provision removing or restricting the right of the group life insured to designate persons to whom or for whose benefit insurance money is to be payable,

i. the method of determining the persons to whom or for whose benefit the insurance money is or may be payable, and

ii. the following statement in conspicuous bold type:

5. In the case of a contract of group insurance that replaces another contract of group insurance on some or all of the group life insured under the replaced contract, whether a designation of a group life insured, a group life insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable under the replaced contract applies to the replacement contract.

6. The rights of the group life insured, debtor insured or a claimant under the contract to obtain copies of documents under subsection 174 (5) or (6).

7. The following statement:

Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002.

2012, c. 8, Sched. 23, s. 13.

Exception — blanket insurance

(2)  This section does not apply to a contract of blanket insurance. 2012, c. 8, Sched. 23, s. 13.

See: 2012, c. 8, Sched. 23, ss. 13, 77.

Conditions Governing Formation of Contract

Insurable interest required

178.  (1)  Subject to subsection (2), where at the time a contract would otherwise take effect the insured has no insurable interest, the contract is void.

Exceptions

(2)  A contract is not void for lack of insurable interest,

(a) if it is a contract of group insurance; or

(b) if the person whose life is insured has consented in writing to the insurance being placed on his or her life.

Consent of minor

(3)  Where the person whose life is insured is under the age of sixteen years, consent to insurance being placed on the person’s life may be given by one of his or her parents or by a person standing in the role of parent to him or her. R.S.O. 1990, c. I.8, s. 178.

Insurable interest, defined

179.  Without restricting the meaning of the expression “insurable interest”, a person has an insurable interest in the person’s own life and in the life of,

(a) the person’s child or grandchild;

(b) the person’s spouse;

(c) any person upon whom the person is wholly or in part dependent, for, or from whom the person is receiving, support or education;

(d) an employee of the person; and

(e) any person in the duration of whose life the person has a pecuniary interest. R.S.O. 1990, c. I.8, s. 179; 1999, c. 6, s. 31 (2); 2005, c. 5, s. 35 (3).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 179 is repealed and the following substituted:

Insurable interest, defined

179.  Without restricting the meaning of “insurable interest”, a person, in this section called the “primary person”, has an insurable interest,

(a) in the case of a primary person who is a natural person, in his or her own life and in the lives of,

(i) the primary person’s child or grandchild,

(ii) the primary person’s spouse,

(iii) a person on whom the primary person is wholly or partly dependent for, or from whom the primary person is receiving, support or education,

(iv) the primary person’s employee, and

(v) a person in the duration of whose life the primary person has a pecuniary interest; and

(b) in the case of a primary person that is not a natural person, in the lives of,

(i) a director, officer or employee of the primary person, and

(ii) a person in the duration of whose life the primary person has a pecuniary interest. 2012, c. 8, Sched. 23, s. 14.

See: 2012, c. 8, Sched. 23, ss. 14, 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, Part V is amended by adding the following section:

Termination of contract by court

Application to court

179.1  (1)  A person may make an application to the court if,

(a) the person’s life is insured under a contract;

(b) the person is not the insured under the contract; and

(c) the person reasonably believes that the person’s life or health might be endangered by the insurance on his or her life continuing under that contract. 2012, c. 8, Sched. 23, s. 15.

Court order

(2)  Upon an application being made under subsection (1), the court may make any order it considers just in the circumstances, including,

(a) an order that the insurance on that person’s life under the contract be terminated in accordance with the terms of the contract other than any terms respecting notice of termination; and

(b) an order that the amount of insurance under the contract on that person’s life be reduced. 2012, c. 8, Sched. 23, s. 15.

Notice

(3)  An application under subsection (1) must be made on at least 30 days notice to the insured, the beneficiary, the insurer and any other person the court considers to have an interest in the contract. 2012, c. 8, Sched. 23, s. 15.

Same

(4)  Despite subsection (3), if the court considers it just to do so, it may dispense with the notice to,

(a) a person other than the insurer; or

(b) if the contract is a contract of group insurance or of creditor’s group insurance, the insured. 2012, c. 8, Sched. 23, s. 15.

Who is bound by order

(5)  An order made under subsection (2) binds any person having an interest in the contract. 2012, c. 8, Sched. 23, s. 15.

See: 2012, c. 8, Sched. 23, ss. 15, 77.

Contract taking effect

180.  (1)  Subject to any provision to the contrary in the application or the policy, a contract does not take effect unless,

(a) the policy is delivered to an insured, the insured’s assign or agent, or to a beneficiary;

(b) payment of the first premium is made to the insurer or its authorized agent; and

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (b) is repealed and the following substituted: (See: 2013, c. 2, Sched. 8, ss. 9, 40)

(b) payment of the initial premium is made to the insurer or its authorized agent; and

(c) no change has taken place in the insurability of the life to be insured between the time the application was completed and the time the policy was delivered. R.S.O. 1990, c. I.8, s. 180 (1).

Delivery to agent

(2)  Where a policy is issued on the terms applied for and is delivered to an agent of the insurer for unconditional delivery to a person referred to in clause (1) (a), it shall be deemed, but not to the prejudice of the insured, to have been delivered to the insured. R.S.O. 1990, c. I.8, s. 180 (2).

Default in paying premium

181.  (1)  Where a cheque or other bill of exchange, or a promissory note or other written promise to pay, is given for the whole or part of a premium and payment is not made according to its tenor, the premium or part thereof shall be deemed not to have been paid.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by striking out “payment is not made according to its tenor” and substituting “the cheque, bill of exchange or promissory note is not honoured according to its tenor”. See: 2012, c. 8, Sched. 23, ss. 16, 77.

Payment by registered letter

(2)  Where a remittance for or on account of a premium is sent in a registered letter to an insurer and is received by it, the remittance shall be deemed to have been received at the time of the registration of the letter. R.S.O. 1990, c. I.8, s. 181.

Payment of premium

Who may pay premium

182.  (1)  Except in the case of group insurance, an assignee of a contract, a beneficiary or a person acting on behalf of one of them or of the insured may pay any premium that the insured is entitled to pay.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is repealed and the following substituted:

Payment of premium

Who may pay premium

(1)  Except in the case of group insurance or of creditor’s group insurance, an assignee of a contract, a beneficiary or a person acting on behalf of one of them or on behalf of the insured may pay any premium that the insured is entitled to pay. 2012, c. 8, Sched. 23, s. 17 (1).

See: 2012, c. 8, Sched. 23, ss. 17 (1), 77.

Period of grace

(2)  Where a premium, other than the initial premium, is not paid at the time it is due, the premium may be paid within a period of grace of,

(a) thirty days or, in the case of an industrial contract, twenty-eight days from and excluding the day on which the premium is due; or

(b) the number of days, if any, specified in the contract for payment of an overdue premium,

whichever is the longer period.

Contract in force during grace period

(3)  Where the happening of the event upon which the insurance money becomes payable occurs during the period of grace and before the overdue premium is paid, the contract shall be deemed to be in effect as if the premium had been paid at the time it was due, but the amount of the premium, together with interest at the rate specified in the contract, but not exceeding 6 per cent per year, and the balance, if any, of the current year’s premium, may be deducted from the insurance money. R.S.O. 1990, c. I.8, s. 182.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (3) is repealed and the following substituted:

Contract in force during grace period

(3)  Where the happening of the event upon which the insurance money becomes payable occurs during the period of grace and before the overdue premium is paid, the contract shall be deemed to be in effect as if the premium had been paid at the time it was due and, except in the case of group insurance or of creditor’s group insurance, the amount of the premium may be deducted from the insurance money. 2012, c. 8, Sched. 23, s. 17 (2).

See: 2012, c. 8, Sched. 23, ss. 17 (2), 77.

Duty to disclose

183.  (1)  An applicant for insurance and a person whose life is to be insured shall each disclose to the insurer in the application, on a medical examination, if any, and in any written statements or answers furnished as evidence of insurability, every fact within the person’s knowledge that is material to the insurance and is not so disclosed by the other.

Failure to disclose

(2)  Subject to section 184, a failure to disclose, or a misrepresentation of, such a fact renders the contract voidable by the insurer. R.S.O. 1990, c. I.8, s. 183.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is amended by adding “and subsection (3) of this section” after “Subject to section 184” at the beginning. See: 2012, c. 8, Sched. 23, ss. 18 (1), 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 183 is amended by adding the following subsection:

Failure to disclose, application for change, etc., in contract

(3)  A failure to disclose, or a misrepresentation of, a fact referred to in subsection (1) relating to evidence of insurability with respect to the following kinds of applications renders the contract voidable by the insurer, but only in relation to the addition, increase or change applied for:

1. For additional coverage under a contract.

2. For an increase in insurance under a contract.

3. For any other change to insurance after the policy is issued. 2012, c. 8, Sched. 23, s. 18 (2).

See: 2012, c. 8, Sched. 23, ss. 18 (2), 77.

Exceptions

184.  (1)  This section does not apply to,

(a) a misstatement of age; or

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (a) is repealed and the following substituted:

(a) a misstatement of age of a person whose life is insured; or

See: 2012, c. 8, Sched. 23, ss. 19 (1), 77.

(b) insurance undertaken by an insurer as part of a contract of life insurance whereby the insurer undertakes to pay insurance money or to provide other benefits in the event that the person whose life is insured becomes disabled as a result of bodily injury or disease. 2002, c. 18, Sched. H, s. 4 (23).

Incontestability, general

(2)  Subject to subsection (3), where a contract has been in effect for two years during the lifetime of the person whose life is insured, a failure to disclose or a misrepresentation of a fact required to be disclosed by section 183 does not, in the absence of fraud, render the contract voidable. R.S.O. 1990, c. I.8, s. 184 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is amended by striking out “where a contract has been in effect” and substituting “where a contract, or an addition, increase or change referred to in subsection 183 (3) has been in effect”. See: 2012, c. 8, Sched. 23, ss. 19 (2), 77.

Incontestability in group insurance

(3)  In the case of a contract of group insurance, a failure to disclose or a misrepresentation of such a fact in respect of a person whose life is insured under the contract does not render the contract voidable, but, if evidence of insurability is specifically requested by the insurer, the insurance in respect of that person is voidable by the insurer unless it has been in effect for two years during the lifetime of that person, in which event it is not, in the absence of fraud, voidable. R.S.O. 1990, c. I.8, s. 184 (3).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (3) is repealed and the following substituted:

Incontestability in group insurance, creditor’s group insurance

(3)  In the case of a contract of group insurance or of creditor’s group insurance, a failure to disclose, or a misrepresentation of, such a fact in respect of a person whose life is insured under the contract does not render the contract voidable, but,

(a) if the failure to disclose or misrepresentation relates to evidence of insurability specifically requested by the insurer at the time of application for the insurance in respect of the person, the insurance in respect of that person is voidable by the insurer; and

(b) if the failure to disclose or misrepresentation relates to evidence of insurability specifically requested by the insurer at the time of application for an addition, increase or change referred to in subsection 183 (3) in respect of the person, the addition, increase or change in respect of that person is voidable by the insurer,

unless the insurance, addition, increase or change has been in effect for two years during the lifetime of that person, in which case the insurance, addition, increase or change is not, in the absence of fraud, voidable. 2012, c. 8, Sched. 23, s. 19 (3).

See: 2012, c. 8, Sched. 23, ss. 19 (3), 77.

Non-disclosure by insurer

185.  Where an insurer fails to disclose or misrepresents a fact material to the insurance, the contract is voidable by the insured, but, in the absence of fraud, the contract is not by reason of such failure or misrepresentation voidable after the contract has been in effect for two years. R.S.O. 1990, c. I.8, s. 185.

Insurable age

186.  (1)  This section does not apply to a contract of group insurance or of creditor’s group insurance.

Misstatement of age

(2)  Subject to subsection (3), where the age of a person whose life is insured is misstated to the insurer, the insurance money provided by the contract shall be increased or decreased to the amount that would have been provided for the same premium at the correct age.

Limitation of insurable age

(3)  Where a contract limits the insurable age and the correct age of the person whose life is insured at the date of the application exceeds the age so limited, the contract is, during the lifetime of that person but not later than five years from the date the contract takes effect, voidable by the insurer within sixty days after it discovers the error. R.S.O. 1990, c. I.8, s. 186.

Misstatement of age in group insurance

187.  In the case of a contract of group insurance or of creditor’s group insurance, a misstatement to the insurer of the age of a person whose life is insured does not of itself render the contract voidable, and the provisions, if any, of the contract with respect to age or misstatement of age apply. R.S.O. 1990, c. I.8, s. 187.

Effect of suicide

188.  (1)  Where a contract contains an undertaking, express or implied, that insurance money will be paid if a person whose life is insured commits suicide, the undertaking is lawful and enforceable.

Suicide and reinstatement

(2)  Where a contract provides that in case a person whose life is insured commits suicide within a certain period of time the contract is void or the amount payable under it is reduced, if the contract lapses and is subsequently reinstated on one or more occasions, the period of time commences to run from the date of the latest reinstatement. R.S.O. 1990, c. I.8, s. 188.

Reinstatement

189.  (1)  This section does not apply to a contract of group insurance or to a contract made by a fraternal society.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding “or of creditor’s group insurance” after “group insurance”. See: 2012, c. 8, Sched. 23, ss. 20 (1), 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 189 is amended by adding the following subsection:

Reinstatement on payment of premium after grace period

(1.1)  Where a contract lapses at the end of a period of grace because a premium due at the beginning of the period of grace was not paid, the contract may be reinstated by payment of the overdue premium within a further period of 30 days after the end of the period of grace, but only if the person whose life was insured under the contract is alive at the time payment is made. 2012, c. 8, Sched. 23, s. 20 (2).

See: 2012, c. 8, Sched. 23, ss. 20 (2), 77.

Reinstatement following up to 2 years lapse

(2)  Where a contract lapses and the insured within two years applies for reinstatement of the contract, if within that time the insured,

(a) pays the overdue premiums and other indebtedness under the contract to the insurer, together with interest at the rate specified in the contract, but not exceeding 6 per cent per year, compounded annually; and

(b) produces,

(i) evidence satisfactory to the insurer of the good health, and

(ii) other evidence satisfactory to the insurer of the insurability,

of the person whose life was insured,

the insurer shall reinstate the contract.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is repealed and the following substituted:

Reinstatement following up to 2 years lapse

(2)  Where a contract lapses and is not reinstated under subsection (1.1), the insurer shall reinstate it if, within two years of the date the contract lapsed, the insured,

(a) applies for the reinstatement;

(b) pays to the insurer all overdue premiums and other indebtedness under the contract together with interest not exceeding the prejudgment interest rate determined under subsection 127 (2) of the Courts of Justice Act; and

(c) produces evidence satisfactory to the insurer of the good health and insurability of the person whose life was insured. 2012, c. 8, Sched. 23, s. 20 (3).

See: 2012, c. 8, Sched. 23, ss. 20 (3), 77.

Exceptions

(3)  Subsection (2) does not apply where the cash surrender value has been paid or an option of taking paid-up or extended insurance has been exercised.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (3) is amended by striking out “Subsection (2) does not apply” at the beginning and substituting “Subsections (1.1) and (2) do not apply”. See: 2012, c. 8, Sched. 23, ss. 20 (4), 77.

Application of other sections

(4)  Sections 183 and 184 apply with necessary modifications to reinstatement of a contract. R.S.O. 1990, c. I.8, s. 189.

Note: On a day to be named by proclamation of the Lieutenant Governor, Part V is amended by adding the following section:

Termination and replacement of group contract

Insurer remains liable under contract

189.1  (1)  Where a contract of group insurance, or a benefit provision in a contract of group insurance, under which the insurer undertakes to pay insurance money or provide other benefits if a group life insured becomes disabled as a result of bodily injury or sickness is terminated, the insurer continues, as though the contract or benefit provision had remained in full force and effect, to be liable to pay insurance money or provide benefits in respect of a group life insured for liability arising from an accident or sickness that occurred before the termination of the contract or benefit provision. 2012, c. 8, Sched. 23, s. 21.

Note: On the day section 21 of Schedule 23 to the Strong Action for Ontario Act (Budget Measures), 2012 comes into force, subsection (1), is amended by striking out “bodily injury or sickness” and substituting “bodily injury or disease” and by striking out “an accident or sickness” and substituting “bodily injury or disease”. (See: 2014, c. 7, Sched. 14, ss. 3, 8 (2))

Exception

(2)  Despite subsection (1), an insurer does not remain liable under a contract or benefit provision described in that subsection to pay insurance money or provide a benefit for the recurrence of a disability after both of the following occur:

1. The termination of the contract or benefit provision.

2. A continuous period of six months, or any longer period provided in the contract, during which the group life insured was not disabled. 2012, c. 8, Sched. 23, s. 21.

Time limit on insurer’s liability

(3)  An insurer that is liable under subsection (1) to pay insurance money or provide a benefit as a result of the disability of a group life insured is not liable to pay the insurance money or provide the benefit for any period longer than the portion remaining, at the date the disability began, of the maximum period provided under the contract for the payment of insurance money or the provision of other benefits in respect of a disability of the group life insured. 2012, c. 8, Sched. 23, s. 21.

Continued coverage under replacement contract

(4)  Where a contract of group insurance, in this section called the “replacement contract”, is entered into within 31 days after the termination of another contract of group insurance, in this section called the “other contract”, and that replacement contract insures some or all of the same group life insured as the other contract,

(a) the replacement contract shall be deemed to provide that any person who was insured under the other contract at the time of its termination is insured under the replacement contract from and after the termination of the other contract if,

(i) the insurance on that person under the other contract terminated by reason only of the termination of the other contract, and

(ii) the person is a member of a class eligible for insurance under the replacement contract; and

(b) no person who was insured under the other contract at the time of its termination may be excluded from eligibility under the replacement contract by reason only of not being actively at work on the effective date of the replacement contract, and despite subsection (1), if the replacement contract provides that insurance money or other benefits to be paid or provided under subsection (1) by the insurer of the other contract are to be paid instead under the replacement contract, the insurer of the other contract is not liable to pay that insurance money or provide those benefits. 2012, c. 8, Sched. 23, s. 21.

See: 2012, c. 8, Sched. 23, ss. 21, 77.

Designation of Beneficiaries

Designation of beneficiary

190.  (1)  An insured may in a contract or by a declaration designate the insured’s personal representative or a beneficiary to receive insurance money.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is repealed and the following substituted:

Designation of beneficiary

(1)  Subject to subsection (4), an insured may in a contract or by a declaration designate the insured, the insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable. 2012, c. 8, Sched. 23, s. 22 (1).

See: 2012, c. 8, Sched. 23, ss. 22 (1), 77.

Change in designation

(2)  Subject to section 191, the insured may from time to time alter or revoke the designation by a declaration.

Meaning of “heirs”, etc.

(3)  A designation in favour of the “heirs”, “next of kin” or “estate” of the insured, or the use of words of like import in a designation, shall be deemed to be a designation of the personal representative of the insured. R.S.O. 1990, c. I.8, s. 190.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 190 is amended by adding the following sections:

Restriction on designations

(4)  Subject to the regulations, an insurer may restrict or exclude in a contract the right of an insured to designate persons to whom or for whose benefit insurance money is to be payable. 2012, c. 8, Sched. 23, s. 22 (2).

Designation may apply to replacement contract

(5)  A contract of group insurance replacing another contract of group insurance on some or all of the group life insured under the replaced contract may provide that a designation applicable to the replaced contract of a group life insured, a group life insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable shall be deemed to apply to the replacement contract. 2012, c. 8, Sched. 23, s. 22 (2).

Same

(6)  Where a contract of group insurance replacing another contract of group insurance provides that a designation referred to in subsection (5) shall be deemed to apply to the replacement contract,

(a) each certificate in respect of the replacement contract must indicate that the designation under the replaced contract has been carried forward and that the group life insured should review the existing designation to ensure it reflects the group life insured’s current intentions; and

(b) as between the insurer under the replacement contract and a claimant under that contract, that insurer is liable to the claimant for any errors or omissions by the previous insurer in respect of the recording of the designation carried forward under the replacement contract. 2012, c. 8, Sched. 23, s. 22 (2).

Settlement option

(7)  Where a beneficiary becomes entitled to insurance money and all or part of that insurance money remains with the insurer under a settlement option provided for in the contract or permitted by the insurer, that portion of the insurance money remaining with the insurer shall be deemed to be insurance money held under a contract on the life of the beneficiary and, subject to the provisions of the settlement option, the beneficiary has the rights and interests of an insured with respect to the insurance money. 2012, c. 8, Sched. 23, s. 22 (2).

See: 2012, c. 8, Sched. 23, ss. 22 (2), 77.

Designation of beneficiary irrevocably

191.  (1)  An insured may in a contract, or by a declaration other than a declaration that is part of a will, filed with the insurer at its head or principal office in Canada during the lifetime of the person whose life is insured, designate a beneficiary irrevocably, and in that event the insured, while the beneficiary is living, may not alter or revoke the designation without the consent of the beneficiary and the insurance money is not subject to the control of the insured or of the insured’s creditors and does not form part of the insured’s estate. R.S.O. 1990, c. I.8, s. 191 (1).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by striking out “and the insurance money is not subject to the control of the insured or of the insured’s creditors and does not form part of the insured’s estate” at the end and substituting “and the insurance money is not subject to the control of the insured, is not subject to the claims of the insured’s creditor and does not form part of the insured’s estate”. (See: 2013, c. 2, Sched. 8, ss. 10, 40)

Attempted designation

(2)  Where the insured purports to designate a beneficiary irrevocably in a will or in a declaration that is not filed as provided in subsection (1), the designation has the same effect as if the insured had not purported to make it irrevocable. R.S.O. 1990, c. I.8, s. 191 (2).

Designation in will, etc.

Designation in invalid will

192.  (1)  A designation in an instrument purporting to be a will is not ineffective by reason only of the fact that the instrument is invalid as a will or that the designation is invalid as a bequest under the will.

Priorities

(2)  Despite the Succession Law Reform Act, a designation in a will is of no effect against a designation made later than the making of the will.

Revocation

(3)  Where a designation is contained in a will, if subsequently the will is revoked by operation of law or otherwise, the designation is thereby revoked.

Idem

(4)  Where a designation is contained in an instrument that purports to be a will, if subsequently the instrument if valid as a will would be revoked by operation of law or otherwise, the designation is thereby revoked. R.S.O. 1990, c. I.8, s. 192.

Trustee for beneficiary

193.  (1)  An insured may in a contract or by a declaration appoint a trustee for a beneficiary and may alter or revoke the appointment by a declaration.

Payment to trustee

(2)  A payment made by an insurer to a trustee for a beneficiary discharges the insurer to the extent of the payment. R.S.O. 1990, c. I.8, s. 193.

Beneficiary’s share of insurance money

Beneficiary predeceasing life insured

194.  (1)  Where a beneficiary predeceases the person whose life is insured, and no disposition of the share of the deceased beneficiary in the insurance money is provided in the contract or by a declaration, the share is payable,

(a) to the surviving beneficiary; or

(b) if there is more than one surviving beneficiary, to the surviving beneficiaries in equal shares; or

(c) if there is no surviving beneficiary, to the insured or the insured’s personal representative.

Several beneficiaries

(2)  Where two or more beneficiaries are designated otherwise than alternatively, but no division of the insurance money is made, the insurance money is payable to them in equal shares. R.S.O. 1990, c. I.8, s. 194.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 194 is amended by adding the following subsections:

Disclaimer by beneficiary

(3)  A beneficiary may disclaim the beneficiary’s right to insurance money by filing notice in writing with the insurer at its head or principal office in Canada. 2012, c. 8, Sched. 23, s. 23.

Same

(4)  A notice of disclaimer filed under subsection (3) is irrevocable. 2012, c. 8, Sched. 23, s. 23.

Same

(5)  Subsection (1) applies in the case of a disclaiming beneficiary or in the case of a beneficiary determined by a court to be disentitled to insurance money as if the disclaiming or disentitled beneficiary died before the person whose life is insured. 2012, c. 8, Sched. 23, s. 23.

See: 2012, c. 8, Sched. 23, ss. 23, 77.

Right to sue

195.  A beneficiary may enforce for the beneficiary’s own benefit, and a trustee appointed pursuant to section 193 may enforce as trustee, the payment of insurance money made payable to him, her or it in the contract or by a declaration and in accordance with the provisions thereof, but the insurer may set up any defence that it could have set up against the insured or the insured’s personal representative. R.S.O. 1990, c. I.8, s. 195.

Insurance money free from other claims, etc.

Claims by creditors

196.  (1)  Where a beneficiary is designated, the insurance money, from the time of the happening of the event upon which the insurance money becomes payable, is not part of the estate of the insured and is not subject to the claims of the creditors of the insured. R.S.O. 1990, c. I.8, s. 196 (1).

Contract exempt from seizure

(2)  While a designation in favour of a spouse, child, grandchild or parent of a person whose life is insured, or any of them, is in effect, the rights and interests of the insured in the insurance money and in the contract are exempt from execution or seizure. R.S.O. 1990, c. I.8, s. 196 (2); 1999, c. 6, s. 31 (3); 2005, c. 5, s. 35 (4).

Dealings with Contract During Lifetime of Insured

Insured dealing with contract

197.  Where a beneficiary,

(a) is not designated irrevocably; or

(b) is designated irrevocably but has attained the age of eighteen years and consents,

the insured may assign, exercise rights under or in respect of, surrender or otherwise deal with the contract as provided therein or in this Part or as may be agreed upon with the insurer. R.S.O. 1990, c. I.8, s. 197.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 197 is amended by adding the following subsections:

Where there is irrevocable designation of beneficiary, who does not consent

(2)  Despite subsection 196 (1), where a beneficiary is designated irrevocably and has not consented as described in clause (l) (b), the insured may exercise any rights in respect of the contract that are prescribed by regulation. 2012, c. 8, Sched. 23, s. 24.

Same

(3)  Subject to the terms of a consent under clause (l) (b) or an order of the court under subsection (4), where there is an irrevocable designation of a beneficiary under a contract, a person acquiring an interest in the contract takes that interest subject to the rights of that beneficiary. 2012, c. 8, Sched. 23, s. 24.

Application to court

(4)  When a beneficiary who is designated irrevocably is unable to provide consent under clause (1) (b) because of legal incapacity, an insured may apply to the court for an order permitting the insured to deal with the contract without that consent. 2012, c. 8, Sched. 23, s. 24.

Same

(5)  The court may grant an order under subsection (4) on any notice and terms it considers just. 2012, c. 8, Sched. 23, s. 24.

See: 2012, c. 8, Sched. 23, ss. 24, 77.

Insured entitled to dividends

198.  (1)  Despite the designation of a beneficiary irrevocably, the insured is entitled while living to the dividends or bonuses declared on a contract, unless the contract otherwise provides.

Insurer may use dividends

(2)  Unless the insured otherwise directs, the insurer may apply the dividends or bonuses declared on the contract for the purpose of keeping the contract in force. R.S.O. 1990, c. I.8, s. 198.

Transfer of ownership

199.  (1)  Despite the Succession Law Reform Act, where in a contract or in an agreement in writing between an insurer and an insured it is provided that a person named in the contract or in the agreement has, upon the death of the insured, the rights and interests of the insured in the contract,

(a) the rights and interests of the insured in the contract do not, upon the death of the insured, form part of his or her estate; and

(b) upon the death of the insured, the person named in the contract or in the agreement has the rights and interests given to the insured by the contract and by this Part and shall be deemed to be the insured.

Successive owners

(2)  Where the contract or agreement provides that two or more persons named in the contract or in the agreement shall, upon the death of the insured, have successively, on the death of each of them, the rights and interests of the insured in the contract, this section applies successively, with necessary modifications, to each of such persons and to his or her rights and interests in the contract.

Saving

(3)  Despite any nomination made pursuant to this section, the insured may, prior to his or her death, assign, exercise rights under or in respect of, surrender or otherwise deal with the contract as if the nomination had not been made, and may alter or revoke the nomination by agreement in writing with the insurer. R.S.O. 1990, c. I.8, s. 199.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 199 is repealed and the following substituted:

Transfer of ownership

199.  (1)  Despite the Succession Law Reform Act, where in a contract or declaration it is provided that a person named in the contract or declaration has, on the death of the insured, the rights and interests of the insured in the contract,

(a) the rights and interests of the insured in the contract do not, on the death of the insured, form part of the insured’s estate; and

(b) on the death of the insured, the person named in the contract or declaration has the rights and interests given to the insured by the contract and by this Part and shall be deemed to be the insured. 2012, c. 8, Sched. 23, s. 25.

Successive owners

(2)  Where the contract or declaration provides that two or more persons named in the contract or declaration shall, on the death of the insured, have successively, on the death of each of them, the rights and interests of the insured in the contract, this section applies successively, with necessary modifications, to each of such persons and to his or her rights and interests in the contract. 2012, c. 8, Sched. 23, s. 25.

Saving

(3)  Despite any nomination made pursuant to this section, the insured may, before his or her death,

(a) assign, exercise rights under or in respect of, surrender or otherwise deal with the contract as if the nomination had not been made; and

(b) subject to the terms of the contract, alter or revoke the nomination by declaration. 2012, c. 8, Sched. 23, s. 25.

See: 2012, c. 8, Sched. 23, ss. 25, 77.

Effect of assignment

Interest of assignee

200.  (1)  Where an assignee of a contract gives notice in writing of the assignment to the insurer at its head or principal office in Canada, the assignee has priority of interest as against,

(a) any assignee other than one who gave notice earlier in like manner; and

(b) a beneficiary other than one designated irrevocably as provided in section 191 prior to the time the assignee gave notice to the insurer of the assignment in the manner prescribed in this subsection.

Effect on beneficiary’s rights

(2)  Where a contract is assigned as security, the rights of a beneficiary under the contract are affected only to the extent necessary to give effect to the rights and interests of the assignee.

Assignee deemed to be insured

(3)  Where a contract is assigned unconditionally and otherwise than as security, the assignee has all the rights and interests given to the insured by the contract and by this Part and shall be deemed to be the insured.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 200 is amended by adding the following subsection:

Effect on designation of beneficiary, transfer of ownership

(3.1)  Unless the document by which the contract is assigned specifies otherwise, an assignment described in subsection (3) made on or after the date this section comes into force revokes,

(a) a designation of a beneficiary made before or after that date and not made irrevocably; and

(b) a nomination referred to in section 199 made before or after that date. 2012, c. 8, Sched. 23, s. 26 (1).

See: 2012, c. 8, Sched. 23, ss. 26 (1), 77.

Prohibition against assignment

(4)  A provision in a contract to the effect that the rights or interests of the insured, or, in the case of group insurance, the group life insured, are not assignable is valid. R.S.O. 1990, c. I.8, s. 200.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (4) is repealed and the following substituted:

Prohibition against assignment

(4)  A contract may provide that the rights or interests of the insured or, in the case of a contract of group insurance or of creditor’s group insurance, of the group life insured or debtor insured, as the case may be, are not assignable. 2012, c. 8, Sched. 23, s. 26 (2).

See: 2012, c. 8, Sched. 23, ss. 26 (2), 77.

Group life insured, enforcing rights

201.  A group life insured may in his or her own name enforce a right given to him or her under a contract, subject to any defence available to the insurer against him or her or against the insured. R.S.O. 1990, c. I.8, s. 201.

Note: On a day to be named by proclamation of the Lieutenant Governor, Part V is amended by adding the following section:

Enforcement of right re creditor’s group insurance

201.1  (1)  A debtor insured or a debtor who is jointly liable for the debt with the debtor insured may enforce in his or her own name the creditor’s rights in respect of a claim arising in relation to the debtor insured, subject to any defence available to the insurer against the creditor or debtor insured. 2012, c. 8, Sched. 23, s. 27.

Insurer to pay creditor

(2)  Subject to subsection (3), where an insurer pays insurance money in respect of a claim under subsection (1), the insurer shall pay the insurance money to the creditor. 2012, c. 8, Sched. 23, s. 27.

Insurer may pay excess above debt to debtor insured

(3)  Where the debtor insured provides evidence satisfactory to the insurer that the insurance money exceeds the debt then owing to the creditor, the insurer may pay the excess directly to that debtor insured. 2012, c. 8, Sched. 23, s. 27.

See: 2012, c. 8, Sched. 23, ss. 27, 77.

Minors

Capacity of minors

202.  Except in respect of his or her rights as beneficiary, a minor who has attained the age of sixteen years has the capacity of a person of the age of eighteen years,

(a) to make an enforceable contract; and

(b) in respect of a contract. R.S.O. 1990, c. I.8, s. 202.

Proceedings under Contract

Proof of claim

203.  (1)  Where an insurer receives sufficient evidence of,

(a) the happening of the event upon which insurance money becomes payable;

(b) the age of the person whose life is insured;

(c) the right of the claimant to receive payment; and

(d) the name and age of the beneficiary, if there is a beneficiary,

it shall, within thirty days after receiving the evidence, pay the insurance money to the person entitled thereto. R.S.O. 1990, c. I.8, s. 203.

Order under Declarations of Death Act, 2002

(2)  Despite sections 208 and 209, an order made under the Declarations of Death Act, 2002 that declares that an individual has died is sufficient evidence of death for the purpose of clause (1) (a) if the insurer had notice of the application. 2002, c. 14, Sched., s. 10.

Exception

(3)  Subsection (2) does not apply if the order is limited, under subsection 2 (6) of the Declarations of Death Act, 2002, to specified purposes other than the payment of insurance money. 2002, c. 14, Sched., s. 10.

Payment of insurance money

Place of payment

204.  (1)  Subject to subsection (4), insurance money is payable in Ontario.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by striking out “Subject to subsection (4)” at the beginning and substituting “Subject to subsections (3), (4) and (5)”. See: 2012, c. 8, Sched. 23, ss. 28 (1), 77.

Dollars

(2)  Unless a contract otherwise provides, a reference therein to dollars means Canadian dollars.

Payment outside Ontario

(3)  Where a person entitled to receive insurance money is not domiciled in Ontario, the insurer may pay the insurance money to that person or to any other person who is entitled to receive it on that person’s behalf by the law of the domicile of the payee.

Exception for group insurance

(4)  In the case of a contract of group insurance, insurance money is payable in the province or territory of Canada in which the group life insured was resident at the time he or she became insured. R.S.O. 1990, c. I.8, s. 204.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 204 is amended by adding the following subsection:

Deceased not resident in Ontario at time of death

(5)  Where insurance money is payable under a contract to a deceased person who was not resident in Ontario at the date of the person’s death or to that person’s personal representative, the insurer may pay the insurance money to the deceased person’s personal representative as appointed under the law of the jurisdiction in which the person was resident at the date of the person’s death, and the payment discharges the insurer to the extent of the amount of the payment. 2012, c. 8, Sched. 23, s. 28 (2).

See: 2012, c. 8, Sched. 23, ss. 28 (2), 77.

Action in Ontario

205.  Despite where a contract was made, an action on it may be brought in a court by a resident of Ontario if the insurer was authorized to transact insurance in Ontario at the time the contract was made or at the time the action is brought. R.S.O. 1990, c. I.8, s. 205.

206.  Repealed: 2002, c. 24, Sched. B, s. 39 (1).

Documents affecting right to insurance money

207.  (1)  Until an insurer receives at its head or principal office in Canada an instrument or an order of a court affecting the right to receive insurance money, or a notarial copy, or a copy verified by statutory declaration, of any such instrument or order, it may make payment of the insurance money and shall be as fully discharged to the extent of the amount paid as if there were no such instrument or order.

Saving

(2)  Subsection (1) does not affect the rights or interests of any person other than the insurer. R.S.O. 1990, c. I.8, s. 207.

Declaration as to sufficiency of proof

208.  Where an insurer admits the validity of the insurance but does not admit the sufficiency of the evidence required by section 203 and there is no other question in issue except a question under section 209, the insurer or the claimant may, before or after action is brought and upon at least thirty days notice, apply to the court for a declaration as to the sufficiency of the evidence furnished, and the court may make the declaration or may direct what further evidence shall be furnished and on the furnishing thereof may make the declaration or, in special circumstances, may dispense with further evidence. R.S.O. 1990, c. I.8, s. 208.

Declaration as to presumption of death

209.  Where a claimant alleges that the person whose life is insured should be presumed to be dead by reason of his or her not having been heard of for seven years and there is no other question in issue except a question under section 208, the insurer or the claimant may, before or after action is brought and upon at least thirty days notice, apply to the court for a declaration as to presumption of the death and the court may make the declaration. R.S.O. 1990, c. I.8, s. 209.

Court orders, application under s. 208 or 209

210.  (1)  Upon making a declaration under section 208 or 209, the court may make such order respecting the payment of the insurance money and respecting costs as it deems just and, subject to section 212, a declaration or direction or order made under this subsection is binding upon the applicant and upon all persons to whom notice of the application has been given.

Payment under order

(2)  A payment made under an order made under subsection (1) discharges the insurer to the extent of the amount paid. R.S.O. 1990, c. I.8, s. 210.

Stay of proceedings

211.  Unless the court otherwise orders, an application made under section 208 or 209 operates as a stay of any pending action with respect to the insurance money. R.S.O. 1990, c. I.8, s. 211.

Appeal, ss. 208 to 210

212.  An appeal lies to the Divisional Court from any declaration, direction or order made under section 208, section 209 or subsection 210 (1). R.S.O. 1990, c. I.8, s. 212.

Court orders, insufficient evidence, etc.

213.  Where the court finds that the evidence furnished under section 203 is not sufficient or that a presumption of death is not established, it may order that the matters in issue be decided in an action brought or to be brought, or may make such other order as it considers just respecting further evidence to be furnished by the claimant, publication of advertisements, further inquiry or any other matter or respecting costs. R.S.O. 1990, c. I.8, s. 213.

Payment into court

214.  Where an insurer admits liability for insurance money and it appears to the insurer that,

(a) there are adverse claimants;

(b) the whereabouts of a person entitled is unknown; or

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (b) is amended by striking out “or” at the end. See: 2012, c. 8, Sched. 23, ss. 29 (1), 77.

(c) there is no person capable of giving and authorized to give a valid discharge therefor, who is willing to do so,

Note: On a day to be named by proclamation of the Lieutenant Governor, section 214 is amended by adding the following clauses:

(d) there is no person entitled to the insurance money; or

(e) the person to whom the insurance money is payable would be disentitled on public policy or other grounds,

See: 2012, c. 8, Sched. 23, ss. 29 (1), 77.

the insurer may, at any time after thirty days from the date of the happening of the event upon which the insurance money becomes payable, apply to the court without notice for an order for payment of the money into court, and the court may upon such notice, if any, as it thinks necessary make an order accordingly. R.S.O. 1990, c. I.8, s. 214.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 214 is amended by adding the following subsections:

Costs order

(2)  The court may fix, without assessment, the costs incurred on or in connection with an application or order made under subsection (1) and may order the costs to be paid out of the insurance money or by the insurer or otherwise, as it considers just. 2012, c. 8, Sched. 23, s. 29 (2).

Note: On a day named by proclamation of the Lieutenant Governor, subsection (2), as enacted by subsection 29 (2) of Schedule 23 to the Strong Action for Ontario Act (Budget Measures), 2012, is repealed. (See: 2013, c. 2, Sched. 8, ss. 11, 40)

Insurer discharged by payment under order

(3)  A payment made by an insurer under an order made under subsection (1) discharges the insurer to the extent of the amount of the payment. 2012, c. 8, Sched. 23, s. 29 (2).

See: 2012, c. 8, Sched. 23, ss. 29 (2), 77.

Simultaneous deaths

215.  Unless a contract or a declaration otherwise provides, where the person whose life is insured and a beneficiary die at the same time or in circumstances rendering it uncertain which of them survived the other, the insurance money is payable in accordance with subsection 194 (1) as if the beneficiary had predeceased the person whose life is insured. R.S.O. 1990, c. I.8, s. 215.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 215 is amended by striking out “in accordance with subsection 194 (1)”. See: 2012, c. 8, Sched. 23, ss. 30, 77.

Insurance money payable in instalments

216.  (1)  Subject to subsections (2) and (3), where insurance money is payable in instalments and a contract, or an instrument signed by the insured and delivered to the insurer, provides that a beneficiary has not the right to commute the instalments or to alienate or assign the beneficiary’s interest therein, the insurer shall not, unless the insured subsequently directs otherwise in writing, commute the instalments or pay them to any person other than the beneficiary, and the instalments are not, in the hands of the insurer, subject to any legal process except an action to recover the value of necessaries supplied to the beneficiary or the beneficiary’s children who are minors.

Commutation by beneficiary

(2)  A court may, upon the application of a beneficiary and upon at least ten days notice, declare that in view of special circumstances,

(a) the insurer may, with the consent of the beneficiary, commute instalments of insurance money; or

(b) the beneficiary may alienate or assign the beneficiary’s interest in the insurance money.

Commutation after death of beneficiary

(3)  After the death of the beneficiary, his or her personal representative may, with the consent of the insurer, commute any instalments of insurance money payable to the beneficiary.

Definition

(4)  In this section,

“instalments” includes insurance money held by the insurer under section 217. R.S.O. 1990, c. I.8, s. 216.

Insurer holding insurance money

217.  (1)  An insurer may hold insurance money,

(a) subject to the order of an insured or a beneficiary; or

(b) upon trusts or other agreements for the benefit of the insured or the beneficiary,

as provided in the contract, by an agreement in writing to which it is a party, or by a declaration, with interest at a rate agreed upon therein or, where no rate is agreed upon, at the rate declared from time to time by the insurer in respect of insurance money so held by it.

Exception

(2)  The insurer is not bound to hold insurance money as provided in subsection (1) under the terms of a declaration to which it has not agreed in writing. R.S.O. 1990, c. I.8, s. 217.

Court may order payment

218.  Where an insurer does not within thirty days after receipt of the evidence required by section 203 pay the insurance money to some person competent to receive it or into court, the court may, upon application of any person, order that the insurance money or any part thereof be paid into court, or may make such other order as to the distribution of the money as it deems just, and payment made in accordance with the order discharges the insurer to the extent of the amount paid. R.S.O. 1990, c. I.8, s. 218.

Costs, s. 214 or 218

219.  The court may fix without assessment the costs incurred in connection with an application or order made under section 214 or 218, and may order them to be paid out of the insurance money or by the insurer or the applicant or otherwise as it considers just. R.S.O. 1990, c. I.8, s. 219.

Minors

220.  (1)  If an insurer admits liability for insurance money payable to a minor, the insurer shall pay the money and any applicable interest, less the applicable costs mentioned in subsection (2), into court to the credit of the minor. 1993, c. 10, s. 13 (1).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is repealed and the following substituted:

Minors

(1)  If an insurer admits liability for insurance money payable to a minor, and there is no person capable of giving and authorized to give a valid discharge for the insurance money who is willing to do so, the insurer shall, within 30 days after receiving the evidence referred to in section 203, pay the money and any applicable interest into court to the credit of the minor. 2012, c. 8, Sched. 23, s. 31.

See: 2012, c. 8, Sched. 23, ss. 31, 77.

Costs

(2)  The insurer may retain out of the insurance money for costs incurred upon payment into court under subsection (1) the sum of $10 where the amount does not exceed $1,000, and the sum of $15 in other cases, and payment of the remainder of the money into court discharges the insurer. R.S.O. 1990, c. I.8, s. 220 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is repealed. See: 2012, c. 8, Sched. 23, ss. 31, 77.

Procedure

(3)  No order is necessary for payment into court under subsection (1), but the accountant or other proper officer shall receive the money upon the insurer filing with him or her an affidavit showing the amount payable and the name, date of birth and residence of the minor, and, upon such payment being made, the insurer shall forthwith notify the Children’s Lawyer and deliver to him or her a copy of the affidavit. R.S.O. 1990, c. I.8, s. 220 (3); 1994, c. 27, s. 43 (2).

Authorized payments

(4)  An insurer may, despite subsection (1), pay insurance money and applicable interest payable to a minor to,

(a) the guardian of the property of the minor, appointed under section 47 of the Children’s Law Reform Act; or

(b) a person referred to in subsection 51 (1) of the Children’s Law Reform Act, if the payment does not exceed the amount set out in that subsection. 1993, c. 10, s. 13 (2).

Beneficiary under disability

221.  Where it appears that a representative of a beneficiary who is under disability may under the law of the domicile of the beneficiary accept payments on behalf of the beneficiary, the insurer may make payment to the representative and any such payment discharges the insurer to the extent of the amount paid. R.S.O. 1990, c. I.8, s. 221.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 221 is repealed and the following substituted:

Beneficiary under legal incapacity

221.  Despite section 220, where it appears to an insurer that a representative of a beneficiary who is a minor or is otherwise under a legal incapacity may accept payments on behalf of the beneficiary under the law of the jurisdiction in which the beneficiary resides, the insurer may make payment to the representative, and the payment discharges the insurer to the extent of the amount paid. 2012, c. 8, Sched. 23, s. 32.

See: 2012, c. 8, Sched. 23, ss. 32, 77.

Miscellaneous Provisions

Presumption against agency

222.  No officer, agent or employee of an insurer and no person soliciting insurance, whether or not the person is an agent of the insurer, shall, to the prejudice of the insured, be deemed to be the agent of the insured in respect of any question arising out of a contract. R.S.O. 1990, c. I.8, s. 222.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 222 is repealed and the following substituted:

Presumption against agency

222.  An officer, agent or employee of an insurer, or a person soliciting insurance, whether or not an agent of the insurer, shall not be considered to be the agent of the insured, person whose life is insured, group life insured or debtor insured, to that person’s prejudice, in respect of any question arising out of a contract. 2012, c. 8, Sched. 23, s. 32.

See: 2012, c. 8, Sched. 23, ss. 32, 77.

Insurer giving information

223.  An insurer does not incur any liability for any default, error or omission in giving or withholding information as to any notice or instrument that it has received and that affects the insurance money. R.S.O. 1990, c. I.8, s. 223.

PART VI
AUTOMOBILE INSURANCE

Interpretation, Part VI

224.  (1)  In this Part,

“automobile” includes,

(a) a motor vehicle required under any Act to be insured under a motor vehicle liability policy, and

(b) a vehicle prescribed by regulation to be an automobile; (“automobile”)

“contract” means a contract of automobile insurance that,

(a) is undertaken by an insurer that is licensed to undertake automobile insurance in Ontario, or

(b) is evidenced by a policy issued in another province or territory of Canada, the United States of America or a jurisdiction designated in the Statutory Accident Benefits Schedule by an insurer that has filed an undertaking under section 226.1; (“contrat”)

“excluded driver” means a person named as an excluded driver in an endorsement under section 249; (“conducteur exclu”)

“fault determination rules” means the rules prescribed under paragraph 21 of subsection 121 (1); (“règles de détermination de la responsabilité”)

“health care” includes all goods and services for which payment is provided by the medical, rehabilitation and attendant care benefits provided for in the Statutory Accident Benefits Schedule; (“soins de santé”)

“insured” means a person insured by a contract whether named or not and includes every person who is entitled to statutory accident benefits under the contract whether or not described therein as an insured person; (“assuré”)

“listed expenses” means, in connection with statutory accident benefits, the amounts payable that, under section 288.1, are listed expenses; (“frais désignés”)

“occupant”, in respect of an automobile, means,

(a) the driver,

(b) a passenger, whether being carried in or on the automobile,

(c) a person getting into or on or getting out of or off the automobile; (“personne transportée”)

“public transit” means,

(a) any service for which a fare is charged for transporting the public by automobiles operated by or on behalf of a municipality or a local board as defined in the Municipal Affairs Act, or under an agreement between a municipality and a person, firm or corporation, but does not include special transportation facilities for persons with disabilities or transportation by special purpose facilities such as school buses or ambulances, and

(b) any service prescribed by regulation to be public transit, in the circumstances and subject to the terms, conditions, provisions, exclusions and limits prescribed by the regulation,

but does not include any service prescribed by regulation not to be public transit, in the circumstances and subject to the terms, conditions, provisions, exclusions and limits prescribed by the regulation; (“transport en commun”)

“public transit vehicle” means an automobile while being used for public transit; (“véhicule de transport en commun”)

“service provider’s licence” means a licence issued under section 288.5; (“permis de fournisseur de services”)

“spouse” means either of two persons who,

(a) are married to each other,

(b) have together entered into a marriage that is voidable or void, in good faith on the part of the person asserting a right under this Act, or

(c) have lived together in a conjugal relationship outside marriage,

(i) continuously for a period of not less than three years, or

(ii) in a relationship of some permanence, if they are the natural or adoptive parents of a child; (“conjoint”)

“statutory accident benefits” means the benefits set out in the regulations made under paragraphs 9 and 10 of subsection 121 (1); (“indemnités d’accident légales”)

Statutory Accident Benefits Schedule” means the regulations made under paragraphs 9 and 10 of subsection 121 (1). (“Annexe sur les indemnités d’accident légales”) R.S.O. 1990, c. I.8, s. 224 (1); 1993, c. 10, s. 1; 1996, c. 21, s. 15; 1999, c. 6, s. 31 (4); 2002, c. 22, s. 115; 2005, c. 5, s. 35 (5-8); 2011, c. 9, Sched. 21, s. 2; 2013, c. 2, Sched. 8, s. 12.

Transition

(2)  A reference to Schedule C in any other Act or in any regulation, contract or other instrument shall, in respect of events occurring after the 21st day of June, 1990, be deemed to be a reference to the Statutory Accident Benefits Schedule and a reference to benefits under Schedule C shall be deemed to be a reference to statutory accident benefits. R.S.O. 1990, c. I.8, s. 224 (2); 1993, c. 10, s. 1.

Idem

(3)  Every contract to which subsection 268 (1) applies shall be deemed to have been amended on the 22nd day of June, 1990, to include statutory accident benefits in accordance with the Statutory Accident Benefits Schedule. R.S.O. 1990, c. I.8, s. 224 (3); 1993, c. 10, s. 1.

Idem

(4)  The benefits of a person who, before the 22nd day of June, 1990, was entitled to benefits under Schedule C shall be determined in accordance with the Insurance Act, being chapter 218 of the Revised Statutes of Ontario, 1980, as that Act read immediately before the 22nd day of June, 1990. R.S.O. 1990, c. I.8, s. 224 (4).

Idem

(5)  For the purposes of subsections (2) and (4),

“Schedule C” means Schedule C to the Insurance Act, being chapter 218 of the Revised Statutes of Ontario, 1980, as that Act read before the 22nd day of June, 1990. R.S.O. 1990, c. I.8, s. 224 (5).

Additional benefits

(6)  An insurer, with the approval of the Superintendent, may offer optional benefits in excess of the benefits that must be provided under the Statutory Accident Benefits Schedule. R.S.O. 1990, c. I.8, s. 224 (6); 1993, c. 10, s. 1; 1997, c. 28, s. 109.

Idem

(7)  Optional benefits offered under subsection (6) shall be deemed to be statutory accident benefits and the Statutory Accident Benefits Schedule applies to them with necessary modifications. R.S.O. 1990, c. I.8, s. 224 (7); 1993, c. 10, s. 1.

Exception re insured

225.  Except as provided in the Statutory Accident Benefits Schedule, the insured under a contract shall be deemed not to include any person who sustains loss or damage while any automobile insured under the contract is being used or operated by an excluded driver. R.S.O. 1990, c. I.8, s. 225; 1993, c. 10, s. 1.

Application of Part

226.  (1)  This Part does not apply to contracts insuring only against,

(a) loss of or damage to an automobile while in or on described premises;

(b) loss of or damage to property carried in or upon an automobile; or

(c) liability for loss of or damage to property carried in or upon an automobile.

Idem

(2)  This Part does not apply to a contract providing insurance in respect of an automobile not required to be registered under the Highway Traffic Act unless it is insured under a contract evidenced by a form of policy approved under this Part.

Idem

(3)  This Part does not apply to a contract insuring solely the interest of a person who has a lien upon, or has as security legal title to, an automobile and who does not have possession of the automobile. R.S.O. 1990, c. I.8, s. 226.

Out-of-province insurers

226.1  An insurer that issues motor vehicle liability policies in another province or territory of Canada, the United States of America or a jurisdiction designated in the Statutory Accident Benefits Schedule may file an undertaking with the Superintendent, in the form provided by the Superintendent, providing that the insurer’s motor vehicle liability policies will provide at least the coverage described in sections 251, 265 and 268 when the insured automobiles are operated in Ontario. 1996, c. 21, s. 16; 1997, c. 28, s. 110.

Approval of Forms

Approval of forms

227.  (1)  An insurer shall not use a form of any of the following documents in respect of automobile insurance unless the form has been approved by the Superintendent:

1. An application for insurance.

2. A policy, endorsement or renewal.

3. A claims form.

4. A continuation certificate. 1996, c. 21, s. 17; 1997, c. 28, s. 111.

Application for insurance

(1.1)  Paragraph 1 of subsection (1) does not apply if, in accordance with the regulations, the insurer uses a form of application for insurance that is prescribed by the regulations. 1996, c. 21, s. 17.

Approval of policies in special cases

(2)  Where, in the opinion of the Superintendent, any provision of this Part, including any statutory condition, is wholly or partly inappropriate to the requirements of a contract or is inapplicable by reason of the requirements of any Act, he or she may approve a form of policy, or part thereof, or endorsement evidencing a contract sufficient or appropriate to insure the risks required or proposed to be insured, and the contract evidenced by the policy or endorsement in the form so approved is effective and binding according to its terms even if those terms are inconsistent with, vary, omit or add to any provision or condition of this Part. R.S.O. 1990, c. I.8, s. 227 (2); 1997, c. 28, s. 111.

Approval of extensions

(3)  The Superintendent may, if he or she considers it to be in the public interest, approve a form of motor vehicle liability policy or endorsement thereto that extends the insurance beyond that prescribed in this Part. R.S.O. 1990, c. I.8, s. 227 (3); 1997, c. 28, s. 111.

Conditions of approval of extension

(4)  The Superintendent, in granting an approval under subsection (3), may require the insurer to charge an additional premium for the extension and to state that fact in the policy or in any endorsement. R.S.O. 1990, c. I.8, s. 227 (4); 1997, c. 28, s. 111.

Standard policies

(5)  The Superintendent may approve the form of standard policies containing insuring agreements and provisions in conformity with this Part for use by insurers in general. 1993, c. 10, s. 14; 1997, c. 28, s. 111.

Publication

(6)  If the Superintendent approves a form of standard policy, the Superintendent shall cause a copy of the form to be published in The Ontario Gazette, but it is not necessary to publish endorsement forms approved for use with the standard policy. 1993, c. 10, s. 14; 1997, c. 28, s. 111.

Revocation of approval

(7)  The Superintendent may revoke an approval given under this section, and, upon notification of the revocation in writing, no insurer shall thereafter use or deliver a form that contravenes the notification. R.S.O. 1990, c. I.8, s. 227 (7); 1997, c. 28, s. 111.

Reason for decision

(8)  The Superintendent shall, on request of any interested insurer, specify in writing his or her reasons for granting, refusing or revoking an approval of a form. R.S.O. 1990, c. I.8, s. 227 (8); 1997, c. 28, s. 111.

Application form

228.  Where so required by the regulations, no insurer shall use a form of application other than a prescribed form. R.S.O. 1990, c. I.8, s. 228.

Other Information

Information for applicants, etc.

229.  (1)  An insurer or broker shall supply at such times as may be prescribed such information as may be prescribed to applicants for automobile insurance and to named insureds under contracts. R.S.O. 1990, c. I.8, s. 229 (1); 1993, c. 10, s. 15 (1).

Information deemed to be part of application

(2)  Information supplied under subsection (1) by an insurer or by a broker on behalf of an insurer to an applicant for automobile insurance shall be deemed to be a part of the application. R.S.O. 1990, c. I.8, s. 229 (2); 1993, c. 10, s. 15 (2).

Information from brokers

230.  (1)  A broker shall provide to an applicant for insurance the names of all the insurers with whom the broker has an agency contract relating to automobile insurance and all information obtained by the broker relating to quotations on automobile insurance for the applicant. 1996, c. 21, s. 18.

Information from agents

(2)  An agent shall inform an applicant for automobile insurance of the insurer or the insurers within an affiliated group of insurers that the agent represents. 2002, c. 22, s. 116.

Request for written information

(3)  The broker or agent shall provide the information referred to in subsection (1) or (2) in writing if the applicant so requests. 2002, c. 22, s. 116.

Application and Policy

Persons forbidden to act as agent

231.  No person carrying on the business of financing the sale or purchase of automobiles and no automobile dealer, insurance agent or broker and no officer or employee of such a person, dealer, agent or broker shall act as the agent of an applicant for the purpose of signing an application for automobile insurance. R.S.O. 1990, c. I.8, s. 231.

Policy, formal requirements

Copy of application in policy

232.  (1)  A copy of the written application, signed by the insured or the insured’s agent, or, if no signed application is made, a copy of the purported application, or a copy of such part of the application or purported application as is material to the contract, shall be embodied in, endorsed upon or attached to the policy when issued by the insurer.

Policy issued where no signed application

(2)  If no signed written application is received by the insurer prior to the issue of the policy, the insurer shall deliver or mail to the insured named in the policy, or to the agent for delivery or mailing to the insured, a form of application to be completed and signed by the insured and returned to the insurer.

Insured entitled to copy

(3)  Subject to subsection (5), the insurer shall deliver or mail to the insured named in the policy, or to the agent for delivery or mailing to the insured, the policy or a true copy thereof and every endorsement or other amendment to the contract.

Form of policy

(4)  Where a written application signed by the insured or the insured’s agent is made for a contract, the policy evidencing the contract shall be deemed to be in accordance with the application unless the insurer points out in writing to the insured named in the policy in what respect the policy differs from the application, and, in that event, the insured shall be deemed to have accepted the policy unless within one week from the receipt of the notification the insured informs the insurer in writing that the insured rejects the policy. R.S.O. 1990, c. I.8, s. 232 (1-4).

Certificate of policy

(5)  If an insurer adopts a standard policy approved under subsection 227 (5), it may, instead of issuing the policy, issue a certificate in a form approved by the Superintendent. 1993, c. 10, s. 16 (1); 1997, c. 28, s. 111.

Effect of certificate

(5.1)  A certificate issued under subsection (5) is of the same force and effect as if it were the standard policy, subject to the limits and coverages shown by the insurer on the certificate and any endorsements issued with or subsequent to the certificate. 1993, c. 10, s. 16 (1).

Copy of policy

(5.2)  At the request of an insured to whom a certificate has been issued under subsection (5), the insurer shall provide a copy of the standard policy approved by the Superintendent. 1993, c. 10, s. 16 (1); 1997, c. 28, s. 111.

Application

(6)  Where a certificate is issued under subsection (5), subsection (8) of this section and subsections 261 (2) and 263 (5.3) apply with necessary modifications. R.S.O. 1990, c. I.8, s. 232 (6); 1993, c. 10, s. 16 (2).

Proof of terms of policy

(7)  Where an insurer issues a certificate under subsection (5), proof of the terms of the policy may be given by production of a copy of The Ontario Gazette containing the form of standard policy approved by the Superintendent. R.S.O. 1990, c. I.8, s. 232 (7); 1993, c. 10, s. 16 (3); 1997, c. 28, s. 111.

Endorsement on forms

(8)  Upon every application form and policy, there shall be printed or stamped in conspicuous type a copy of subsection 233 (1). R.S.O. 1990, c. I.8, s. 232 (8).

Inspection requirements

232.1  Before issuing a policy in respect of an automobile, an insurer shall comply with the inspection requirements prescribed by the regulations. 1996, c. 21, s. 19.

Misrepresentation or violation of conditions renders claim invalid

233.  (1)  Where,

(a) an applicant for a contract,

(i) gives false particulars of the described automobile to be insured to the prejudice of the insurer, or

(ii) knowingly misrepresents or fails to disclose in the application any fact required to be stated therein;

(b) the insured contravenes a term of the contract or commits a fraud; or

(c) the insured wilfully makes a false statement in respect of a claim under the contract,

a claim by the insured is invalid and the right of the insured to recover indemnity is forfeited. R.S.O. 1990, c. I.8, s. 233 (1).

Statutory accident benefits protected

(2)  Subsection (1) does not invalidate such statutory accident benefits as are set out in the Statutory Accident Benefits Schedule. R.S.O. 1990, c. I.8, s. 233 (2); 1993, c. 10, s. 1.

Use of application as defence

(3)  No statement of the applicant shall be used in defence of a claim under the contract unless it is contained in the signed written application therefor or, where no signed written application is made, in the purported application, or part thereof, that is embodied in, endorsed upon or attached to the policy.

Idem

(4)  No statement contained in a purported copy of the application, or part thereof, other than a statement describing the risk and the extent of the insurance, shall be used in defence of a claim under the contract unless the insurer proves that the applicant made the statement attributed to the applicant in the purported application, or part thereof. R.S.O. 1990, c. I.8, s. 233 (3, 4).

Statutory conditions

234.  (1)  The conditions prescribed by the regulations made under paragraph 15.1 of subsection 121 (1) are statutory conditions and shall be deemed to be part of every contract to which they apply and shall be printed in English or French in every policy to which they apply with the heading “Statutory Conditions” or “Conditions légales”, as may be appropriate.

Variation

(2)  No variation or omission of or addition to a statutory condition is binding on the insured.

Exceptions

(3)  Except as otherwise provided in the contract, the statutory conditions referred to in subsection (1) do not apply to the insurance required by section 265 or 268.

Definition

(4)  In subsection (1),

“policy” does not include an interim receipt or binder. 1993, c. 10, s. 17.

235.  Repealed: 1993, c. 10, s. 18.

Notice of expiry or variation

236.  (1)  If an insurer does not intend to renew a contract or if an insurer proposes to renew a contract on varied terms, the insurer shall,

(a) give the named insured not less than thirty days notice in writing of the insurer’s intention or proposal; or

(b) give the broker, if any, through whom the contract was placed forty-five days notice in writing of the insurer’s intention or proposal. R.S.O. 1990, c. I.8, s. 236 (1).

Idem

(2)  Subject to subsection (4), a broker to whom an insurer has given notice under clause (1) (b) shall give the named insured under the contract not less than thirty days notice in writing of the insurer’s intention or proposal. R.S.O. 1990, c. I.8, s. 236 (2).

Reasons

(3)  Notices given under subsections (1) and (2) shall set out the reasons for the insurer’s intention or proposal. R.S.O. 1990, c. I.8, s. 236 (3).

Exception

(4)  Where, before a broker is required to have given notice to a named insured under subsection (2), the broker places with another insurer a replacement contract containing substantially similar terms as the expiring contract, the broker is exempted from giving notice under subsection (2). R.S.O. 1990, c. I.8, s. 236 (4).

Effect of failure to comply

(5)  A contract of insurance is in force until there is compliance with subsections (1), (2) and (3). R.S.O. 1990, c. I.8, s. 236 (5).

Exception

(6)  This section does not apply to prescribed types of contracts in prescribed circumstances. 2002, c. 22, s. 117.

Limitation on termination

237.  (1)  If so required by the regulations and unless the insurer has complied therewith, an insurer shall not decline to issue or terminate or refuse to renew a contract in respect of such coverages and endorsements as may be set out in the regulations or decline to issue, terminate or refuse to renew any contract or refuse to provide or continue any coverage or endorsement on any ground set out in the regulations. R.S.O. 1990, c. I.8, s. 237 (1).

Information

(2)  The Superintendent may require insurers, agents and brokers to provide such information, material and evidence as the Superintendent considers necessary to determine compliance with subsection (1). R.S.O. 1990, c. I.8, s. 237 (2); 1997, c. 28, s. 111.

Exemption

(3)  An insurer may apply to the Superintendent for an exemption from subsection (1). R.S.O. 1990, c. I.8, s. 237 (3); 1997, c. 28, s. 111.

Idem

(4)  An application for an exemption from compliance with subsection (1) shall be in a form approved by the Superintendent and shall be filed together with such information, materials and evidence as the Superintendent considers necessary. R.S.O. 1990, c. I.8, s. 237 (4); 1997, c. 28, s. 111.

Idem

(5)  The Superintendent may exempt an insurer in whole or in part from compliance with subsection (1) if, in the opinion of the Superintendent, compliance with the regulations would impair the solvency of the insurer or would cause the insurer to be in contravention of this Act or the regulations. R.S.O. 1990, c. I.8, s. 237 (5); 1997, c. 28, s. 111.

Non-application

(6)  Subsection (1) does not apply in respect of a contract if any payment in respect of premiums payable under the contract or under any ancillary agreement is overdue or if,

(a) the insured has given false particulars of the described automobile to the prejudice of the insurer;

(b) the insured has knowingly misrepresented or failed to disclose in an application for insurance any fact required to be stated therein. R.S.O. 1990, c. I.8, s. 237 (6).

Grounds to terminate

238.  (1)  An insurer shall not decline to issue, terminate or refuse to renew a contract or refuse to provide or continue a coverage or endorsement, except on a ground filed with the Superintendent under this section. 1993, c. 10, s. 19; 1997, c. 28, s. 111.

Filing of grounds

(2)  An insurer shall file with the Superintendent the grounds on which the insurer intends to decline to issue, terminate or refuse to renew a contract or refuse to provide or continue a coverage or endorsement. 1993, c. 10, s. 19; 1997, c. 28, s. 111.

Material to be furnished

(3)  The grounds shall be filed in a form approved by the Superintendent and shall be filed together with such information, material and evidence as the Superintendent may specify. 1993, c. 10, s. 19; 1997, c. 28, s. 111.

Request for additional information

(3.1)  The Superintendent may require that the insurer provide such additional information, material and evidence as the Superintendent may specify in order to make a decision with respect to a filed ground. 2010, c. 26, Sched. 9, s. 1 (1).

Prohibition from using ground

(4)  The Superintendent shall notify the insurer orally or otherwise that the insurer is prohibited from using one or more of the grounds filed under subsection (2) if the Superintendent is of the opinion that the ground,

(a) is subjective;

(b) is arbitrary;

(c) bears little or no relationship to the risk to be borne by the insurer in respect of an insured; or

(d) is contrary to public policy. 2010, c. 26, Sched. 9, s. 1 (2).

When insurer may use ground

(4.1)  Unless the Superintendent notifies the insurer that the insurer is prohibited from using a ground, the insurer may use the ground 30 days after the later of,

(a) the day the insurer files the ground under subsection (2); or

(b) the day the additional information, material or evidence requested is provided, if the Superintendent requires the insurer to provide additional information, material or evidence under subsection (3.1). 2010, c. 26, Sched. 9, s. 1 (2).

Notice

(5)  If the Superintendent notifies an insurer orally that the insurer is prohibited from using a ground, the Superintendent shall promptly mail a written notice to the insurer confirming that fact. 1993, c. 10, s. 19; 1997, c. 28, s. 111.

Appeal to Tribunal

(6)  If the Superintendent notifies an insurer that the insurer is prohibited from using a ground, the insurer may within 15 days appeal the decision to the Tribunal. 1997, c. 28, s. 112.

Prohibition by Tribunal

(7)  After the hearing, the Tribunal shall prohibit the insurer from using the ground if the Tribunal finds that the ground comes within any of clauses (4) (a), (b), (c) and (d). 1997, c. 28, s. 112.

Reconsideration

(8)  The Superintendent may, at any time, give notice in writing to an insurer that,

(a) he or she is of the opinion that a ground that has been filed under this section or the manner in which it is applied comes within any of clauses (4) (a), (b), (c) and (d); and

(b) he or she intends to prohibit the use of the ground or to prohibit the use of the ground in a specified manner. 1997, c. 28, s. 112.

Request for hearing

(9)  Within 15 days after receiving the notice, the insurer may request in writing that the Tribunal hold a hearing before the Superintendent takes any action described in the notice. 1997, c. 28, s. 112.

Hearing

(10)  If, within the time period allowed, the insurer requests a hearing, the Tribunal shall hold a hearing. 1997, c. 28, s. 112.

No request for hearing

(11)  If, within the time period allowed, the insurer does not request a hearing, the Superintendent may take any action described in the notice. 1997, c. 28, s. 112.

Powers of Tribunal

(12)  At a hearing, if the Tribunal finds that the ground or the manner in which it applies comes within any of clauses (4) (a), (b), (c) and (d), the Tribunal shall prohibit the insurer from using the ground or from using it in a specified manner. 1997, c. 28, s. 112.

Information to provide

(13)  The Superintendent or the Tribunal may require insurers, agents and brokers to provide the information, material and evidence that the Superintendent or Tribunal, as the case requires, considers necessary for the purposes of this section. 1997, c. 28, s. 112.

Affiliated automobile insurers, concurrent filing

238.1  (1)  The Superintendent may require that affiliated insurers who write automobile insurance in Ontario file their grounds under section 238 concurrently. 2010, c. 26, Sched. 9, s. 2.

Insurer’s application, consideration of affiliate’s grounds

(2)  The Superintendent may consider the grounds filed by the affiliates of an insurer when deciding on the grounds filed by the insurer. 2010, c. 26, Sched. 9, s. 2.

Interpretation

(3)  For the purpose of this section, an insurer is considered to be affiliated with another insurer if one of them is the subsidiary of the other or both are subsidiaries of the same body corporate or each of them is controlled by the same person. 2010, c. 26, Sched. 9, s. 2.

Motor Vehicle Liability Policies

Policy coverage

Coverage of owner’s policy, specific automobile

239.  (1)  Subject to section 240, every contract evidenced by an owner’s policy insures the person named therein, and every other person who with the named person’s consent drives, or is an occupant of, an automobile owned by the insured named in the contract and within the description or definition thereof in the contract, against liability imposed by law upon the insured named in the contract or that other person for loss or damage,

(a) arising from the ownership or directly or indirectly from the use or operation of any such automobile; and

(b) resulting from bodily injury to or the death of any person and damage to property. R.S.O. 1990, c. I.8, s. 239 (1).

Saving, statutory accident benefits

(2)  A lack of consent does not invalidate such statutory accident benefits as are set out in the Statutory Accident Benefits Schedule. R.S.O. 1990, c. I.8, s. 239 (2); 1993, c. 10, s. 1.

Coverage of owner’s policy, other automobiles

(3)  Where the contract evidenced by an owner’s policy also provides insurance against liability in respect of an automobile not owned by the insured named in the contract, an insurer may stipulate in the contract that the insurance is restricted to such persons as are specified in the contract. R.S.O. 1990, c. I.8, s. 239 (3).

Death of person named in owner’s policy

(4)  Where the insured named in an owner’s policy dies, the following persons shall be deemed to be the insured under the policy:

1. The spouse of the deceased insured.

2. In respect of the described automobile, a newly-acquired automobile that was acquired by the deceased insured prior to his or her death and a temporary substitute automobile, all as defined by the policy,

i. any person having proper temporary custody thereof until grant of probate or administration to the personal representative of the deceased insured,

ii. the personal representative of the deceased insured. R.S.O. 1990, c. I.8, s. 239 (4); 1999, c. 6, s. 31 (5); 2005, c. 5, s. 35 (9).

Insurer not liable re excluded driver

240.  If a contract evidenced by a motor vehicle liability policy names an excluded driver, the insurer is not liable to any person under the contract or under this Act or the regulations for any loss or damage that occurs while the excluded driver is driving an automobile insured under the contract, except as provided in the Statutory Accident Benefits Schedule. R.S.O. 1990, c. I.8, s. 240; 1993, c. 10, s. 1.

Coverage of non-owner’s policy

241.  Every contract evidenced by a non-owner’s policy insures the person named therein and such other person, if any, as is specified in the policy against liability imposed by law upon the insured named in the contract or that other person for loss or damage,

(a) arising directly or indirectly from the use or operation of an automobile within the definition thereof in the policy, other than an automobile owned by him, her or it or registered in his, her or its name; and

(b) resulting from bodily injury to or the death of any person, and damage to property. R.S.O. 1990, c. I.8, s. 241.

Persons deemed not owners

242.  For the purposes of this Part, a person shall not be deemed to be the owner of an automobile for the reason only that the person has a lien on the automobile or has legal title to the automobile as security. R.S.O. 1990, c. I.8, s. 242.

Territorial limits

243.  (1)  Insurance under sections 239 and 241 applies to the ownership, use or operation of the insured automobile in Canada, the United States of America and any other jurisdiction designated in the Statutory Accident Benefits Schedule, and on a vessel plying between ports of Canada, the United States of America or a designated jurisdiction. 1996, c. 21, s. 20.

Same

(1.1)  Payment provided for under subsection 265 (1) applies to loss or damage resulting from an accident involving an uninsured or unidentified automobile in Canada, the United States of America and any other jurisdiction designated in the Statutory Accident Benefits Schedule, and on a vessel plying between ports of Canada, the United States of America or a designated jurisdiction. 2002, c. 22, s. 118.

Same

(2)  Statutory accident benefits provided under section 268 apply to the use or operation of any automobile in Canada, the United States of America and any other jurisdiction designated in the Statutory Accident Benefits Schedule, and on a vessel plying between ports of Canada, the United States of America or a designated jurisdiction. 1996, c. 21, s. 20.

Rights of unnamed insured

244.  Any person insured by but not named in a contract to which section 239 or 241 applies may recover indemnity in the same manner and to the same extent as if named therein as the insured, and for that purpose shall be deemed to be a party to the contract and to have given consideration therefor. R.S.O. 1990, c. I.8, s. 244.

Additional agreements

245.  Every contract evidenced by a motor vehicle liability policy shall provide that, where a person insured by the contract is involved in an accident resulting from the ownership, or directly or indirectly from the use or operation of an automobile in respect of which insurance is provided under the contract and resulting in loss or damage to persons or property, the insurer shall,

(a) upon receipt of notice of loss or damage caused to persons or property, make such investigations, conduct such negotiations with the claimant and effect such settlement of any resulting claims as are deemed expedient by the insurer;

(b) defend in the name and on behalf of the insured and at the cost of the insurer any civil action that is at any time brought against the insured on account of loss or damage to persons or property;

(c) pay all costs assessed against the insured in any civil action defended by the insurer and any interest accruing after entry of judgment upon that part of the judgment that is within the limits of the insurer’s liability; and

(d) where the injury is to a person, reimburse the insured for outlay for such medical aid as is immediately necessary at the time. R.S.O. 1990, c. I.8, s. 245.

Liability for contamination

246.  Liability arising from contamination of property carried in an automobile shall not be deemed to be liability arising from the ownership, use or operation of such automobile. R.S.O. 1990, c. I.8, s. 246.

Other liability, possible exclusions

247.  The insurer may provide under a contract evidenced by a motor vehicle liability policy, in either or both of the following cases, that it shall not be liable,

(a) to indemnify any person engaged in the business of selling, repairing, maintaining, servicing, storing or parking automobiles for any loss or damage sustained while engaged in the use or operation of or while working upon the automobile in the course of that business unless the person is the owner of the automobile or is an employee of the owner of the automobile;

(b) for loss of or damage to property carried in or upon the automobile or to any property owned or rented by or in the care, custody or control of the insured. R.S.O. 1990, c. I.8, s. 247.

Liability for damage caused by machinery, etc.

248.  Subject to the limitations and exclusions of the endorsement, the insurer may provide by endorsement to a contract evidenced by a motor vehicle liability policy that it shall not be liable for loss or damage resulting from the ownership, use or operation of any machinery or apparatus, including its equipment, mounted on or attached to the automobile while such automobile is at the site of the use or operation of that machinery or apparatus. R.S.O. 1990, c. I.8, s. 248.

Excluded driver endorsement

249.  A named insured may stipulate by endorsement to a contract evidenced by a motor vehicle liability policy that any person named in the endorsement is an excluded driver under the contract. R.S.O. 1990, c. I.8, s. 249.

Liability, possible exclusions for other uses

250.  (1)  The insurer may provide under a contract evidenced by a motor vehicle liability policy, in one or more of the following cases, that, except as provided in the Statutory Accident Benefits Schedule, it shall not be liable while,

(a) the automobile is rented or leased to another person;

(b) the automobile is used to carry explosives or to carry radio-active material for research, education, development or industrial purposes or for purposes incidental thereto;

(c) the automobile is used as a taxicab, public omnibus, livery, jitney or sightseeing conveyance or for carrying passengers for compensation or hire;

(d) where the insured vehicle is an automobile, other than a trailer, it is used for towing a trailer owned by the insured unless like indemnity is also provided by the insurer in respect of the trailer;

(e) where the insured vehicle is a trailer, it is towed by an automobile owned by the insured unless like indemnity is also provided by the insurer in respect of the automobile. R.S.O. 1990, c. I.8, s. 250 (1); 1993, c. 10, s. 1.

Definition

(2)  In clause (1) (b),

“radio-active material” means,

(a) spent nuclear fuel rods that have been exposed to radiation in a nuclear reactor,

(b) radio-active waste material,

(c) unused enriched nuclear fuel rods, or

(d) any other radio-active material of such quantity and quality as to be harmful to persons or property if its container were destroyed or damaged. R.S.O. 1990, c. I.8, s. 250 (2).

Exception

(3)  Clause (1) (a) does not include the use by an employee of his or her automobile on the business of the employee’s employer and for which the employee is paid. R.S.O. 1990, c. I.8, s. 250 (3).

Certain rules excepted

(4)  Clause (1) (c) does not include,

(a) the use by a person of the person’s automobile for the carriage of another person in return for the former’s carriage in the automobile of the latter;

(b) the occasional and infrequent use by a person of the person’s automobile for the carriage of another person who shares the cost of the trip;

(c) the use by a person of the person’s automobile for the carriage of a temporary or permanent domestic servant of the insured or his or her spouse;

(d) the use by a person of the person’s automobile for the carriage of a client or customer or a prospective client or customer; or

(e) the occasional and infrequent use by the insured of the insured’s automobile for the transportation of children to or from school or school activities conducted within the educational program. R.S.O. 1990, c. I.8, s. 250 (4); 1999, c. 6, s. 31 (6); 2005, c. 5, s. 35 (10).

Minimum liability under policy

251.  (1)  Every contract evidenced by a motor vehicle liability policy insures, in respect of any one accident, to the limit of at least $200,000, exclusive of interest and costs, against liability resulting from bodily injury to or the death of one or more persons and loss of or damage to property.

Priorities

(2)  The contract shall be interpreted to mean that where, by reason of any one accident, liability results from bodily injury or death and from loss of or damage to property,

(a) claims against the insured arising out of bodily injury or death have priority to the extent of $190,000 over claims arising out of loss of or damage to property; and

(b) claims against the insured arising out of loss of or damage to property have priority to the extent of $10,000 over claims arising out of bodily injury or death.

Minimum limits where separate limits designated

(3)  The insurer may, instead of specifying a limit in the policy for an inclusive amount, specify a limit of liability of at least $200,000, exclusive of interest and costs, against liability resulting from bodily injury to or the death of one or more persons and a limit of liability of at least $200,000, exclusive of interest and costs, against liability for loss of or damage to property.

Variation of limits

(4)  Nothing in this Part precludes an insurer, with respect to a limit or limits in excess of those specified in subsection (1) or (3), from increasing or reducing the limit or limits specified in the contract with respect to the use or operation of the automobile by a named person, but no reduction is effective for a limit less than that required under subsection (1) or (3). R.S.O. 1990, c. I.8, s. 251.

Liability arising from use, etc., outside Ontario

252.  (1)  Every motor vehicle liability policy issued in Ontario shall provide that, in the case of liability arising out of the ownership or, directly or indirectly, out of the use or operation of the automobile in any province or territory of Canada, in a jurisdiction of the United States of America or in any other jurisdiction designated in the Statutory Accident Benefits Schedule,

(a) the insurer is liable up to the minimum limits prescribed for that province, territory or jurisdiction if those limits are higher than the limits prescribed by the policy;

(b) the insurer will not set up a defence to a claim that could not be set up if the policy were a motor vehicle liability policy issued in that province, territory or jurisdiction; and

(c) the insured, by acceptance of the policy, constitutes and appoints the insurer as the insured’s irrevocable attorney to appear and defend in any province or territory of Canada, any jurisdiction of the United States of America or any other jurisdiction designated in the Statutory Accident Benefits Schedule in which an action is brought against the insured arising out of the ownership, use or operation of the automobile. 1996, c. 21, s. 21.

Power of attorney binding

(2)  A provision in a motor vehicle liability policy in accordance with clause (1) (c) is binding on the insured. R.S.O. 1990, c. I.8, s. 252 (2).

Excess insurance

253.  (1)  Nothing in this Part precludes an insurer from providing insurance under a contract evidenced by a motor vehicle liability policy restricted to a limit in excess of that provided by another designated contract evidenced by a motor vehicle liability policy, whether the designated contract is a first loss insurance or an excess insurance.

Termination of excess insurance

(2)  Where the contract designated in the excess contract terminates or is terminated, the excess contract is also automatically terminated. R.S.O. 1990, c. I.8, s. 253.

Agreement for partial payment of claim by insured

254.  Nothing in this Part precludes an insurer from entering into an agreement with its insured under a contract evidenced by a motor vehicle liability policy providing that the insured will reimburse the insurer in an agreed amount in respect of any claim by or judgment in favour of a third party against the insured, and the agreement may be enforced against the insured according to its tenor. R.S.O. 1990, c. I.8, s. 254.

Liability for nuclear energy hazard

255.  (1)  In this section,

“nuclear energy hazard” means the radio-active, toxic, explosive or other hazardous properties of nuclear substances under the Nuclear Safety and Control Act (Canada). 2004, c. 31, Sched. 20, s. 7.

Liability when nuclear energy contract also in force

(2)  Where an insured is covered, whether named therein or not, under a contract evidenced by a motor vehicle liability policy for loss or damage resulting from bodily injury to or the death of any person or damage to property arising directly or indirectly out of a nuclear energy hazard and is also covered, whether named therein or not, against such loss or damage under a contract evidenced by a policy of nuclear energy hazard liability insurance issued by a group of insurers and in force at the time of the event giving rise to the loss or damage,

(a) the motor vehicle liability insurance is excess to the nuclear energy hazard liability insurance, and the insurer under the contract of motor vehicle liability insurance is not liable to pay beyond the minimum limits prescribed by section 251; and

(b) the unnamed insured under the contract of nuclear energy liability insurance may, in respect of such loss or damage, recover indemnity under that contract in the same manner and to the same extent as if named therein as the insured, and for that purpose the unnamed insured shall be deemed to be a party to the contract and to have given consideration therefor. R.S.O. 1990, c. I.8, s. 255 (2).

When contract deemed in force

(3)  For the purpose of this section, a contract of nuclear energy hazard liability insurance shall be deemed to be in force at the time of the event giving rise to the loss or damage, even if the limits of liability thereunder have been exhausted. R.S.O. 1990, c. I.8, s. 255 (3).

Advance payments and release by claimant

256.  (1)  Where an insurer makes a payment on behalf of an insured under a contract evidenced by a motor vehicle liability policy to a person who is or claims to be entitled to recover from the insured covered by the policy, the payment constitutes, to the extent of the payment, a release by the person or the person’s personal representative of any claim that the person or the person’s personal representative or any person claiming through or under him or by virtue of Part V of the Family Law Act may have against the insured and the insurer.

Idem

(2)  Nothing in this section precludes the insurer making the payment from demanding, as a condition precedent to such payment, a release from the person or the person’s personal representative or any other person to the extent of such payment.

Payment to be taken into account

(3)  Where the person commences an action, the court shall adjudicate upon the matter first without reference to the payment but in giving judgment the payment shall be taken into account and the person shall only be entitled to judgment for the net amount, if any.

Intention

(4)  The intention of this section is to permit payments to a claimant without prejudice to the defendant or the defendant’s insurer, either as an admission of liability or otherwise, and the fact of any payment shall not be disclosed to the judge or jury until after judgment but before formal entry thereof. R.S.O. 1990, c. I.8, s. 256.

Defence where more than one contract

257.  (1)  Where a person is insured under more than one contract evidenced by a motor vehicle liability policy, whether the insurance is first loss insurance or excess, and a question arises under clause 245 (b) between an insurer and the insured or between the insurers as to which insurer shall undertake the obligation to defend in the name and on behalf of the insured, whether or not any insurer denies liability under its contract, the insured or any insurer may apply to the Superior Court of Justice, and the court shall give such directions as may appear proper with respect to the performance of the obligation. R.S.O. 1990, c. I.8, s. 257 (1); 2006, c. 19, Sched. C, s, 1 (1).

Hearing

(2)  On an application under subsection (1), the only parties entitled to notice thereof and to be heard thereon are the insured and the insured’s insurers, and no material or evidence used or taken upon such an application is admissible upon the trial of an action brought against the insured for loss or damage to persons or property arising out of the use or operation of the automobile in respect of which the insurance is provided. R.S.O. 1990, c. I.8, s. 257 (2).

Order

(3)  An order under subsection (1) does not affect the rights and obligations of the insurers in respect of payment of any indemnity under their respective policies. R.S.O. 1990, c. I.8, s. 257 (3).

Contribution

(4)  Where indemnity is provided to the insured under two or more contracts and one or more of them are excess insurance, the insurers shall, as between themselves, contribute to the payment of expenses, costs and reimbursement for which provision is made in section 245 in accordance with their respective liabilities for damages awarded against the insured. R.S.O. 1990, c. I.8, s. 257 (4).

Application of insurance money, 3rd party claims, etc.

258.  (1)  Any person who has a claim against an insured for which indemnity is provided by a contract evidenced by a motor vehicle liability policy, even if such person is not a party to the contract, may, upon recovering a judgment therefor in any province or territory of Canada against the insured, have the insurance money payable under the contract applied in or towards satisfaction of the person’s judgment and of any other judgments or claims against the insured covered by the contract and may, on the person’s own behalf and on behalf of all persons having such judgments or claims, maintain an action against the insurer to have the insurance money so applied. R.S.O. 1990, c. I.8, s. 258 (1).

(2)  Repealed: 2002, c. 24, Sched. B, s. 39 (2).

Other creditors excluded

(3)  A creditor of the insured is not entitled to share in the insurance money payable under any contract unless the creditor’s claim is one for which indemnity is provided for by that contract. R.S.O. 1990, c. I.8, s. 258 (3).

Insurer absolutely liable

(4)  The right of a person who is entitled under subsection (1) to have insurance money applied upon the person’s judgment or claim is not prejudiced by,

(a) an assignment, waiver, surrender, cancellation or discharge of the contract, or of any interest therein or of the proceeds thereof, made by the insured after the happening of the event giving rise to a claim under the contract;

(b) any act or default of the insured before or after that event in contravention of this Part or of the terms of the contract; or

(c) any contravention of the Criminal Code (Canada) or a statute of any province or territory of Canada or of any state or the District of Columbia of the United States of America by the owner or driver of the automobile,

and nothing mentioned in clause (a), (b) or (c) is available to the insurer as a defence in an action brought under subsection (1). R.S.O. 1990, c. I.8, s. 258 (4).

Section applicable to purported policy

(5)  It is not a defence to an action under this section that an instrument issued as a motor vehicle liability policy by a person engaged in the business of an insurer and alleged by a party to the action to be such a policy is not a motor vehicle liability policy, and this section applies with necessary modifications to the instrument. R.S.O. 1990, c. I.8, s. 258 (5).

Contribution among insurers

(6)  The insurer may require any other insurers liable to indemnify the insured in whole or in part in respect of judgments or claims to which reference is made in subsection (1) to be made parties to the action and contribute according to their respective liabilities, whether the contribution is rateably or by way of first loss or excess insurance, as the case may be, and the insured shall on demand furnish the insurer with particulars of all other insurance covering the subject-matter of the contract. R.S.O. 1990, c. I.8, s. 258 (6).

Payment into court

(7)  Where any person has recovered a judgment against the insured and is entitled to bring action under subsection (1), and the insurer admits liability to pay the insurance money under the contract and the insurer considers that,

(a) there are or may be other claimants; or

(b) there is no person capable of giving and authorized to give a valid discharge for payment who is willing to do so,

the insurer may apply to the court without notice for an order for payment of the money into court, and the court may, upon such notice, if any, as it thinks necessary, make an order accordingly. R.S.O. 1990, c. I.8, s. 258 (7).

Effect of order

(8)  The receipt of the proper officer of the court is sufficient discharge to the insurer for the insurance money paid into court under subsection (7), and the insurance money shall be dealt with as the court may order upon application of any person interested therein. R.S.O. 1990, c. I.8, s. 258 (8).

Defence to excess limits claim relating to s. 250 coverage

(9)  Despite anything contained therein to the contrary, every contract evidenced by a motor vehicle liability policy shall, for the purposes of this section, be deemed to provide all the types of coverage mentioned in section 250, but the insurer is not liable to a claimant with respect to such coverage in excess of the limits mentioned in section 251. R.S.O. 1990, c. I.8, s. 258 (9).

Defence where coverage under s. 247 or 248

(10)  Where one or more contracts provide for coverage of a type mentioned in section 247 or 248, except as provided in subsection (12), the insurer may,

(a) with respect to that type of coverage; and

(b) as against a claimant,

avail itself of any defence that it is entitled to set up against the insured, despite subsection (4). R.S.O. 1990, c. I.8, s. 258 (10).

Defence where excess limits

(11)  Where one or more contracts provide for coverage in excess of the limits mentioned in section 251, except as provided in subsection (12), the insurer may,

(a) with respect to the coverage in excess of those limits; and

(b) as against a claimant,

avail itself of any defence that it is entitled to set up against the insured, despite subsection (4). R.S.O. 1990, c. I.8, s. 258 (11).

Defence where vehicle used in business of carrying passengers

(12)  Where a contract provides coverage of the type mentioned in clause 216 (a) of The Insurance Act, being chapter 224 of the Revised Statutes of Ontario, 1970, in respect of an automobile operated in the business of carrying passengers for compensation or hire and insured for that purpose, the insurer may,

(a) with respect to that type of coverage; and

(b) as against a claimant,

only avail itself of a defence that it is entitled to set up against the insured in respect of that part of the coverage, if any, that exceeds,

(c) the limits mentioned in section 251; or

(d) the minimum limits required for that type of coverage by or under any other Act,

whichever is the greater. R.S.O. 1990, c. I.8, s. 258 (12).

Insured’s liability to reimburse insurer

(13)  The insured shall reimburse the insurer upon demand in the amount that the insurer has paid by reason of this section and that it would not otherwise be liable to pay. R.S.O. 1990, c. I.8, s. 258 (13).

Insurer may be made third party

(14)  Where an insurer denies liability under a contract evidenced by a motor vehicle liability policy, it shall, upon application to the court, be made a third party in any action to which the insured is a party and in which a claim is made against the insured by any party to the action in which it is or might be asserted that indemnity is provided by the contract, whether or not the insured enters an appearance or defence in the action. R.S.O. 1990, c. I.8, s. 258 (14).

Rights of insurer

(15)  Upon being made a third party, the insurer may,

(a) contest the liability of the insured to any party claiming against the insured;

(b) contest the amount of any claim made against the insured;

(c) deliver any pleadings in respect of the claim of any party claiming against the insured;

(d) have production and discovery from any party adverse in interest; and

(e) examine and cross-examine witnesses at the trial,

to the same extent as if it were a defendant in the action. R.S.O. 1990, c. I.8, s. 258 (15).

Idem

(16)  An insurer may avail itself of subsection (15) even if another insurer is defending in the name and on behalf of the insured an action to which its insured is a party. R.S.O. 1990, c. I.8, s. 258 (16).

Notice of accident

258.1  (1)  If an automobile insured under a contract is involved in an incident that is required to be reported to the police under the Highway Traffic Act or in respect of which the insured intends to make a claim under the contract, the insured shall give the insurer written notice of the incident, with all available particulars.

Same

(2)  Subject to subsection (3), the notice required by subsection (1) shall be given to the insurer within seven days of the incident.

Same

(3)  If the insured is unable because of incapacity to comply with subsection (1) within seven days of the incident, the insured shall comply as soon as possible thereafter. 1996, c. 21, s. 22.

Application of ss. 258.3 to 258.6

258.2  Sections 258.3 to 258.6 apply only in respect of a claim for loss or damage from bodily injury or death arising from the use or operation, after section 29 of the Automobile Insurance Rate Stability Act, 1996 comes into force, of an automobile in Canada, the United States of America or a jurisdiction designated in the Statutory Accident Benefits Schedule. 1996, c. 21, s. 22.

Notice and disclosure before action

258.3  (1)  An action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile shall not be commenced unless,

(a) the plaintiff has applied for statutory accident benefits;

(b) the plaintiff served written notice of the intention to commence the action on the defendant within 120 days after the incident or within such longer period as a court in which the action may be commenced may authorize, on motion made before or after the expiry of the 120-day period;

(c) the plaintiff provided the defendant with the information prescribed by the regulations within the time period prescribed by the regulations;

(d) the plaintiff has, at the defendant’s expense, undergone examinations by one or more persons selected by the defendant who are members of Colleges as defined in the Regulated Health Professions Act, 1991, if the defendant requests the examinations within 90 days after receiving the notice under clause (b);

(e) the plaintiff has provided the defendant with a statutory declaration describing the circumstances surrounding the incident and the nature of the claim being made, if the statutory declaration is requested by the defendant; and

(f) the plaintiff has provided the defendant with evidence of the plaintiff’s identity, if evidence of the plaintiff’s identity is requested by the defendant.

Notice to insurer

(2)  An insured who receives a notice under clause (1) (b) shall give a copy of the notice to the insurer within seven days of receiving the notice.

Same

(3)  If the insured is unable because of incapacity to comply with subsection (2) within seven days of receiving the notice, the insured shall comply as soon as possible thereafter.

Contents of notice

(4)  The notice under clause (1) (b) shall inform the person to whom it is given of the obligation under subsection (2).

Limits on examination

(5)  An examination under clause (1) (d) shall not be unnecessarily repetitious and shall not involve a procedure that is unreasonable or dangerous.

Examiner may ask questions

(6)  A person examined under clause (1) (d) shall answer the questions of the examiner relevant to the examination.

Copy of report

(7)  If a person who performs an examination under clause (1) (d) gives a report on the examination to the defendant, the defendant shall ensure that the plaintiff receives a copy of the report within 60 days after the defendant receives the report.

Prejudgment interest

(8)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, no prejudgment interest shall be awarded under section 128 of the Courts of Justice Act for any period of time before the plaintiff served the notice under clause (1) (b).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 258.3 is amended by adding the following subsection: (See: 2014, c. 9, Sched. 3, ss. 12, 22)

Same

(8.1)  Subsection 128 (2) of the Courts of Justice Act does not apply in respect of the calculation of prejudgment interest for damages for non-pecuniary loss in an action referred to in subsection (8). 2014, c. 9, Sched. 3, s. 12.

Failure to comply

(9)  Despite subsection (1), a person may commence an action without complying with subsection (1), but the court shall consider the non-compliance in awarding costs.

Service

(10)  Section 33 applies, with necessary modifications, to the service of a notice under clause (1) (b). 1996, c. 21, s. 22.

Duty to disclose limits

258.4  An insurer that receives a notice under clause 258.3 (1) (b) shall promptly inform the plaintiff whether there is a motor vehicle liability policy issued by the insurer to the defendant and, if so,

(a) the liability limits under the policy; and

(b) whether the insurer will respond under the policy to the claim. 1996, c. 21, s. 22.

Duty of insurer re settlement of claim

258.5  (1)  An insurer that is defending an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile on behalf of an insured or that receives a notice under clause 258.3 (1) (b) from an insured shall attempt to settle the claim as expeditiously as possible.

Advance payment

(2)  If the insurer admits liability in respect of all or part of a claim for income loss, the insurer shall make payments to the person making the claim pending the determination of the amount owing.

Amount of payments

(3)  The amount of the payments under subsection (2) shall be based on the insurer’s estimate of the amount owing in respect of the claim for income loss, having regard to any information provided to the insurer by the person making the claim.

Application of subss. 256 (1-3)

(4)  Subsections 256 (1), (2) and (3) apply, with necessary modifications, to advance payments made under this section.

Failure to comply

(5)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, an insurer’s failure to comply with this section shall be considered by the court in awarding costs. 1996, c. 21, s. 22.

Mediation

258.6  (1)  A person making a claim for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile and an insurer that is defending an action in respect of the claim on behalf of an insured or that receives a notice under clause 258.3 (1) (b) in respect of the claim shall, on the request of either of them, participate in a mediation of the claim in accordance with the procedures prescribed by the regulations.

Failure to comply

(2)  In an action in respect of the claim, a person’s failure to comply with this section shall be considered by the court in awarding costs. 1996, c. 21, s. 22.

Notice of action and judgment against insured

Insured to give notice of action

259.  (1)  Every insured against whom an action is commenced for damages occasioned by an automobile shall give notice thereof in writing to the insurer within five days after service of every notice or process in the action.

Insured to disclose insurance

(2)  Every insured against whom an action is commenced for damages occasioned by an automobile shall, upon recovery of a judgment against the insured, disclose to a judgment creditor entitled to the benefit of any motor vehicle liability policy particulars of such contract within ten days after written demand therefor. R.S.O. 1990, c. I.8, s. 259.

Limitation period

259.1  A proceeding against an insurer under a contract in respect of loss or damage to an automobile or its contents shall be commenced within one year after the happening of the loss or damage. 2002, c. 24, Sched. B, s. 39 (3).

Physical Damage Cover

Physical damage cover, limitations and exclusions

260.  Subject to subsection 227 (1), the insurer may provide in a contract such exclusions and limitations, in respect of loss of or damage to or the loss of use of the automobile, as it considers necessary. R.S.O. 1990, c. I.8, s. 260.

Partial payment of loss clause

261.  (1)  A contract or part of a contract providing insurance against loss of or damage to an automobile and the loss of use thereof may contain a clause to the effect that, in the event of loss, the insurer shall pay only,

(a) an agreed portion of any loss that may be sustained; or

(b) the amount of the loss after deduction of a sum specified in the policy,

and in either case not exceeding the amount of the insurance. R.S.O. 1990, c. I.8, s. 261 (1).

Mandatory deductible

(1.1)  Despite subsection (1), in the circumstances prescribed by the regulations, a contract or part of a contract providing insurance against loss of or damage to an automobile and the loss of use thereof shall contain a clause to the effect that, in the event of loss, the insurer shall pay only the amount of the loss after deduction of a sum specified in the policy not exceeding the amount of the insurance. 1996, c. 21, s. 23 (1).

Stamping required

(2)  Where a clause is inserted in accordance with subsection (1) or (1.1), there shall be printed or stamped upon the face of the policy in conspicuous type the words “This policy contains a partial payment of loss clause” or the French equivalent. R.S.O. 1990, c. I.8, s. 261 (2); 1996, c. 21, s. 23 (2).

Claims under other contracts to be adjusted

262.  (1)  Where a claim is made under any contract other than a contract evidenced by a motor vehicle liability policy, the insurer shall, despite any agreement, adjust the amount of the claim with the insured named in the contract as well as with any person having an interest indicated in the contract. R.S.O. 1990, c. I.8, s. 262 (1).

Exception

(2)  Despite subsection (1), if notice of a claim is given or proof of loss is made by a person having an interest indicated in the contract, and no notice is given and no proof of loss is made by the insured within sixty days after the day the notice or proof is required under the contract, the insurer may adjust and pay the claim to the other person having an interest indicated in the contract. 1993, c. 10, s. 20.

Direct Compensation — Property Damage

Accidents involving two or more insured automobiles

263.  (1)  This section applies if,

(a) an automobile or its contents, or both, suffers damage arising directly or indirectly from the use or operation in Ontario of one or more other automobiles;

(b) the automobile that suffers the damage or in respect of which the contents suffer damage is insured under a contract evidenced by a motor vehicle liability policy issued by an insurer that is licensed to undertake automobile insurance in Ontario or that has filed with the Superintendent, in the form provided by the Superintendent, an undertaking to be bound by this section; and

(c) at least one other automobile involved in the accident is insured under a contract evidenced by a motor vehicle liability policy issued by an insurer that is licensed to undertake automobile insurance in Ontario or that has filed with the Superintendent, in the form provided by the Superintendent, an undertaking to be bound by this section. 1993, c. 10, s. 21 (1); 1997, c. 28, s. 113.

Exempt automobiles, undertaking to be bound

(1.1)  This section applies, with necessary modifications, in respect of an automobile the owner, operator or lessee of which is exempt from the requirement to be insured under the Compulsory Automobile Insurance Act, if the organization that is financially responsible for the damages resulting from the accident involving the automobile files with the Superintendent an undertaking to be bound by this section. 1997, c. 19, s. 10 (29); 1997, c. 28, s. 114 (2).

Damage recovery from insured’s insurer

(2)  If this section applies, an insured is entitled to recover for the damages to the insured’s automobile and its contents and for loss of use from the insured’s insurer under the coverage described in subsection 239 (1) as though the insured were a third party.

Fault-based recovery

(3)  Recovery under subsection (2) shall be based on the degree of fault of the insurer’s insured as determined under the fault determination rules.

Dispute resolution

(4)  An insured may bring an action against the insurer if the insured is not satisfied that the degree of fault established under the fault determination rules accurately reflects the actual degree of fault or the insured is not satisfied with a proposed settlement and the matters in issue shall be determined in accordance with the ordinary rules of law. R.S.O. 1990, c. I.8, s. 263 (2-4).

Restrictions on other recovery

(5)  If this section applies,

(a) an insured has no right of action against any person involved in the incident other than the insured’s insurer for damages to the insured’s automobile or its contents or for loss of use;

(a.1) an insured has no right of action against a person under an agreement, other than a contract of automobile insurance, in respect of damages to the insured’s automobile or its contents or loss of use, except to the extent that the person is at fault or negligent in respect of those damages or that loss;

(b) an insurer, except as permitted by the regulations, has no right of indemnification from or subrogation against any person for payments made to its insured under this section. R.S.O. 1990, c. I.8, s. 263 (5); 1996, c. 21, s. 24 (1).

Agreement for partial payment

(5.1)  Nothing in this Part precludes an insurer, in a contract belonging to a class prescribed by the regulations, from agreeing with an insured that, in the event that a claim is made by the insured under this section, the insurer shall pay only,

(a) an agreed portion of the amount that the insured would otherwise be entitled to recover; or

(b) the amount that the insured would otherwise be entitled to recover, reduced by a sum specified in the agreement.

Application of subs. (5.1)

(5.2)  Subsection (5.1) does not apply unless, before the insurer enters into the contract referred to in that subsection, the insurer offers to enter into another contract with the prospective insured that does not contain the agreement referred to in that subsection but is identical to the contract referred to in subsection (5.1) in all other respects except for the amount of the premium. 1993, c. 10, s. 21 (2).

Mandatory deductible

(5.2.1)  In the circumstances prescribed by the regulations, a contract belonging to a class prescribed for the purpose of subsection (5.1) shall provide that, in the event that a claim is made by the insured under this section, the insurer shall pay only the amount that the insured would otherwise be entitled to recover, reduced by a sum specified in the contract.

Application of subs. (5.2)

(5.2.2)  Subsection (5.2) does not apply to a contract that contains a provision required by subsection (5.2.1). 1996, c. 21, s. 24 (2).

Stamping required

(5.3)  If a contract contains an agreement referred to in subsection (5.1) or a provision required by subsection (5.2.1), the policy shall have printed or stamped on its face in conspicuous type the words “This policy contains a partial payment of recovery clause for property damage” in English or “La présente police comporte une clause de recouvrement partiel en cas de dommages matériels” in French, as may be appropriate. 1993, c. 10, s. 21 (2); 1996, c. 21, s. 24 (3).

Other coverages not affected

(6)  This section does not affect an insured’s right to recover in respect of any physical damage coverage in respect of the insured automobile.

Non-application

(7)  This section does not apply to damages to those contents of an automobile that are being carried for reward.

Idem

(8)  This section does not apply if the damage occurred before the 22nd day of June, 1990.

Idem

(9)  This section does not apply if both automobiles are owned by the same person.

Idem

(10)  This section does not apply to damage to an automobile owned by the insured or to its contents if the damage is caused by the insured while driving another automobile. R.S.O. 1990, c. I.8, s. 263 (6-10).

264.  Repealed: 1996, c. 21, s. 25.

Limited Accident Insurances

Uninsured automobile coverage

265.  (1)  Every contract evidenced by a motor vehicle liability policy shall provide for payment of all sums that,

(a) a person insured under the contract is legally entitled to recover from the owner or driver of an uninsured automobile or unidentified automobile as damages for bodily injuries resulting from an accident involving an automobile;

(b) any person is legally entitled to recover from the owner or driver of an uninsured automobile or unidentified automobile as damages for bodily injury to or the death of a person insured under the contract resulting from an accident involving an automobile; and

(c) a person insured under the contract is legally entitled to recover from the identified owner or driver of an uninsured automobile as damages for accidental damage to the insured automobile or its contents, or to both the insured automobile and its contents, resulting from an accident involving an automobile,

subject to the terms, conditions, provisions, exclusions and limits as are prescribed by the regulations. R.S.O. 1990, c. I.8, s. 265 (1).

Definitions

(2)  For the purposes of this section,

“insured automobile” means the automobile as defined or described under the contract; (“automobile assurée”)

“owner” includes, in respect of an accident occurring on or after the day this definition comes into force, a person who is a lessee for the purposes of section 192 of the Highway Traffic Act; (“propriétaire”)

“person insured under the contract” means,

(a) in respect of a claim for damage to the insured automobile, the owner of the automobile,

(b) in respect of a claim for damage to the contents of the insured automobile, the owner of the contents,

(c) in respect of a claim for bodily injuries or death,

(i) any person while an occupant of the insured automobile,

(ii) the insured and his or her spouse and any dependent relative of either,

(A) while an occupant of an uninsured automobile, or

(B) while not the occupant of an automobile or of railway rolling stock that runs on rails, who is struck by an uninsured or unidentified automobile,

(iii) if the insured is a corporation, unincorporated association or partnership, any director, officer, employee or partner of the insured for whose regular use the insured automobile is furnished, and his or her spouse and any dependent relative of the person or the spouse,

(A) while an occupant of an uninsured automobile, or

(B) while not the occupant of an automobile or of railway rolling stock that runs on rails, who is struck by an uninsured or unidentified automobile,

where such director, officer, employee or partner or his or her spouse is not the owner of an automobile insured under a contract; (“personne assurée aux termes du contrat”)

“unidentified automobile” means an automobile with respect to which the identity of either the owner or driver cannot be ascertained; (“automobile non identifiée”)

“uninsured automobile” means an automobile with respect to which neither the owner nor driver thereof has applicable and collectible bodily injury liability and property damage liability insurance for its ownership, use or operation, but does not include an automobile owned by or registered in the name of the insured or his or her spouse. (“automobile non assurée”) R.S.O. 1990, c. I.8, s. 265 (2); 1999, c. 6, s. 31 (7, 8); 2005, c. 5, s. 35 (11, 12); 2005, c. 31, Sched. 12, s. 2.

Exclusion from coverage

(3)  Despite the definition of “person insured under the contract” in subsection (2), a person who sustains loss or damage while the insured automobile is being used or operated by an excluded driver shall be deemed not to be a person insured under the contract in which the excluded driver is named, except as provided in the Statutory Accident Benefits Schedule. R.S.O. 1990, c. I.8, s. 265 (3); 1993, c. 10, s. 1.

Idem

(4)  Where a dependent relative referred to in clause (c) of the definition of “person insured under the contract” in subsection (2),

(a) is the owner of an automobile insured under a contract; or

(b) sustains bodily injuries or dies as the result of accident while the occupant of his or her own uninsured automobile,

such relative shall be deemed not to be a dependent relative for the purposes of this section. R.S.O. 1990, c. I.8, s. 265 (4).

Regulations

(5)  The Lieutenant Governor in Council may make regulations,

(a) prescribing, amending or altering the terms, conditions, provisions, exclusions and limits with respect to payments under subsection (1);

(b) deeming any term, condition, provision, exclusion or limit as prescribed, amended or altered by a regulation made under clause (a) to be included in any motor vehicle liability policy made or renewed on or after the effective date of the regulation and in any motor vehicle liability policy that is subsisting on the effective date of the regulation;

(c) requiring that terms, conditions, provisions, exclusions and limits, as prescribed, amended or altered by a regulation made under clause (a), be attached to or included in every motor vehicle liability policy as a schedule in or to the policy. R.S.O. 1990, c. I.8, s. 265 (5).

Subrogation

(6)  Where an amount is paid under subsection (1), the insurer is subrogated to the rights of the person to whom such amount is paid and the insurer may maintain an action in its name or in the name of such person against any other person or persons responsible for the use or operation of the uninsured or unidentified automobile. R.S.O. 1990, c. I.8, s. 265 (6).

Restriction on recovery

(7)  No person has a right of action against any other person in respect of damage to an uninsured automobile or its contents arising directly or indirectly from the use or operation of an automobile if at the time of the damage the uninsured automobile was required by any Act to be insured under a contract evidenced by a motor vehicle liability policy. R.S.O. 1990, c. I.8, s. 265 (7).

Release

(8)  A release under section 274 does not enure to the benefit of any person against whom the insurer may subrogate under subsection (6). R.S.O. 1990, c. I.8, s. 265 (8).

Application

(9)  This section applies to all contracts evidenced by motor vehicle liability policies made or renewed on or after the 1st day of March, 1980, and all contracts evidenced by motor vehicle liability policies that were subsisting on the 1st day of March, 1980, shall be deemed to provide for the payments referred to in subsection (1) in respect of an accident arising out of the use or operation of an automobile occurring on or after that date. R.S.O. 1990, c. I.8, s. 265 (9).

Statutory accident principle established, automobile use, June 22, 1990 – Dec. 31, 1993

266.  (1)  In respect of loss or damage arising directly or indirectly from the use or operation, after the 21st day of June, 1990, of an automobile and despite any other Act, none of the owner of an automobile, the occupants of an automobile or any person present at the incident are liable in an action in Ontario for loss or damage from bodily injury arising from such use or operation in Canada, the United States of America or any other jurisdiction designated in the Statutory Accident Benefits Schedule involving the automobile unless, as a result of such use or operation, the injured person has died or has sustained,

(a) permanent serious disfigurement; or

(b) permanent serious impairment of an important bodily function caused by continuing injury which is physical in nature. R.S.O. 1990, c. I.8, s. 266 (1); 1993, c. 10, s. 1.

Idem

(2)  Subsection (1) does not relieve any person from liability other than the owner of the automobile, occupants of the automobile and persons present at the incident.

Judicial determination

(3)  In an action for loss or damage from bodily injury arising directly or indirectly from the use or operation of an automobile, a judge shall, on motion made before or at trial, determine if the injured person has, as a result of the accident, died or has sustained,

(a) permanent serious disfigurement; or

(b) permanent serious impairment of an important bodily function caused by continuing injury which is physical in nature.

Idem

(4)  Even though a defence motion under subsection (3) is denied, the defendant may, at trial, in the absence of the jury, and following the hearing of evidence, raise the defence provided in subsection (1).

Joint and several liability, joint tortfeasors

(5)  In a proceeding involving a plaintiff who cannot recover against the owner of an automobile, the occupant of an automobile or a person present at the incident because of the operation of subsection (1), a defendant is not liable for damages caused by any person who is excluded from liability because of the operation of subsection (1) and is not liable to contribute or indemnify in respect of such damages.

Idem

(6)  For the purposes of subsection (5), the proportion of liability of all persons involved in the incident from which the proceeding arose shall be determined as though all persons wholly or partly responsible for the loss or damage were parties to the proceeding even though any such person is not actually a party.

Definition

(7)  For the purposes of this section,

“owner” includes an operator as defined in subsection 16 (1) of the Highway Traffic Act. R.S.O. 1990, c. I.8, s. 266 (2-7).

Application

(8)  This section does not apply to an action for loss or damage arising from the use or operation, after December 31, 1993, of an automobile. 1996, c. 21, s. 26.

Collateral source rule not to apply, automobile use, Oct. 24, 1989 – Dec. 31, 1993

267.  (1)  The damages awarded to a person in a proceeding for loss or damage arising directly or indirectly from the use or operation of an automobile shall be reduced by,

(a) all payments that the person has received or that were or are available for statutory accident benefits and by the present value of any statutory accident benefits to which the person is entitled;

(b) all payments that the person has received under any medical, surgical, dental, hospitalization, rehabilitation or long-term care plan or law and by the present value of such payments to which the person is entitled;

(c) all payments that the person has received or that were or are available for loss of income under the laws of any jurisdiction or under an income continuation benefit plan and by the present value of any such payments to which the person is entitled; and

(d) all payments that the person has received under a sick leave plan arising by reason of the person’s occupation or employment. R.S.O. 1990, c. I.8, s. 267 (1); 1993, c. 10, s. 1.

Exception

(2)  Payments or benefits received or that were, are or may become available to a person under the insurance plan established under the Workplace Safety and Insurance Act, 1997 shall not be applied under subsection (1) to reduce the damages awarded. R.S.O. 1990, c. I.8, s. 267 (2); 1997, c. 16, s. 9 (1).

Idem

(3)  A reduction made under subsection (1) does not apply for the purpose of determining a person’s entitlement to benefits under subsection 30 (14) of the Workplace Safety and Insurance Act, 1997. R.S.O. 1990, c. I.8, s. 267 (3); 1997, c. 16, s. 9 (2).

Limitation on subrogation

(4)  A person who has made a payment or who has a liability to pay a benefit described in clause (1) (a), (b), (c) or (d) is not subrogated to a right of recovery of the insured against another person in respect of that payment or benefit. R.S.O. 1990, c. I.8, s. 267 (4).

Idem

(5)  The Workplace Safety and Insurance Board is not subrogated to a right of recovery of the insured against another person in respect of a payment or benefit paid by the Workplace Safety and Insurance Board to the insured or in respect of a liability to make such payment or benefit. R.S.O. 1990, c. I.8, s. 267 (5); 1997, c. 16, s. 9 (3).

Application

(6)  This section applies to damages awarded for loss or damage arising directly or indirectly from the use or operation, after the 23rd day of October, 1989 and before January 1, 1994, of an automobile. R.S.O. 1990, c. I.8, s. 267 (6); 1993, c. 10, s. 24; 1996, c. 21, s. 27.

Protection from liability, automobile use, Jan. 1, 1994 - Oct. 31, 1996

267.1  (1)  Despite any other Act and subject to subsections (2) and (6), the owner of an automobile, the occupants of an automobile and any person present at the incident are not liable in a proceeding in Ontario for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of the automobile in Canada, the United States of America or any other country designated in the Statutory Accident Benefits Schedule.

Non-pecuniary loss

(2)  Subsection (1) does not relieve a person from liability for damages for non-pecuniary loss, including damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act, if as a result of the use or operation of the automobile the injured person has died or has sustained,

(a) serious disfigurement; or

(b) serious impairment of an important physical, mental or psychological function.

Motion to determine if non-pecuniary loss threshold met

(3)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, a judge shall, on motion made before trial with the consent of the parties or in accordance with an order of a judge who conducts a pre-trial conference, determine if, as a result of the use or operation of the automobile, the injured person has died or has sustained,

(a) serious disfigurement; or

(b) serious impairment of an important physical, mental or psychological function.

Determination binding

(4)  The determination of a judge on a motion under subsection (3) is binding on the parties at the trial.

Determination at trial

(5)  If no motion is made under subsection (3), the trial judge shall determine if, as a result of the use or operation of the automobile, the injured person has died or has sustained,

(a) serious disfigurement; or

(b) serious impairment of an important physical, mental or psychological function.

Liability of other persons

(6)  Subsection (1) does not relieve any person from liability other than the owner of the automobile, the occupants of the automobile and the persons present at the incident.

Joint and several liability, pecuniary loss

(7)  If, in the absence of subsection (1), the owner of an automobile, an occupant of an automobile or a person present at the incident would have been jointly and severally liable for damages for pecuniary loss with one or more other persons who are not relieved of liability by subsection (1), the other persons are liable for those damages only to the extent that they are at fault or negligent in respect of those damages.

Non-pecuniary loss, amount of damages

(8)  Subject to subsections (2) to (5), in a proceeding for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, the court shall determine the amount of damages for non-pecuniary loss to be awarded against the owner of the automobile, an occupant of the automobile or a person present at the incident in accordance with the following rules:

1. The court shall first determine the amount of damages for non-pecuniary loss for which the owner of the automobile, the occupant of the automobile or the person present at the incident would be liable without regard to this Part.

2. The determination under paragraph 1 shall be made in the same manner as a determination of the amount of damages for non-pecuniary loss in a proceeding to which this section does not apply and, in particular, without regard to,

i. the statutory accident benefits provided for under subsection 268 (1),

ii. the provisions of this section that protect the owner of the automobile, the occupants of the automobile and the persons present at the incident from liability for damages for pecuniary loss, and

iii. the provisions of paragraph 3.

3. The amount of damages for non-pecuniary loss to be awarded against the owner of the automobile, the occupant of the automobile or the person present at the incident shall be determined by reducing the amount determined under paragraph 1 by,

i. in the case of damages for non-pecuniary loss other than damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act,

A. $10,000, if the award of damages is made in 1993 or 1994, or

B. the non-pecuniary loss deductible published under clause 267.2 (1) (a) for the year in which the court makes the award of damages, if the award of damages is made in a year after 1994, and

ii. in the case of damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act,

A. $5,000, if the award of damages is made in 1993 or 1994, or

B. the Family Law Act deductible published under clause 267.2 (1) (b) for the year in which the court makes the award of damages, if the award of damages is made in a year after 1994.

Same

(9)  Subsection (8) applies in respect of each person who is entitled to damages for non-pecuniary loss.

Non-pecuniary loss, other tortfeasors

(10)  If, in a proceeding for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, one or more persons other than the owner of the automobile, the occupants of the automobile and the persons present at the incident are found to be liable for damages for non-pecuniary loss,

(a) the other persons,

(i) are jointly and severally liable with the owner, occupants and persons present at the incident for the damages for which the owner, occupants and persons present at the incident are liable under subsection (8), and

(ii) are solely liable for any amount by which the amount mentioned in subclause (i) is less than the amount that the other persons would have been liable to make contribution and indemnify the owner, occupants and persons present at the incident in respect of non-pecuniary loss in the absence of this section;

(b) the other persons are liable to make contribution and indemnify the owner, occupants and persons present at the incident in respect of non-pecuniary loss to the same extent as if this section did not apply, up to the amount for which the owner, occupants and persons present at the incident are liable under subsection (8); and

(c) the owner, occupants and persons present at the incident are liable to make contribution and indemnify the other persons for the amount that the owner, occupants and persons present at the incident are liable under subsection (8), reduced by the amount that the other persons are liable to make contribution and indemnify the owner, occupants and persons present at the incident under clause (b).

Determination of liability

(11)  For the purposes of subsections (7) to (10), the liability of all persons involved in the incident from which the proceeding arose shall be determined as though all persons wholly or partly responsible for the damages were parties to the proceeding even though any of those persons is not actually a party.

Costs

(12)  In a proceeding for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, the determination of a party’s entitlement to costs shall be made without regard to the effect of paragraph 3 of subsection (8) on the amount of damages, if any, awarded for non-pecuniary loss. 1993, c. 10, s. 25.

(13)  Repealed: 1996, c. 21, s. 28 (1).

Definition

(14)  For the purposes of this section,

“owner” includes an operator as defined in subsection 16 (1) of the Highway Traffic Act. 1993, c. 10, s. 25.

Application

(15)  This section applies only to a proceeding for loss or damage arising from the use or operation, after December 31, 1993 and before section 29 of the Automobile Insurance Rate Stability Act, 1996 comes into force, of an automobile. 1996, c. 21, s. 28 (2).

Publication of deductible amounts

267.2  (1)  Before the 1st day of January in each year after 1994, the Superintendent shall determine in accordance with this section and publish in The Ontario Gazette,

(a) the non-pecuniary loss deductible to be used under subparagraph i of paragraph 3 of subsection 267.1 (8) in respect of awards of damages made in the year that begins on the 1st day of January; and

(b) the Family Law Act deductible to be used under subparagraph ii of paragraph 3 of subsection 267.1 (8) in respect of awards of damages made in the year that begins on the 1st day of January. 1993, c. 10, s. 25; 1997, c. 28, s. 115.

Rules for determination

(2)  The following rules apply to the determination of the non-pecuniary loss deductible and the Family Law Act deductible:

1. The non-pecuniary loss deductible for 1993 and 1994 is $10,000.

2. The Family Law Act deductible for 1993 and 1994 is $5,000.

3. The non-pecuniary loss deductible and the Family Law Act deductible for a year after 1994 shall be determined by adjusting the deductible for the previous year by the percentage change in the Consumer Price Index for Canada (All Items), as published by Statistics Canada under the authority of the Statistics Act (Canada), for the period from September in the year immediately preceding the previous year to September of the previous year.

4. Despite paragraph 3, if the Consumer Price Index information required by paragraph 3 to determine the deductibles for a year is not available by the 1st day of November in the previous year, or if in the Superintendent’s opinion the information published by Statistics Canada does not provide a reasonable reflection of changes in consumer prices, the Superintendent may determine the deductibles in a manner that the Superintendent considers will provide a reasonable reflection of changes in consumer prices. 1993, c. 10, s. 25; 1997, c. 28, s. 115.

Court Proceedings for Accidents on or after November 1, 1996

Definitions, ss. 267.4 to 267.12

267.3  In sections 267.4 to 267.12,

“owner” includes an operator as defined in subsection 16 (1) of the Highway Traffic Act and a person who is a lessee for the purposes of section 192 of that Act; (“propriétaire”)

“protected defendant” means a person who is protected from liability by subsections 267.5 (1), (3) and (5). (“défendeur exclu”) 2005, c. 31, Sched. 12, s. 3.

Application of ss. 267.5 to 267.11, automobile use on or after Nov. 1, 1996

267.4  (1)  Sections 267.5 to 267.11 apply only to proceedings for loss or damage from bodily injury or death arising from the use or operation, after section 29 of the Automobile Insurance Rate Stability Act, 1996 comes into force, of an automobile in Canada, the United States of America or a jurisdiction designated in the Statutory Accident Benefits Schedule. 1996, c. 21, s. 29.

Effect of amendments

(2)  Subsection (1) shall not be interpreted as requiring an amendment made to sections 267.5 to 267.11 to apply in respect of the use or operation, before the amendment came into force, of an automobile. 2002, c. 22, s. 119.

Protection from liability

Income loss and loss of earning capacity

267.5  (1)  Despite any other Act and subject to subsections (6) and (6.1), the owner of an automobile, the occupants of an automobile and any person present at the incident are not liable in an action in Ontario for the following damages for income loss and loss of earning capacity from bodily injury or death arising directly or indirectly from the use or operation of the automobile:

1. Damages for income loss suffered in the seven days after the incident.

2. Damages for income loss suffered more than seven days after the incident and before the trial of the action in excess of,

i. 80 per cent of the net income loss during that period, as determined in accordance with the regulations, if the incident occurred before September 1, 2010, or

ii. 70 per cent of the amount of gross income that is lost during that period, as determined in accordance with the regulations, in any other case.

3. Damages for loss of earning capacity suffered after the incident and before the trial of the action in excess of,

i. 80 per cent of the net loss of earning capacity during that period, as determined in accordance with the regulations, if the incident occurred before September 1, 2010, or

ii. 70 per cent of the loss of earning capacity during that period, as determined in accordance with the regulations, in any other case. 1996, c. 21, s. 29; 2010, c. 1, Sched. 11, s. 1 (1); 2011, c. 9, Sched. 21, s. 3 (1).

Application

(2)  Subsection (1) applies to all actions, including actions under subsection 61 (1) of the Family Law Act. 1996, c. 21, s. 29.

Protection from liability; health care expenses

(3)  Despite any other Act and subject to subsections (6) and (6.1), the owner of an automobile, the occupants of an automobile and any person present at the incident are not liable in an action in Ontario for damages for expenses that have been incurred or will be incurred for health care resulting from bodily injury arising directly or indirectly from the use or operation of the automobile unless, as a result of the use or operation of the automobile, the injured person has died or has sustained,

(a) permanent serious disfigurement; or

(b) permanent serious impairment of an important physical, mental or psychological function. 2002, c. 22, s. 120 (1); 2011, c. 9, Sched. 21, s. 3 (2).

(4)  Repealed: 2002, c. 22, s. 120 (2).

Non-pecuniary loss

(5)  Despite any other Act and subject to subsections (6) and (6.1), the owner of an automobile, the occupants of an automobile and any person present at the incident are not liable in an action in Ontario for damages for non-pecuniary loss, including damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act, from bodily injury or death arising directly or indirectly from the use or operation of the automobile, unless as a result of the use or operation of the automobile the injured person has died or has sustained,

(a) permanent serious disfigurement; or

(b) permanent serious impairment of an important physical, mental or psychological function. 1996, c. 21, s. 29; 2011, c. 9, Sched. 21, s. 3 (3).

Application of subss. (1), (3) and (5)

(6)  Subsections (1), (3) and (5) do not protect a person from liability if the person is defended in the action by an insurer that is not licensed to undertake automobile insurance in Ontario unless the insurer has filed an undertaking under section 226.1. 1996, c. 21, s. 29.

Same, public transit vehicles

(6.1)  In respect of an incident that occurs on or after the date this subsection comes into force, subsections (1), (3) and (5) do not protect the owner or driver of a public transit vehicle if it did not collide with another automobile or any other object in the incident. 2011, c. 9, Sched. 21, s. 3 (4).

Amount of damages for non-pecuniary loss

(7)  Subject to subsections (5), (12), (13) and (15), in an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, the court shall determine the amount of damages for non-pecuniary loss to be awarded against a protected defendant in accordance with the following rules:

1. The court shall first determine the amount of damages for non-pecuniary loss for which the protected defendant would be liable without regard to this Part.

2. The determination under paragraph 1 shall be made in the same manner as a determination of the amount of damages for non-pecuniary loss in an action to which this section does not apply and, in particular, without regard to,

i. the statutory accident benefits provided for under subsection 268 (1),

ii. the provisions of this section that protect protected defendants from liability for damages for pecuniary loss, and

iii. the provisions of paragraph 3.

3. Subject to subsections (8), (8.1) and (8.1.1), the amount of damages for non-pecuniary loss to be awarded against the protected defendant shall be determined by reducing the amount determined under paragraph 1 by,

i. in the case of damages for non-pecuniary loss other than damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act, the greater of,

A. $15,000, and

B. the amount prescribed by the regulations, and

ii. in the case of damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act, the greater of,

A. $7,500, and

B. the amount prescribed by the regulations.

4. If fault or negligence on the part of the person entitled to damages for non-pecuniary loss contributed to those damages, the award for damages shall be reduced under paragraph 3 before the damages are apportioned under section 3 of the Negligence Act. 1996, c. 21, s. 29; 2002, c. 22, s. 120 (3); 2010, c. 1, Sched. 11, s. 1 (2).

Application of subpar. 3 i of subs. (7)

(8)  Subparagraph 3 i of subsection (7) does not apply if the amount of damages for non-pecuniary loss, other than damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act, would exceed $100,000 in the absence of that subparagraph. 2002, c. 22, s. 120 (4).

Application of subpar. 3 ii of subs. (7)

(8.1)  Subparagraph 3 ii of subsection (7) does not apply if the amount of damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act would exceed $50,000 in the absence of that subparagraph. 2002, c. 22, s. 120 (4).

No reduction under par. 3 i or ii of subs. (7)

(8.1.1)  Subparagraphs 3 i and ii of subsection (7) do not apply to damages awarded for non-pecuniary loss awarded in respect of a person who dies as a direct or indirect result of an incident that occurs after August 31, 2010. 2010, c. 1, Sched. 11, s. 1 (3).

Application of subss. (7)-(8.1.1)

(8.2)  Subsections (7), (8), (8.1) and (8.1.1) apply in respect of each person who is entitled to damages for non-pecuniary loss. 2002, c. 22, s. 120 (4); 2010, c. 1, Sched. 11, s. 1 (3).

Costs

(9)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, the determination of a party’s entitlement to costs shall be made without regard to the effect of paragraph 3 of subsection (7) on the amount of damages, if any, awarded for non-pecuniary loss. 1996, c. 21, s. 29.

Liability of other persons

(10)  Subsections (1), (3) and (5) do not relieve any person from liability other than a protected defendant. 1996, c. 21, s. 29.

Vicarious liability

(10.1)  Despite any provision of this Part, a person vicariously liable for the fault or negligence of a protected defendant is not, in respect of the person’s vicarious liability, liable for any amount greater than the amount of damages for which the protected defendant is liable. 2002, c. 22, s. 120 (5).

(11)  Repealed: 2002, c. 22, s. 120 (6).

Motion to determine if threshold met; non-pecuniary loss

(12)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, a judge shall, on motion made before trial with the consent of the parties or in accordance with an order of a judge who conducts a pre-trial conference, determine for the purpose of subsections (3) and (5) whether, as a result of the use or operation of the automobile, the injured person has died or has sustained,

(a) permanent serious disfigurement; or

(b) permanent serious impairment of an important physical, mental or psychological function. 1996, c. 21, s. 29; 2002, c. 22, s. 120 (7).

Determination binding

(13)  The determination of a judge on a motion under subsection (12) is binding on the parties at the trial. 1996, c. 21, s. 29; 2002, c. 22, s. 120 (8).

(14)  Repealed: 2002, c. 22, s. 120 (9).

Determination at trial; non-pecuniary loss

(15)  If no motion is made under subsection (12), the trial judge shall determine for the purpose of subsections (3) and (5) whether, as a result of the use or operation of the automobile, the injured person has died or has sustained,

(a) permanent serious disfigurement; or

(b) permanent serious impairment of an important physical, mental or psychological function. 1996, c. 21, s. 29; 2002, c. 22, s. 120 (10).

No action by uninsured owner or lessee

267.6  (1)  Despite any other Act, a person is not entitled in an action in Ontario to recover any loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile if, at the time of the incident, the person was contravening subsection 2 (1) of the Compulsory Automobile Insurance Act in respect of that automobile.

Prosecution not necessary

(2)  Subsection (1) applies whether or not the person was prosecuted for or convicted of an offence under the Compulsory Automobile Insurance Act. 1996, c. 21, s. 29.

Joint and several liability with other tortfeasors

267.7  (1)  If, in an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, one or more protected defendants and one or more other persons are found to be liable for damages,

(a) the other persons,

(i) are jointly and severally liable with the protected defendants for the damages for which the protected defendants are liable, having regard to section 267.5, and

(ii) are solely liable for any amount by which the amount mentioned in subclause (i) is less than the amount that the other persons would have been liable to make contribution and indemnify the protected defendants in respect of damages in the absence of section 267.5;

(b) the other persons are liable to make contribution and indemnify the protected defendants in respect of damages to the same extent as if section 267.5 did not apply, up to the amount for which the protected defendants are liable having regard to section 267.5; and

(c) the protected defendants are liable to make contribution and indemnify the other persons for the amount that the protected defendants are liable, having regard to section 267.5, reduced by the amount that the other persons are liable to make contribution and indemnify the protected defendants under clause (b).

Separate determinations

(2)  Liability shall be determined under subsection (1) separately for each of the following categories of damages:

1. Damages for income loss and loss of earning capacity.

2. Damages for expenses that have been incurred or will be incurred for health care.

3. Damages for pecuniary loss, other than damages referred to in paragraphs 1 and 2.

4. Damages for non-pecuniary loss, including damages for non-pecuniary loss under clause 61 (2) (e) of the Family Law Act.

Determination of liability

(3)  For the purposes of subsection (1), the liability of all persons involved in the incident from which the action arose shall be determined as though all persons wholly or partly responsible for the damages were parties to the action even though any of those persons is not actually a party. 1996, c. 21, s. 29.

Collateral benefits

Income loss and loss of earning capacity

267.8  (1)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, the damages to which a plaintiff is entitled for income loss and loss of earning capacity shall be reduced by the following amounts:

1. All payments in respect of the incident that the plaintiff has received or that were available before the trial of the action for statutory accident benefits in respect of the income loss and loss of earning capacity.

2. All payments in respect of the incident that the plaintiff has received or that were available before the trial of the action for income loss or loss of earning capacity under the laws of any jurisdiction or under an income continuation benefit plan.

3. All payments in respect of the incident that the plaintiff has received before the trial of the action under a sick leave plan arising by reason of the plaintiff’s occupation or employment. 1996, c. 21, s. 29.

Exception

(2)  No reduction shall be made under subsection (1) for payments in respect of income loss if the payments are in respect of income loss suffered in the seven days after the incident. 1996, c. 21, s. 29.

Priority with other tortfeasors

(3)  If persons other than protected defendants are liable for damages for income loss or loss of earning capacity, the reduction required by subsection (1) shall first be applied to the damages for which the protected defendants and the other persons are jointly and severally liable under subclause 267.7 (1) (a) (i), and any excess shall be applied to the amount for which the other persons are solely liable under subclause 267.7 (1) (a) (ii). 1996, c. 21, s. 29.

Health care expenses

(4)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, the damages to which a plaintiff is entitled for expenses that have been incurred or will be incurred for health care shall be reduced by the following amounts:

1. All payments in respect of the incident that the plaintiff has received or that were available before the trial of the action for statutory accident benefits in respect of the expenses for health care.

2. All payments in respect of the incident that the plaintiff has received before the trial of the action under any medical, surgical, dental, hospitalization, rehabilitation or long-term care plan or law. 1996, c. 21, s. 29.

Exception

(5)  Paragraph 2 of subsection (4) does not apply to a payment made by the Ministry of Health and Long-Term Care if the action is brought under section 30 of the Health Insurance Act. 1996, c. 21, s. 29; 2006, c. 19, Sched. L, s. 11 (3).

Other pecuniary loss

(6)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, the damages to which a plaintiff is entitled for pecuniary loss, other than the damages for income loss or loss of earning capacity and the damages for expenses that have been incurred or will be incurred for health care, shall be reduced by all payments in respect of the incident that the plaintiff has received or that were available before the trial of the action for statutory accident benefits in respect of pecuniary loss, other than income loss, loss of earning capacity and expenses for health care. 1996, c. 21, s. 29.

Non-pecuniary loss

(7)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, the damages in respect of non-pecuniary loss to which a plaintiff is entitled shall not be reduced because of any payments or benefits that the plaintiff has received or is entitled to receive. 1996, c. 21, s. 29.

Contributory negligence

(8)  The reductions required by subsections (1), (4) and (6) shall be made after any apportionment of damages required by section 3 of the Negligence Act. 1996, c. 21, s. 29.

Future collateral benefits

(9)  A plaintiff who recovers damages for income loss, loss of earning capacity, expenses that have been or will be incurred for health care, or other pecuniary loss in an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile shall hold the following amounts in trust:

1. All payments in respect of the incident that the plaintiff receives after the trial of the action for statutory accident benefits in respect of income loss or loss of earning capacity.

2. All payments in respect of the incident that the plaintiff receives after the trial of the action for income loss or loss of earning capacity under the laws of any jurisdiction or under an income continuation benefit plan.

3. All payments in respect of the incident that the plaintiff receives after the trial of the action under a sick leave plan arising by reason of the plaintiff’s occupation or employment.

4. All payments in respect of the incident that the plaintiff receives after the trial of the action for statutory accident benefits in respect of expenses for health care.

5. All payments in respect of the incident that the plaintiff receives after the trial of the action under any medical, surgical, dental, hospitalization, rehabilitation or long-term care plan or law.

6. All payments in respect of the incident that the plaintiff receives after the trial of the action for statutory accident benefits in respect of pecuniary loss, other than income loss, loss of earning capacity and expenses for health care. 1996, c. 21, s. 29.

Payments from trust

(10)  A plaintiff who holds money in trust under subsection (9) shall pay the money to the persons from whom damages were recovered in the action, in the proportions that those persons paid the damages. 1996, c. 21, s. 29.

Disputes

(11)  Any dispute concerning a plaintiff’s liability to make payments under subsection (10) shall, on the request of a person who claims to be entitled to a payment under that subsection, be submitted to arbitration in accordance with the Arbitration Act, 1991. 1996, c. 21, s. 29.

Assignment of future collateral benefits

(12)  The court that heard and determined the action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of the automobile, on motion, may order that, subject to any conditions the court considers just,

(a) the plaintiff who recovered damages in the action assign to the defendants or the defendants’ insurers all rights in respect of all payments to which the plaintiff who recovered damages is entitled in respect of the incident after the trial of the action,

(i) for statutory accident benefits in respect of income loss or loss of earning capacity,

(ii) for income loss or loss of earning capacity under the laws of any jurisdiction or under an income continuation benefit plan,

(iii) under a sick leave plan arising by reason of the plaintiff’s occupation or employment,

(iv) for statutory accident benefits in respect of expenses for health care,

(v) under any medical, surgical, dental, hospitalization, rehabilitation or long-term care plan or law, and

(vi) for statutory accident benefits in respect of pecuniary loss, other than income loss, loss of earning capacity and expenses for health care; and

(b) the plaintiff who recovered damages in the action co-operate with the defendants or the defendants’ insurers in any claim or proceeding brought by the defendants or the defendants’ insurers in respect of a payment assigned pursuant to clause (a). 1996, c. 21, s. 29.

Application of subs. (9)

(13)  Subsection (9) no longer applies if an order is made under subsection (12). 1996, c. 21, s. 29.

Pension Benefits Act

(14)  Subsections (9) to (13) prevail over sections 65, 66 and 67 of the Pension Benefits Act in the event of a conflict. 1996, c. 21, s. 29.

Workplace Safety and Insurance Act, 1997

(15)  Payments or benefits received or that were, are or may become available to a person under the Workplace Safety and Insurance Act, 1997 shall not be applied under subsection (1), (4) or (6) to reduce the damages awarded. 1996, c. 21, s. 29; 1997, c. 16, s. 9 (4).

(16)  Repealed: 1997, c. 16, s. 9 (5).

Limitation on subrogation

(17)  A person who has made a payment described in subsection (1), (4) or (6) is not subrogated to a right of recovery of the insured against another person in respect of that payment.

Exception

(18)  Subsection (17) does not apply if,

(a) the Ministry of Health and Long-Term Care made the payment; and

(b) the right of recovery is against a person other than a person insured under a motor vehicle liability policy issued in Ontario. 1996, c. 21, s. 29; 2006, c. 19, Sched. L, s. 11 (3).

Workplace Safety and Insurance Board

(19)  The Workplace Safety and Insurance Board is not subrogated to a right of recovery of the insured against another person in respect of a payment or benefit paid by the Workplace Safety and Insurance Board to the insured or in respect of a liability to make such payment or benefit. 1996, c. 21, s. 29; 1997, c. 16, s. 9 (6).

Determination of liability

(20)  For the purposes of subsections (1), (3), (4) and (6), the damages payable by a person who is a party to the action shall be determined as though all persons wholly or partly responsible for the damages were parties to the action even though any of those persons is not actually a party.

Interpretation

(21)  For the purpose of subsection (1), (4) or (6), a payment shall be deemed not to be available to a plaintiff if the plaintiff made an application for the payment and the application was denied.

Same

(22)  Subsection (21) does not apply if the court is satisfied that the plaintiff impaired his or her entitlement to the payment by,

(a) failing to give any notice required by law of the application for the payment;

(b) failing to make himself or herself reasonably available for any examination that was requested by the person to whom the application was made and that was required by law; or

(c) settling in bad faith his or her entitlement to the payment to the detriment of a person found liable for damages in the action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of the automobile. 1996, c. 21, s. 29.

Proceedings by action

267.9  A proceeding for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile shall be brought only by way of an action. 1996, c. 21, s. 29.

Structured judgments

267.10  In the circumstances prescribed by the regulations, the court shall order that an award for damages in an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile shall be paid periodically on such terms as the court considers just. 1996, c. 21, s. 29.

No gross-up for income tax

267.11  (1)  In an action for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of an automobile, an award against a protected defendant shall not include any amount to offset liability for income tax payable on income from investment of the award with respect to,

(a) damages for income loss or loss of earning capacity;

(b) damages that are payable periodically pursuant to an order of a court under section 267.10;

(c) any component of an award, other than an award for damages mentioned in clause (b), that the plaintiff and defendant agree the defendant shall pay on a periodic basis. 2002, c. 22, s. 123.

Application

(2)  Clause (1) (a) does not apply to an award for income loss or loss of earning capacity under subsection 61 (1) of the Family Law Act. 2002, c. 22, s. 123.

Liability of lessors

267.12  (1)  Despite any other provision in this Part, except subsections (4) and (5), in an action in Ontario for loss or damage from bodily injury or death arising directly or indirectly from the use or operation of a motor vehicle that is leased, the maximum amount for which the lessor or lessors of the motor vehicle are liable in respect of the same incident in their capacity as lessors of the motor vehicle is the amount determined under subsection (3) less any amounts,

(a) that are recovered for loss or damage from bodily injury or death under the third party liability provisions of contracts evidenced by motor vehicle liability policies issued to persons other than a lessor;

(b) that are in respect of the use or operation of the motor vehicle; and

(c) that are in respect of the same incident. 2005, c. 31, Sched. 12, s. 4.

Same

(2)  For the purposes of subsection (1), the amounts referred to in clauses (1) (a), (b) and (c) include only amounts recovered under the coverages referred to in subsections 239 (1) and (3) and section 241 and exclude,

(a) any sum referred to in subsection 265 (1);

(b) any amount payable as damages by the Motor Vehicle Accident Claims Fund under the Motor Vehicle Accident Claims Act; and

(c) any other amounts determined in the manner prescribed by the regulations. 2005, c. 31, Sched. 12, s. 4.

Maximum amount

(3)  The maximum amount for the purposes of subsection (1) is the greatest of,

(a) $1,000,000;

(b) the amount of third party liability insurance required by law to be carried in respect of the motor vehicle; and

(c) the amount determined in the manner prescribed by the regulations, if regulations are made prescribing the manner for determining an amount for the purposes of this clause. 2005, c. 31, Sched. 12, s. 4.

Exceptions

(4)  Subsection (1) does not apply,

(a) in such circumstances as may be prescribed by the regulations or to such persons, classes of persons, motor vehicles or classes of motor vehicles as may be prescribed in the regulations, subject to such terms, conditions, provisions, exclusions and limits as may be prescribed by the regulations;

(b) in respect of amounts payable by a lessor other than by reason of the vicarious liability imposed under section 192 of the Highway Traffic Act; or

(c) in respect of a motor vehicle used as a taxicab, livery vehicle or limousine for hire. 2005, c. 31, Sched. 12, s. 4.

Application of subs. (1)

(5)  Subsection (1) applies only to proceedings for loss or damage from bodily injury or death arising from the use or operation of a motor vehicle on or after the day this section comes into force. 2005, c. 31, Sched. 12, s. 4.

Definitions

(6)  In this section,

“lessor” means, in respect of a motor vehicle, a person who is leasing or renting the motor vehicle to another person for any period of time, and “leased” has a corresponding meaning; (“bailleur”)

“motor vehicle” has the same meaning as in subsection 1 (1) of the Highway Traffic Act. (“véhicule automobile”) 2005, c. 31, Sched. 12, s. 4.

Statutory accident benefits

268.  (1)  Every contract evidenced by a motor vehicle liability policy, including every such contract in force when the Statutory Accident Benefits Schedule is made or amended, shall be deemed to provide for the statutory accident benefits set out in the Schedule and any amendments to the Schedule, subject to the terms, conditions, provisions, exclusions and limits set out in that Schedule. 1993, c. 10, s. 26 (1).

Exception, public transit vehicles

(1.1)  Despite subsection (1) and the Statutory Accident Benefits Schedule, no statutory accident benefits are payable in respect of an occupant of a public transit vehicle, in respect of an incident that occurs on or after the date this subsection comes into force, if the public transit vehicle did not collide with another automobile or any other object in the incident. 2011, c. 9, Sched. 21, s. 4.

(1.2), (1.3)  Repealed: 1996, c. 21, s. 30 (1).

Indexation

(1.4)  Subject to subsection (1.5) and to the terms, conditions, provisions, exclusions and limits established by the Statutory Accident Benefits Schedule, the Schedule shall provide that, in respect of incidents involving the use or operation, after December 31, 1993 and before section 29 of the Automobile Insurance Rate Stability Act, 1996 comes into force, of an automobile,

(a) every continuing periodic amount payable by an insurer as an income replacement benefit, education disability benefit, caregiver benefit or loss of earning capacity benefit in accordance with the Schedule shall be revised, effective the 1st day of January in every year after 1994, using the indexation percentage published under subsection 268.1 (1); and

(b) every monetary amount set out in the Schedule shall be revised, effective the 1st day of January in every year after 1994, by adjusting the amount by the indexation percentage published under subsection 268.1 (1). 1993, c. 10, s. 26 (1); 1996, c. 21, s. 30 (2).

No decrease in payments

(1.5)  A continuing periodic amount payable by an insurer in accordance with the Statutory Accident Benefits Schedule shall not be reduced by the operation of the indexation percentage referred to in subsection (1.4). 1993, c. 10, s. 26 (1).

Liability to pay

(2)  The following rules apply for determining who is liable to pay statutory accident benefits:

1. In respect of an occupant of an automobile,

i. the occupant has recourse against the insurer of an automobile in respect of which the occupant is an insured,

ii. if recovery is unavailable under subparagraph i, the occupant has recourse against the insurer of the automobile in which he or she was an occupant,

iii. if recovery is unavailable under subparagraph i or ii, the occupant has recourse against the insurer of any other automobile involved in the incident from which the entitlement to statutory accident benefits arose,

iv. if recovery is unavailable under subparagraph i, ii or iii, the occupant has recourse against the Motor Vehicle Accident Claims Fund.

2. In respect of non-occupants,

i. the non-occupant has recourse against the insurer of an automobile in respect of which the non-occupant is an insured,

ii. if recovery is unavailable under subparagraph i, the non-occupant has recourse against the insurer of the automobile that struck the non-occupant,

iii. if recovery is unavailable under subparagraph i or ii, the non-occupant has recourse against the insurer of any automobile involved in the incident from which the entitlement to statutory accident benefits arose,

iv. if recovery is unavailable under subparagraph i, ii or iii, the non-occupant has recourse against the Motor Vehicle Accident Claims Fund. R.S.O. 1990, c. I.8, s. 268 (2); 1993, c. 10, s. 1; 1996, c. 21, s. 30 (3, 4).

Liability

(3)  An insurer against whom a person has recourse for the payment of statutory accident benefits is liable to pay the benefits. R.S.O. 1990, c. I.8, s. 268 (3); 1993, c. 10, s. 1.

Choice of insurer

(4)  If, under subparagraph i or iii of paragraph 1 or subparagraph i or iii of paragraph 2 of subsection (2), a person has recourse against more than one insurer for the payment of statutory accident benefits, the person, in his or her absolute discretion, may decide the insurer from which he or she will claim the benefits. R.S.O. 1990, c. I.8, s. 268 (4); 1993, c. 10, s. 1.

Same

(5)  Despite subsection (4), if a person is a named insured under a contract evidenced by a motor vehicle liability policy or the person is the spouse or a dependant, as defined in the Statutory Accident Benefits Schedule, of a named insured, the person shall claim statutory accident benefits against the insurer under that policy. 1993, c. 10, s. 26 (2); 1999, c. 6, s. 31 (9); 2005, c. 5, s. 35 (13).

Same

(5.1)  Subject to subsection (5.2), if there is more than one insurer against which a person may claim benefits under subsection (5), the person, in his or her discretion, may decide the insurer from which he or she will claim the benefits. 1993, c. 10, s. 26 (2).

Same

(5.2)  If there is more than one insurer against which a person may claim benefits under subsection (5) and the person was, at the time of the incident, an occupant of an automobile in respect of which the person is the named insured or the spouse or a dependant of the named insured, the person shall claim statutory accident benefits against the insurer of the automobile in which the person was an occupant. 1993, c. 10, s. 26 (2); 1999, c. 6, s. 31 (10); 2005, c. 5, s. 35 (14).

Excess insurance

(6)  The insurance mentioned in subsection (1) is excess insurance to any other insurance not being automobile insurance of the same type indemnifying the injured person or in respect of a deceased person for the expenses. R.S.O. 1990, c. I.8, s. 268 (6).

Idem

(7)  The insurance mentioned in subsection (1) is excess insurance to any other insurance indemnifying the injured person or in respect of a deceased person for the expenses. R.S.O. 1990, c. I.8, s. 268 (7).

Payments pending dispute resolution

(8)  Where the Statutory Accident Benefits Schedule provides that the insurer will pay a particular statutory accident benefit pending resolution of any dispute between the insurer and an insured, the insurer shall pay the benefit until the dispute is resolved. R.S.O. 1990, c. I.8, s. 268 (8); 1993, c. 10, s. 1.

Winding-up orders

268.0.1  (1)  The making of a winding-up order in respect of an insurer under the Winding-up and Restructuring Act (Canada) shall not be taken into account in determining under section 268 whether the insurer is liable to pay statutory accident benefits. 2002, c. 22, s. 124.

Motor Vehicle Accident Claims Fund

(2)  If an insurer in respect of which a winding-up order has been made under the Winding-up and Restructuring Act (Canada) is liable to pay statutory accident benefits, the benefits, including any benefits that were outstanding at the time the order was made, shall be paid out of the Motor Vehicle Accident Claims Fund. 2002, c. 22, s. 124.

Application

(3)  This section applies to winding-up orders made after this section comes into force. 2002, c. 22, s. 124.

Publication of indexation percentage

268.1  (1)  Before the 1st day of January in each year after 1994, the Superintendent shall determine in accordance with this section and publish in The Ontario Gazette the indexation percentage to be used effective the 1st day of January under subsection 268 (1.4). 1993, c. 10, s. 27; 1997, c. 28, s. 115.

Rules for determination

(2)  The following rules apply to the determination of the indexation percentage to be used under subsection 268 (1.4) effective the 1st day of January in a year:

1. The indexation percentage shall be the percentage change in the Consumer Price Index for Canada (All Items), as published by Statistics Canada under the authority of the Statistics Act (Canada), for the period from September in the year immediately preceding the previous year to September of the previous year.

2. Despite paragraph 1, if the Consumer Price Index information required by paragraph 1 to determine the indexation percentage is not available by the 1st day of November in the previous year, or if in the Superintendent’s opinion the information published by Statistics Canada does not provide a reasonable reflection of changes in consumer prices, the Superintendent may determine the indexation percentage in a manner that the Superintendent considers will provide a reasonable reflection of changes in consumer prices. 1993, c. 10, s. 27; 1997, c. 28, s. 115.

Publication of monetary amounts in Schedule

(3)  At the time an indexation percentage is published under subsection (1), the Superintendent shall publish in The Ontario Gazette the amounts to which the monetary amounts set out in the Statutory Accident Benefits Schedule shall be revised, effective the 1st day of January, in accordance with clause 268 (1.4) (b). 1993, c. 10, s. 27; 1997, c. 28, s. 115.

Rules of interpretation, Statutory Accident Benefits Schedule

268.2  The Statutory Accident Benefits Schedule shall be interpreted in accordance with the rules made under paragraph 10.2 of subsection 121 (1). 1993, c. 10, s. 27; 1996, c. 21, s. 31.

Guidelines, Statutory Accident Benefits Schedule

268.3  (1)  The Superintendent may issue guidelines on the interpretation and operation of the Statutory Accident Benefits Schedule or any provision of that Schedule. 1993, c. 10, s. 27; 1997, c. 28, s. 116.

Same

(1.1)  The Superintendent may issue guidelines setting out the treatment, services, measures or goods applicable in respect of types of impairments for the purposes of payment of a medical or rehabilitation benefit provided under the Statutory Accident Benefits Schedule, and such guidelines may include conditions, restrictions and limits with respect to such treatment, services, measures or goods. 2002, c. 22, s. 125.

Effect of guideline

(2)  Subject to section 268.2, a guideline shall be considered in any determination involving the interpretation of the Statutory Accident Benefits Schedule. 1993, c. 10, s. 27.

Incorporation by reference

(2.1)  Despite subsection (2), a guideline that is incorporated by reference into the Statutory Accident Benefits Schedule is binding. 2013, c. 2, Sched. 8, s. 13.

Effective date

(3)  A guideline takes effect on the day it is published in The Ontario Gazette. 1993, c. 10, s. 27.

Immunity

268.4  No action or other proceeding for damages may be commenced against any person for an act done or omitted in good faith in conducting an assessment by a designated assessment centre under the Statutory Accident Benefits Schedule. 2002, c. 22, s. 126.

Particulars of insurance

269.  (1)  A person who is entitled to statutory accident benefits or his or her personal representative is entitled to particulars as to whether the owner or operator of any automobile against whom the person may have a claim has insurance that provides for statutory accident benefits and the name of the insurer, if any. R.S.O. 1990, c. I.8, s. 269 (1); 1993, c. 10, s. 1.

Demand for particulars

(2)  The person or his or her personal representative may demand the particulars described in subsection (1) by registered mail from the owner or operator of the automobile or the insurer, if any, of either of them. R.S.O. 1990, c. I.8, s. 269 (2).

Reply

(3)  Every owner, operator and insurer shall comply with a demand under subsection (2) within ten days of receiving the demand. R.S.O. 1990, c. I.8, s. 269 (3).

Definition

(4)  In this section,

“owner” includes a person who is a lessee for the purposes of section 192 of the Highway Traffic Act. 2005, c. 31, Sched. 12, s. 5.

Rights of unnamed insured

270.  Any person insured by but not named in a contract to which section 265 or 268 applies may recover under the contract in the same manner and to the same extent as if named therein as the insured, and for that purpose shall be deemed to be a party to the contract and to have given consideration therefor. R.S.O. 1990, c. I.8, s. 270.

Payment into court

271.  (1)  Where an insurer admits liability for insurance money payable under section 265 or 268 and it appears that,

(a) there are adverse claimants;

(b) the whereabouts of an insured person entitled is unknown; or

(c) subject to subsections (1.1) and (1.2), there is no person capable of giving and authorized to give a valid discharge therefor who is willing to do so,

the insurer may, at any time after thirty days after the date upon which the insurance money becomes payable, apply to the court without notice for an order for payment of the money into the Superior Court of Justice, and the court may upon such notice, if any, as it thinks necessary make an order accordingly. R.S.O. 1990, c. I.8, s. 271 (1); 1993, c. 10, s. 28 (1); 2006, c. 19, Sched. C, s. 1 (1).

Minors

(1.1)  If an insurer admits liability for insurance money payable to a minor under section 265 or 268, the insurer shall pay the money and any applicable interest into the Superior Court of Justice to the credit of the minor. 1993, c. 10, s. 28 (2); 2006, c. 19, Sched. C, s. 1 (1).

Same, affidavit

(1.2)  No order is necessary for payment into the Superior Court of Justice under subsection (1.1), but the proper officer of the court shall receive the money if the insurer files with the court an affidavit showing the amount payable and the name, date of birth and residence of the minor. 1993, c. 10, s. 28 (2); 2006, c. 19, Sched. C, s. 1 (1).

Same, notice to Children’s Lawyer

(1.3)  The insurer shall promptly give the Children’s Lawyer notice of a payment into court under subsection (1.2) and a copy of the affidavit filed under that subsection. 2009, c. 33, Sched. 16, s. 7 (4).

Same, authorized payments

(1.4)  An insurer may, despite subsection (1.1), pay insurance money and applicable interest payable to a minor under section 265 or 268 to,

(a) the guardian of the property of the minor, appointed under section 47 of the Children’s Law Reform Act;

(b) a person referred to in subsection 51 (1) of the Children’s Law Reform Act, if the payment does not exceed the amount set out in that subsection; or

(c) the minor, if payment directly to the minor is authorized by the regulations. 1993, c. 10, s. 28 (2).

Discharge of insurer

(2)  The receipt of the proper officer of the court is sufficient discharge to the insurer for the insurance money paid into the Superior Court of Justice, and the insurance money shall be dealt with as the court orders. R.S.O. 1990, c. I.8, s. 271 (2); 2006, c. 19, Sched. C, s. 1 (1).

272.  Repealed: 2002, c. 24, Sched. B, s. 39 (4).

Claimant’s obligation to inform

273.  (1)  Where any person makes a claim for damages in respect of bodily injury or death sustained by the person or any other person while driving or being carried in or upon or entering or getting onto or alighting from or as a result of being struck by an automobile, the claimant shall furnish the person against whom the claim is made full particulars of all insurance available to the claimant under contracts falling within the scope of section 268. R.S.O. 1990, c. I.8, s. 273.

Claim for statutory accident benefits

(2)  If a person makes a claim for statutory accident benefits, the person shall furnish the person against whom the claim is made with full particulars of,

(a) all insurance available to the person under contracts to which subsection 268 (1) applies;

(b) any medical, surgical, dental, hospitalization, rehabilitation or long-term care plan under which benefits are available to the person;

(c) any income continuation benefit plan that provides benefits for loss of income under which benefits are available to the person;

(d) any law of a jurisdiction outside Canada under which benefits are available to the person; and

(e) any claim made by the person under a sick leave plan arising by reason of the person’s occupation or employment. 1993, c. 10, s. 29.

Information to Ministry of Community and Social Services, etc.

273.1  (1)  Every insurer shall provide the Ministry of Community and Social Services, a municipality, a board established under the District Social Services Administration Boards Act, a band approved under section 15 of the General Welfare Assistance Act or a delivery agent under the Ontario Works Act, 1997 or the Ontario Disability Support Program Act, 1997, with such information as may be prescribed by the regulations, including personal information, subject to such conditions as may be prescribed by the regulations. 1997, c. 25, Sched. E, s. 5.

Definition

(2)  In this section,

“insurer” includes the Facility Association. 1997, c. 25, Sched. E, s. 5; 2002, c. 17, Sched. F, Table.

Release

274.  (1)  Payments made or available to a person under the Statutory Accident Benefits Schedule constitute, to the extent of the payments, a release by the person, the person’s personal representatives, the person’s insurer and anyone claiming through or under the person or by virtue of Part V of the Family Law Act,

(a) of any claim under subsection 265 (1) or 268 (1), if the claim arises directly or indirectly from the use or operation, before January 1, 1994, of an automobile; and

(b) of any claim under subsection 268 (1), if the claim arises directly or indirectly from the use or operation, on or after January 1, 1994, of an automobile. 1993, c. 10, s. 30; 1996, c. 21, s. 33 (1, 2).

Same; accidents on or after Nov. 1, 1996

(2)  Payments made or available to a person under the Statutory Accident Benefits Schedule in respect of a claim arising directly or indirectly from the use or operation, after section 29 of the Automobile Insurance Rate Stability Act, 1996 comes into force, of an automobile constitute, to the extent of the payments, a release by the person, the person’s personal representatives, the person’s insurer and anyone claiming through or under the person or by virtue of Part V of the Family Law Act,

(a) of any claim under subsection 268 (1); and

(b) to the extent that the payments are made in respect of lost income, of any claim under subsection 265 (1). 1996, c. 21, s. 33 (3).

Indemnification in certain cases

275.  (1)  The insurer responsible under subsection 268 (2) for the payment of statutory accident benefits to such classes of persons as may be named in the regulations is entitled, subject to such terms, conditions, provisions, exclusions and limits as may be prescribed, to indemnification in relation to such benefits paid by it from the insurers of such class or classes of automobiles as may be named in the regulations involved in the incident from which the responsibility to pay the statutory accident benefits arose. R.S.O. 1990, c. I.8, s. 275 (1); 1993, c. 10, s. 1.

Idem

(2)  Indemnification under subsection (1) shall be made according to the respective degree of fault of each insurer’s insured as determined under the fault determination rules. R.S.O. 1990, c. I.8, s. 275 (2).

Deductible

(3)  No indemnity is available under subsection (2) in respect of the first $2,000 of statutory accident benefits paid in respect of a person described in that subsection. R.S.O. 1990, c. I.8, s. 275 (3); 1993, c. 10, s. 1.

Arbitration

(4)  If the insurers are unable to agree with respect to indemnification under this section, the dispute shall be resolved through arbitration under the Arbitrations Act. R.S.O. 1990, c. I.8, s. 275 (4).

Stay of arbitration

(5)  No arbitration hearing shall be held with respect to indemnification under this section if, in respect of the incident for which indemnification is sought, any of the insurers and an insured are parties to a mediation under section 280, an arbitration under section 282, an appeal under section 283 or a proceeding in a court in respect of statutory accident benefits. 1993, c. 10, s. 31.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (5) is repealed and the following substituted: (See: 2014, c. 9, ss. 13, 22)

Stay of arbitration

(5)  No arbitration hearing shall be held with respect to indemnification under this section if, in respect of the incident for which indemnification is sought, any of the insurers and an insured are parties to a proceeding before the Licence Appeal Tribunal under section 280 or to an appeal from such a proceeding. 2014, c. 9, Sched. 3, s. 13.

Terms of certain insurances, insurance under s. 265

276.  Subject to subsection 227 (1), an insurer may in a policy,

(a) provide insurance that is less extensive in scope than the insurance mentioned in section 265; and

(b) provide the terms of the contract that relate to the insurance mentioned in section 265. R.S.O. 1990, c. I.8, s. 276.

Other Insurance

Other insurance

277.  (1)  Subject to section 255, insurance under a contract evidenced by a valid owner’s policy of the kind mentioned in the definition of “owner’s policy” in section 1 is, in respect of liability arising from or occurring in connection with the ownership, or directly or indirectly with the use or operation of an automobile owned by the insured named in the contract and within the description or definition thereof in the policy, a first loss insurance, and insurance attaching under any other valid motor vehicle liability policy is excess insurance only. R.S.O. 1990, c. I.8, s. 277 (1).

Order in which policies are to respond

(1.1)  Despite subsection (1), if an automobile is leased, the following rules apply to determine the order in which the third party liability provisions of any available motor vehicle liability policies shall respond in respect of liability arising from or occurring in connection with the ownership or, directly or indirectly, with the use or operation of the automobile on or after the day this subsection comes into force:

1. Firstly, insurance available under a contract evidenced by a motor vehicle liability policy under which the lessee of the automobile is entitled to indemnity as an insured named in the contract.

2. Secondly, insurance available under a contract evidenced by a motor vehicle liability policy under which the driver of the automobile is entitled to indemnity, either as an insured named in the contract, as the spouse of an insured named in the contract who resides with that insured or as a driver named in the contract, is excess to the insurance referred to in paragraph 1.

3. Thirdly, insurance available under a contract evidenced by a motor vehicle liability policy under which the owner of the automobile is entitled to indemnity as an insured named in the contract is excess to the insurance referred to in paragraphs 1 and 2. 2005, c. 31, Sched. 12, s. 6 (1).

If more than one policy required to respond

(1.2)  For the purposes of the application of each of paragraphs 1, 2 and 3 of subsection (1.1), if insurance is available under more than one motor vehicle liability policy that is required to respond, each insurer is liable only for its rateable proportion of any liability, expense, loss or damage. 2005, c. 31, Sched. 12, s. 6 (1).

Exceptions

(1.3)  Subsection (1.1) does not apply,

(a) to an insured’s right of recovery referred to in subsection 263 (2);

(b) if the automobile is not a motor vehicle as defined in subsection 1 (1) of the Highway Traffic Act; or

(c) if subsection 267.12 (1) does not apply. 2005, c. 31, Sched. 12, s. 6 (1).

Insurer liable only for its rateable proportion of liability, etc.

(2)  Subject to sections 255 and 268 and to subsection (1) of this section, if the insured named in a contract has or places any other valid insurance, whether against liability for the ownership, use or operation of or against loss of or damage to an automobile or otherwise, of the insured’s interest in the subject-matter of the contract or any part thereof, the insurer is liable only for its rateable proportion of any liability, expense, loss or damage. R.S.O. 1990, c. I.8, s. 277 (2).

Rateable proportion defined

(3)  “Rateable proportion” as used in subsections (1.2) and (2) means,

(a) if there are two insurers liable and each has the same policy limits, each of the insurers shall share equally in any liability, expense, loss or damage;

(b) if there are two insurers liable with different policy limits, the insurers shall share equally up to the limit of the smaller policy limit;

(c) if there are more than two insurers liable, clauses (a) and (b) apply with necessary modifications. R.S.O. 1990, c. I.8, s. 277 (3); 2005, c. 31, Sched. 12, s. 6 (2).

Lessee defined

(4)  In this section,

“lessee” means, in respect of an automobile, a person who is leasing or renting the automobile for any period of time, and “leased” has a corresponding meaning. 2005, c. 31, Sched. 12, s. 6 (3).

Subrogation

Subrogation

278.  (1)  An insurer who makes any payment or assumes liability therefor under a contract is subrogated to all rights of recovery of the insured against any person and may bring action in the name of the insured to enforce those rights. R.S.O. 1990, c. I.8, s. 278 (1).

Pro-rating recovery

(2)  Where the net amount recovered whether by action or on settlement is, after deduction of the costs of the recovery, not sufficient to provide complete indemnity for the loss or damage suffered, the amount remaining shall be divided between the insurer and the insured in the proportion in which the loss or damage has been borne by them. R.S.O. 1990, c. I.8, s. 278 (2).

Action when s. 261 applies

(3)  Where the interest of an insured in any recovery is limited to the amount provided under a clause in the contract to which section 261 applies, the insurer shall have control of the action. R.S.O. 1990, c. I.8, s. 278 (3).

Application to court

(4)  Where the interest of an insured in any recovery exceeds that referred to in subsection (3) and the insured and the insurer cannot agree as to,

(a) the solicitors to be instructed to bring the action in the name of the insured;

(b) the conduct and carriage of the action or any matters pertaining thereto;

(c) any offer of settlement or the apportionment thereof, whether action has been commenced or not;

(d) the acceptance of any money paid into court or the apportionment thereof;

(e) the apportionment of costs; or

(f) the launching or prosecution of an appeal,

either party may apply to the Superior Court of Justice for the determination of the matters in question, and the court shall make such order as it considers reasonable having regard to the interests of the insured and the insurer in any recovery in the action or proposed action or in any offer of settlement. R.S.O. 1990, c. I.8, s. 278 (4); 2006, c. 19, Sched. C, s. 1 (1).

Idem

(5)  On an application under subsection (4), the only parties entitled to notice and to be heard thereon are the insured and the insurer, and no material or evidence used or taken upon the application is admissible upon the trial of an action brought by or against the insured or the insurer. R.S.O. 1990, c. I.8, s. 278 (5).

Concurrence in settlement or release

(6)  A settlement or release given before or after an action is brought does not bar the rights of the insured or the insurer, as the case may be, unless they have concurred therein. R.S.O. 1990, c. I.8, s. 278 (6).

Dispute Resolution — Statutory Accident Benefits

Dispute resolution

279.  (1)  Disputes in respect of any insured person’s entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured person is entitled shall be resolved in accordance with sections 280 to 283 and the Statutory Accident Benefits Schedule. R.S.O. 1990, c. I.8, s. 279 (1); 1993, c. 10, s. 1.

Opting out

(2)  Any restriction on a party’s right to mediate, litigate, appeal or apply to vary an order as provided in sections 280 to 284, or on a party’s right to arbitrate under section 282, is void except as provided in the regulations. 1996, c. 21, s. 34 (1).

Meaning of “insured person”, ss. 279 to 284

(3)  For the purposes of this section and sections 280 to 284,

“insured person” includes a person who is claiming funeral expenses or a death benefit under the Statutory Accident Benefits Schedule. R.S.O. 1990, c. I.8, s. 279 (3); 1993, c. 10, s. 1.

Orders

(4)  The Director and every arbitrator appointed by the Director shall determine issues before them by order and may make an order subject to such conditions as are set out in the order. R.S.O. 1990, c. I.8, s. 279 (4); 1996, c. 21, s. 34 (2).

Interim orders

(4.1)  The Director and every arbitrator appointed by the Director may make interim orders pending the final order in any matter before the Director or arbitrator. 1993, c. 10, s. 32 (2); 1996, c. 21, s. 34 (3).

Power to bind parties

(5)  If an insurer or an insured is represented in a mediation under section 280, an evaluation under section 280.1, an arbitration under section 282, an appeal under section 283 or a variation proceeding under section 284, the mediator, person performing the evaluation, arbitrator or Director, as the case may be, may adjourn the proceeding, with or without conditions, if the representative is not authorized to bind the party he or she represents. 1996, c. 21, s. 34 (4).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 279 is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Definitions

279.  For the purposes of sections 280 to 283,

“insured person” includes a person who is claiming funeral expenses or a death benefit under the Statutory Accident Benefits Schedule; (“personne assurée”)

“Licence Appeal Tribunal” means the Licence Appeal Tribunal established under the Licence Appeal Tribunal Act, 1999. (“Tribunal d’appel en matière de permis”) 2014, c. 9, Sched. 3, s. 14.

Mediation

280.  (1)  Either the insured person or the insurer may refer to a mediator any issue in dispute in respect of the insured person’s entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which the insured person is entitled. R.S.O. 1990, c. I.8, s. 280 (1); 1993, c. 10, s. 1; 1996, c. 21, s. 35 (1).

Starting the process

(2)  The party seeking mediation shall file an application for the appointment of a mediator with the Commission.

Mediator’s appointment

(3)  The Director shall ensure that a mediator is appointed promptly.

Mediation

(4)  The mediator shall enquire into the issues in dispute and attempt to effect a settlement of as many of the issues as possible within the time prescribed in the regulations for the settlement of the type of dispute in question.

Extension of time

(5)  The parties may by agreement extend the time for the completion of the mediation process, even if the time for completion has expired.

Notice of failure

(6)  If at any time before a settlement is effected the mediator is of the opinion that mediation will fail, he or she shall forthwith notify the parties.

Idem

(7)  Mediation has failed when the mediator has given notice to the parties that in his or her opinion mediation will fail, or when the prescribed or agreed time for mediation has expired and no settlement has been reached. R.S.O. 1990, c. I.8, s. 280 (2-7).

Report

(8)  If mediation fails, the mediator, in addition to any notice required to be given, shall prepare and give to the parties a report,

(a) setting out the insurer’s last offer and the mediator’s description of the issues that remain in dispute;

(b) containing a list of materials requested by the parties that have not been produced and that, in the opinion of the mediator, were required for the purpose of discussing a settlement of the issues; and

(c) containing a recommendation as to whether or not the issues in dispute should be referred for an evaluation under section 280.1.

Same

(9)  The mediator may give his or her report to a person performing an evaluation under section 280.1 or an arbitrator conducting an arbitration under section 282. 1996, c. 21, s. 35 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 280 is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Resolution of disputes

280.  (1)  This section applies with respect to the resolution of disputes in respect of an insured person’s entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured person is entitled. 2014, c. 9, Sched. 3, s. 14.

Application to Tribunal

(2)  The insured person or the insurer may apply to the Licence Appeal Tribunal to resolve a dispute described in subsection (1). 2014, c. 9, Sched. 3, s. 14.

Limit on court proceedings

(3)  No person may bring a proceeding in any court with respect to a dispute described in subsection (1), other than an appeal from a decision of the Licence Appeal Tribunal or an application for judicial review. 2014, c. 9, Sched. 3, s. 14.

Resolution in accordance with Schedule

(4)  The dispute shall be resolved in accordance with the Statutory Accident Benefits Schedule. 2014, c. 9, Sched. 3, s. 14.

Orders, powers and duties

(5)  The regulations may provide for and govern the orders and interim orders that the Licence Appeal Tribunal may make and may provide for and govern the powers and duties that the Licence Appeal Tribunal shall have for the purposes of conducting the proceeding. 2014, c. 9, Sched. 3, s. 14.

Orders for costs, other amounts

(6)  Without limiting what else the regulations may provide for and govern, the regulations may provide for and govern the following:

1. Orders, including interim orders, to pay costs, including orders requiring a person representing a party to pay costs personally.

2. Orders, including interim orders, to pay amounts even if those amounts are not costs or amounts to which a party is entitled under the Statutory Accident Benefits Schedule. 2014, c. 9, Sched. 3, s. 14.

Neutral evaluation

280.1  (1)  If mediation fails, the parties jointly or the mediator who conducted the mediation may, for the purpose of assisting in the resolution of the issues in dispute, refer the issues in dispute to a person appointed by the Director for an evaluation of the probable outcome of a proceeding in court or an arbitration under section 282.

Evaluator’s appointment

(2)  The Director shall ensure that a person is appointed promptly to perform the evaluation.

Information

(3)  The insurer and the insured person shall provide the person performing the evaluation with any information that he or she requests.

Opinion and report

(4)  The person performing the evaluation shall give the parties,

(a) an oral opinion on the probable outcome of a proceeding in court or an arbitration under section 282; and

(b) a written report,

(i) stating that the issues in dispute were evaluated by the person,

(ii) identifying the issues that were evaluated,

(iii) identifying the issues that remain in dispute,

(iv) setting out the insurer’s last offer, and

(v) containing a list of materials requested by the person performing the evaluation that were not provided by the parties.

Same

(5)  The person who performed the evaluation may give his or her written report to an arbitrator conducting an arbitration under section 282. 1996, c. 21, s. 36.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 280.1 is repealed. (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Litigation or arbitration

281.  (1)  Subject to subsection (2),

(a) the insured person may bring a proceeding in a court of competent jurisdiction;

(b) the insured person may refer the issues in dispute to an arbitrator under section 282; or

(c) the insurer and the insured person may agree to submit any issue in dispute to any person for arbitration in accordance with the Arbitration Act, 1991. 1996, c. 21, s. 37.

Limitation

(2)  No person may bring a proceeding in any court, refer the issues in dispute to an arbitrator under section 282 or agree to submit an issue for arbitration in accordance with the Arbitration Act, 1991 unless mediation was sought, mediation failed and, if the issues in dispute were referred for an evaluation under section 280.1, the report of the person who performed the evaluation has been given to the parties. 1996, c. 21, s. 37.

Payment pending dispute resolution

(3)  Subject to subsection (4), if mediation fails, the insurer shall pay statutory accident benefits in accordance with the last offer of settlement that it had made before the failure until otherwise agreed by the parties or until otherwise ordered by a court, by an arbitrator acting under this Act or the Arbitration Act, 1991, or by the Director. 1996, c. 21, s. 37.

Same

(4)  If a dispute involves a statutory accident benefit that the insurer is required to pay under subsection 268 (8) and no step authorized by subsection (1) has been taken within 45 days after the day mediation failed, the insurer shall pay the insured in accordance with the last offer made by the insurer before the failure until otherwise agreed by the parties or until otherwise ordered by a court, by an arbitrator acting under this Act or the Arbitrations Act, 1991, or by the Director. 1996, c. 21, s. 37.

(5)  Repealed: 2002, c. 24, Sched. B, s. 39 (5).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 281 is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Protection of benefits after Tribunal resolution

281.  (1)  After the Licence Appeal Tribunal issues a decision, the insurer shall not reduce benefits to the insured person on the basis of an alleged change of circumstances, alleged new evidence or an alleged error except as provided under this section. 2014, c. 9, Sched. 3, s. 14.

When benefits may be reduced

(2)  The insurer may reduce benefits if,

(a) the insured person agrees;

(b) the insurer is authorized to do so as a result of a successful appeal of the Licence Appeal Tribunal’s decision; or

(c) the insurer is authorized to do so by the Licence Appeal Tribunal. 2014, c. 9, Sched. 3, s. 14.

Limitation period

281.1  (1)  A mediation proceeding or evaluation under section 280 or 280.1 or a court proceeding or arbitration under section 281 shall be commenced within two years after the insurer’s refusal to pay the benefit claimed. 2002, c. 24, Sched. B, s. 39 (6).

Exception

(2)  Despite subsection (1), a proceeding or arbitration under clause 281 (1) (a) or (b) may be commenced,

(a) if there is an evaluation under section 280.1, within 30 days after the person performing the evaluation reports to the parties under clause 280.1 (4) (b);

(b) if mediation fails but there is no evaluation under section 280.1, within 90 days after the mediator reports to the parties under subsection 280 (8). 2002, c. 24, Sched. B, s. 39 (6).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 281.1 is repealed. (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Arbitration

282.  (1)  An insured person seeking arbitration under this section shall file an application for the appointment of an arbitrator with the Commission. R.S.O. 1990, c. I.8, s. 282 (1); 1996, c. 21, s. 38 (1).

Arbitrator’s appointment

(2)  The Director shall ensure that an arbitrator is appointed promptly. R.S.O. 1990, c. I.8, s. 282 (2).

Determination of issues

(3)  The arbitrator shall determine all issues in dispute, whether the issues are raised by the insured person or the insurer. 1996, c. 21, s. 38 (2).

Procedures

(4)  The arbitration shall be conducted in accordance with the procedures and within the time-limits set out in the regulations. R.S.O. 1990, c. I.8, s. 282 (4).

(5)-(9)  Repealed: 1996, c. 21, s. 38 (3).

Special award

(10)  If the arbitrator finds that an insurer has unreasonably withheld or delayed payments, the arbitrator, in addition to awarding the benefits and interest to which an insured person is entitled under the Statutory Accident Benefits Schedule, shall award a lump sum of up to 50 per cent of the amount to which the person was entitled at the time of the award together with interest on all amounts then owing to the insured (including unpaid interest) at the rate of 2 per cent per month, compounded monthly, from the time the benefits first became payable under the Schedule. R.S.O. 1990, c. I.8, s. 282 (10); 1993, c. 10, s. 1.

Expenses

(11)  The arbitrator may award, according to criteria prescribed by the regulations, to the insured person or the insurer, all or part of such expenses incurred in respect of an arbitration proceeding as may be prescribed in the regulations, to the maximum set out in the regulations. 1996, c. 21, s. 38 (4).

Interim award of expenses

(11.1)  The arbitrator may at any time during an arbitration proceeding make an interim award of expenses, subject to such terms and conditions as may be established by the arbitrator. 1993, c. 10, s. 33.

Liability of representative for costs

(11.2)  An arbitrator may make an order requiring a person representing an insured person or an insurer for compensation in an arbitration proceeding to personally pay all or part of any expenses awarded against a party if the arbitrator is satisfied that,

(a) in respect of a representative of an insured person, the representative commenced or conducted the proceeding without authority from the insured person or did not advise the insured person that he or she could be liable to pay all or part of the expenses of the proceeding;

(b) in respect of a representative of an insured person, the representative caused expenses to be incurred without reasonable cause by advancing a frivolous or vexatious claim on behalf of the insured person; or

(c) the representative caused expenses to be incurred without reasonable cause or to be wasted by unreasonable delay or other default. 2002, c. 22, s. 127.

Non-application to solicitors

(11.3)  Clause (11.2) (a) does not apply to a barrister or solicitor acting in the usual course of the practice of law. 2002, c. 22, s. 127.

Opportunity to make representations

(11.4)  An order under subsection (11.2) shall not be made unless the representative is given a reasonable opportunity to make representations to the arbitrator. 2002, c. 22, s. 127.

Bias

(12)  A party may apply to the Director for the appointment of a new arbitrator if the party believes that the arbitrator is biased and the Director shall determine the issue. R.S.O. 1990, c. I.8, s. 282 (12).

Copies of decision

(13)  The arbitrator, forthwith upon making a decision in an arbitration, shall deliver a copy of his or her order together with a copy of the arbitrator’s written reasons, if any, to the insured person, the insurer and the Director. R.S.O. 1990, c. I.8, s. 282 (13); 1996, c. 21, s. 38 (5).

(14), (15)  Repealed: 1996, c. 21, s. 38 (6).

Non-application of the Arbitration Act, 1991

(16)  The Arbitration Act, 1991 does not apply to arbitrations under this section. 2002, c. 18, Sched. H, s. 4 (24).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 282 is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Assessment of dispute resolution costs

282.  (1)  The Lieutenant Governor in Council may, in accordance with the regulations, assess all insurers that have issued motor vehicle liability policies in Ontario for expenses and expenditures of the Licence Appeal Tribunal relating to disputes described in subsection 280 (1). 2014, c. 9, Sched. 3, s. 14.

Same

(2)  If an assessment is made under subsection (1), the share of a particular insurer shall be determined in the manner prescribed by regulation, which may take into account the degree of usage made of the Licence Appeal Tribunal that is specified in the regulations. 2014, c. 9, Sched. 3, s. 14.

Same, fees received

(3)  In setting an assessment under subsection (1), the Lieutenant Governor in Council shall take into account the fees received from insurers and insured persons in respect of disputes described in subsection 280 (1). 2014, c. 9, Sched. 3, s. 14.

Insurer’s duty to pay

(4)  An insurer shall pay the amount assessed against it. 2014, c. 9, Sched. 3, s. 14.

Same

(5)  If an insurer fails to pay an assessment made under subsection (1), the Superintendent may suspend or cancel the insurer’s licence. 2014, c. 9, Sched. 3, s. 14.

Same

(6)  The Superintendent may revive the licence of an insurer whose licence was suspended or cancelled under subsection (5) if the insurer pays all amounts owing by the insurer under this section. 2014, c. 9, Sched. 3, s. 14.

Appeal against arbitration order

283.  (1)  A party to an arbitration under section 282 may appeal the order of the arbitrator to the Director on a question of law. 1996, c. 21, s. 39 (1).

Notice of appeal

(2)  A notice of appeal shall be in writing and shall be delivered to the Commission within thirty days after the date of the arbitrator’s order and the appellant shall serve the notice on the respondent. R.S.O. 1990, c. I.8, s. 283 (2).

Extension of time for appeal

(3)  The Director may extend the time for requesting an appeal, before or after the time for requesting the appeal has expired, if the Director is satisfied that there are reasonable grounds for granting the extension, and the Director may give such directions as he or she considers proper as a condition of granting the extension.

Nature of appeal

(4)  The Director may determine the appeal on the record or in such other manner as the Director may decide, with or without a hearing. 1996, c. 21, s. 39 (2).

Power of the Director

(5)  The Director may confirm, vary or rescind the order appealed from or substitute his or her order for that of the arbitrator. R.S.O. 1990, c. I.8, s. 283 (5); 1996, c. 21, s. 39 (3).

Order not stayed

(6)  An appeal does not stay the order of the arbitrator unless the Director decides otherwise. R.S.O. 1990, c. I.8, s. 283 (6).

Medical reports, special awards, expenses

(7)  Subsections 282 (10) to (11.2) apply with necessary modifications to appeals before the Director. R.S.O. 1990, c. I.8, s. 283 (7); 1993, c. 10, s. 34; 1996, c. 21, s. 39 (4).

Interventions

(8)  The Director may permit persons who are not parties to the appeal to make submissions on issues of law arising in an appeal. R.S.O. 1990, c. I.8, s. 283 (8).

(9), (10)  Repealed: 1996, c. 21, s. 39 (5).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 283 is repealed and the following substituted: (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Transition — regulations

283.  (1)  The Lieutenant Governor in Council may make regulations,

(a) providing for transitional matters in connection with the resolution of disputes described in subsection (2);

(b) governing when a dispute arises and when it is finally determined for the purposes of clause (2) (a);

(c) providing for transitional matters in connection with the coming into force of the following provisions:

(i) Sections 1 to 10, subsections 11 (1) to (4) and (6) to (8) and sections 13 and 14, of Schedule 3 of the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014, which amend this Act.

(ii) Sections 1 to 4 of Schedule 5 of the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014, which amend the Financial Services Commission of Ontario Act, 1997.

(iii) Section 7 of Schedule 5 of the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014, which amends the Motor Vehicle Accident Claims Act. 2014, c. 9, Sched. 3, s. 14.

Unresolved prior disputes

(2)  The disputes referred to in clause (1) (a) are disputes that,

(a) arise before the transition date but are not finally determined before that date; and

(b) are in respect of an insured person’s entitlement to statutory accident benefits or in respect of the amount of statutory accident benefits to which the insured person is entitled. 2014, c. 9, Sched. 3, s. 14.

Regulations relating to disputes

(3)  Without limiting what regulations may be made under clause (1) (a), the regulations under that clause may,

(a) provide that sections 279 to 282 do not apply or apply with such modifications as the regulations may specify;

(b) provide that sections 279 to 287 as those sections read immediately before being repealed by section 14 of Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014 apply with such modifications as the regulations may specify;

(c) provide for other provisions of this Act, as those provisions read immediately before being amended or repealed by a provision of Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014, to apply with such modifications as the regulations may specify;

(d) provide for the continuation of,

(i) the office of the director of arbitrations appointed under section 6 as that section read immediately before being repealed by section 2 of Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014,

(ii) arbitrators appointed under section 8 as that section read immediately before being repealed by section 4 of Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014, and

(iii) mediators appointed under section 9 as that section read immediately before being repealed by section 5 of Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014;

(e) provide for the continuation of the powers and duties that any of the officials referred to in clause (d) had before the transition date to be exercised by the officials continued by regulations made under clause (d) or to be exercised by other persons or bodies specified in the regulations. 2014, c. 9, Sched. 3, s. 14.

Other regulations

(4)  Without limiting what regulations may be made under clause (1) (c), the regulations under that clause may,

(a) if the regulations made under clause (1) (a) provide for the continuation of the office of the director of arbitrations appointed under section 6 as that section read immediately before being repealed by section 2 of Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014, provide for that official to continue to be a member of the Financial Services Commission of Ontario, despite subsection 2 (2) of the Financial Services Commission of Ontario Act, 1997;

(b) govern how section 25 of the Financial Services Commission of Ontario Act, 1997 applies in respect of assessments that cover expenses and expenditures relating to disputes described in subsection (2);

(c) modify the application of clause 6 (2) (b) of the Motor Vehicle Accident Claims Act with respect to disputes described in subsection (2). 2014, c. 9, Sched. 3, s. 14.

Transition date

(5)  In this section,

“transition date” means the date on which this section (as re-enacted by section 14 of Schedule 3 to the Fighting Fraud and Reducing Automobile Insurance Rates Act, 2014) comes into force. 2014, c. 9, Sched. 3, s. 14.

Application for variation, Director’s or arbitrator’s order

284.  (1)  Either the insured person or the insurer may apply to the Director to vary or revoke an order made by the Director or an arbitrator appointed by the Director. R.S.O. 1990, c. I.8, s. 284 (1); 1996, c. 21, s. 40 (1).

Idem

(2)  If an application is made to vary or revoke an arbitrator’s order, the Director may decide the matter or he or she may appoint the same arbitrator or some other arbitrator to determine it.

Powers on variation

(3)  If the arbitrator or Director is satisfied that there has been a material change in the circumstances of the insured or that evidence not available on the arbitration or appeal has become available or that there is an error in the order, the arbitrator or Director may vary or revoke the order and may make a new order if he or she considers it advisable to do so.

Idem

(4)  An order made, varied or revoked under subsection (3) may be prospective or retroactive. R.S.O. 1990, c. I.8, s. 284 (2-4).

Application of subss. 282 (11 to 11.2)

(5)  Subsections 282 (11) to (11.2) apply with necessary modifications to an application under this section. 1996, c. 21, s. 40 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 284 is repealed. (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Restrictions on who may represent

284.1  (1)  Despite section 10 of the Statutory Powers Procedure Act and subject to subsection (2), a party to a proceeding under sections 279 to 284 may not be represented by another person for compensation except in accordance with the regulations and subject to such terms and conditions as may be specified in the regulations. 2002, c. 22, s. 128.

Non-application to solicitors

(2)  This section does not apply to a barrister or solicitor acting in the usual course of the practice of law. 2002, c. 22, s. 128.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 284.1 is repealed. (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Stated case by Director

285.  (1)  The Director may state a case in writing for the opinion of the Divisional Court upon any question that, in his or her opinion, is a question of law.

Idem

(2)  The Divisional Court shall hear and determine the stated case. R.S.O. 1990, c. I.8, s. 285.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 285 is repealed. (See: 2014, c. 9, Sched. 3, ss. 14, 22)

When arbitrator cannot act

286.  An arbitrator appointed by the Director cannot vary or revoke an order made by him or her and cannot make a new order to replace an order made by him or her if the order is under appeal. R.S.O. 1990, c. I.8, s. 286; 1996, c. 21, s. 41.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 286 is repealed. (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Protection of benefits

287.  An insurer shall not, after an order of the Director or of an arbitrator appointed by the Director, reduce benefits to an insured person on the basis of an alleged change of circumstances, alleged new evidence or an alleged error, unless the insured person agrees or unless the Director or an arbitrator so orders in a variation or appeal proceeding under section 283 or 284. R.S.O. 1990, c. I.8, s. 287; 1996, c. 21, s. 42.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 287 is repealed. (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Finding of possible unfair or deceptive business practice

288.  The Director shall review arbitration orders and may recommend to the Superintendent that the Superintendent investigate the business practices of an insurer if the Director is of the opinion that any one or more arbitrations or appeals from arbitrations reveal unfair or deceptive business practices. R.S.O. 1990, c. I.8, s. 288; 1996, c. 21, s. 43.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 288 is repealed. (See: 2014, c. 9, Sched. 3, ss. 14, 22)

Insurers’ Payments for Listed Expenses — Statutory Accident Benefits

Listed expenses in connection with statutory accident benefits

288.1  (1)  For the purposes of this Part, the following are listed expenses in connection with statutory accident benefits:

1. Amounts payable for such assessments, examinations, reports, forms or plans authorized or required by the Statutory Accident Benefits Schedule as may be prescribed for the purposes of this section and expenses relating to those assessments, examinations, reports, forms and plans.

2. Amounts payable for prescribed goods or services that relate to such medical benefits, rehabilitation benefits, attendant care benefits and other statutory accident benefits as may be prescribed for the purposes of this section. 2013, c. 2, Sched. 8, s. 14; 2014, c. 7, Sched. 14, s. 4.

Exceptions

(2)  Despite subsection (1), the regulations may specify that certain types of amounts payable are not listed expenses in such circumstances as may be prescribed. 2013, c. 2, Sched. 8, s. 14.

Note: On December 1, 2014, the day named by proclamation of the Lieutenant Governor, the Act is amended by adding the following section: (See: 2013, c. 2, Sched. 8, ss. 15, 40)

Restrictions re payments for listed expenses

Payment by insurer

288.2  (1)  An insurer is not permitted to make payments for listed expenses directly to a person or entity who does not hold a service provider’s licence at the applicable time, as determined in accordance with the regulations. 2013, c. 2, Sched. 8, s. 15.

Exception

(2)  The restriction imposed by subsection (1) does not apply with respect to payments to such persons or entities as may be prescribed, or in such circumstances as may be prescribed. 2013, c. 2, Sched. 8, s. 15.

Reimbursement of insured person

(3)  An insurer is permitted to reimburse an insured person for a listed expense, whether or not the payment for which reimbursement is sought was made to the holder of a service provider’s licence. 2013, c. 2, Sched. 8, s. 15.

Motor Vehicle Accident Claims Fund

(4)  This section applies, with necessary modifications, with respect to the Motor Vehicle Accident Claims Fund. 2013, c. 2, Sched. 8, s. 15.

Public registry re service provider’s licences

288.3  (1)  The Superintendent shall maintain one or more registers listing the holders of a service provider’s licence and the former holders of such a licence. 2013, c. 2, Sched. 8, s. 16.

Same

(2)  The registers must contain such other information as may be prescribed. 2013, c. 2, Sched. 8, s. 16.

Same

(3)  The information in a register shall be made available for inspection by the public without charge and in accordance with the regulations. 2013, c. 2, Sched. 8, s. 16.

Service provider’s licence — attributes and duties

288.4  (1)  The holder of a service provider’s licence is eligible to be paid directly by an insurer for listed expenses in connection with statutory accident benefits. 2013, c. 2, Sched. 8, s. 17.

Standards for business systems and practices, etc.

(2)  It is a condition of a service provider’s licence that the licensee is required to comply with such standards as may be prescribed with respect to its business systems and practices, in connection with statutory accident benefits, and such standards as may be prescribed with respect to matters of integrity in the management of the licensee’s operations. 2013, c. 2, Sched. 8, s. 17.

Invoices for listed expenses

(3)  It is a condition of a service provider’s licence that the licensee is required to submit invoices to the applicable insurer, or to such other person or entity as the insurer directs, for payment of listed expenses in connection with statutory accident benefits. 2013, c. 2, Sched. 8, s. 17.

Other conditions

(4)  A service provider’s licence is subject to such other conditions as may be prescribed or as may be imposed by the Superintendent or Tribunal with respect to the matters described in subsection (2) and with respect to the administration of this Act and the Statutory Accident Benefits Schedule. 2013, c. 2, Sched. 8, s. 17.

Same

(5)  For greater certainty, a regulation prescribing conditions may require the licensee to submit periodic reports to the Superintendent. 2013, c. 2, Sched. 8, s. 17.

Principal representative

(6)  A licensee shall designate an individual as the licensee’s principal representative to exercise such powers and perform such duties as may be prescribed, and the individual so designated shall carry out his or her powers and duties in accordance with the regulations, if any. 2013, c. 2, Sched. 8, s. 17.

Same

(7)  An individual who satisfies the prescribed criteria is eligible to be designated as a licensee’s principal representative. 2013, c. 2, Sched. 8, s. 17.

Issuance of service provider’s licence

Application

288.5  (1)  A person or entity who wishes to apply for a service provider’s licence shall submit an application to the Superintendent in the manner required by the Superintendent and shall give the Superintendent such information, evidence and material as he or she may require and shall pay the applicable fee. 2013, c. 2, Sched. 8, s. 18.

Withdrawal of application

(2)  The applicant may withdraw the application at any time before the licence is issued. 2013, c. 2, Sched. 8, s. 18.

Issuance of licence

(3)  The Superintendent shall issue a service provider’s licence to an applicant who satisfies the prescribed requirements relating to its business systems and practices and the management of its operations,

(a) unless the Superintendent believes, on reasonable grounds, that the applicant is not suitable to hold a licence having regard to such circumstances as may be prescribed relating to the applicant’s business systems and practices and the management of its operations or having regard to such other matters as the Superintendent considers appropriate; or

(b) unless an administrative penalty imposed on the applicant under Part XVIII.1 has not been paid. 2013, c. 2, Sched. 8, s. 18.

Not transferable

(4)  A service provider’s licence is not transferable. 2013, c. 2, Sched. 8, s. 18.

Proposal to refuse application

(5)  If the Superintendent proposes to refuse to issue a service provider’s licence to an applicant, the Superintendent shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18.

Proposal to impose conditions

(6)  If the Superintendent proposes to issue the service provider’s licence and, without the applicant’s consent, to impose conditions on the licence, the Superintendent shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18.

Amendment of licence

(7)  The Superintendent may amend a service provider’s licence at any time. 2013, c. 2, Sched. 8, s. 18.

Proposal to amend

(8)  If the Superintendent proposes to amend a service provider’s licence without the licensee’s consent, the Superintendent shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18.

Revocation, suspension or surrender of service provider’s licence

Revocation or suspension

288.6  (1)  The Superintendent may, by order, revoke or suspend a service provider’s licence in any of the following circumstances:

1. The licensee ceases to satisfy a prescribed requirement for issuance of the licence.

2. The licensee has contravened or failed to comply with this Act, the regulations or a condition of the licence.

3. The Superintendent believes, on reasonable grounds, that the licensee is no longer suitable to be licensed having regard to such circumstances as may be prescribed relating to the licensee’s business systems and practices and the management of its operations or having regard to such other matters as the Superintendent considers appropriate.

4. Such other circumstances as may be prescribed. 2013, c. 2, Sched. 8, s. 18.

Proposal to revoke or suspend

(2)  If the Superintendent proposes to revoke or suspend a service provider’s licence under subsection (1) without the licensee’s consent, the Superintendent shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18.

Expedited order to revoke or suspend

(3)  The Superintendent may, by order, revoke or suspend a service provider’s licence in any of the following circumstances, without taking the steps required by section 288.7:

1. The licensee fails to pay an administrative penalty imposed under Part XVIII.1.

2. Such other circumstances as may be prescribed. 2013, c. 2, Sched. 8, s. 18.

Effect of suspension

(4)  During a suspension, the licensee is deemed not to hold a service provider’s licence for the purposes of section 288.2. 2013, c. 2, Sched. 8, s. 18.

Interim order suspending licence

(5)  If, in the Superintendent’s opinion, the interests of the public may be adversely affected by any delay in the revocation or suspension of a licence as a result of the steps required by section 288.7, the Superintendent may, without notice, make an interim order suspending the licence and may do so before or after giving the notice required by subsection 288.7 (2) with respect to the proposal to revoke or suspend the licence. 2013, c. 2, Sched. 8, s. 18.

Effect of interim order

(6)  An interim order suspending a service provider’s licence takes effect immediately and remains in effect until the expiry of the period for requesting a hearing under subsection 288.7 (3) about the Superintendent’s proposal to revoke or suspend the licence. 2013, c. 2, Sched. 8, s. 18.

Same

(7)  Despite subsection (6), if the Superintendent does not give the licensee the notice required by subsection 288.7 (2) within 21 days after the day on which the interim order is made or within such other period as may be prescribed, the interim order expires at the end of the 21-day period or the prescribed period, as the case may be. 2013, c. 2, Sched. 8, s. 18.

Extension of interim order

(8)  If the licensee requests a hearing about the Superintendent’s proposal to revoke or suspend the licence, the Superintendent may extend the interim order until the proposal is finally determined. 2013, c. 2, Sched. 8, s. 18.

Application to surrender licence

(9)  A licensee may apply to the Superintendent for permission to surrender the service provider’s licence and shall submit the application to the Superintendent in the manner required by the Superintendent, shall give the Superintendent such information, evidence and material as he or she may require and shall pay the applicable fee. 2013, c. 2, Sched. 8, s. 18.

Decision re surrender

(10)  The Superintendent shall allow the applicant to surrender the licence unless the Superintendent believes, on reasonable grounds, that the surrender of the licence is not in the public interest having regard to such criteria as may be prescribed relating to the licensee’s business systems and practices and the management of its operations and such other factors as the Superintendent considers appropriate. 2013, c. 2, Sched. 8, s. 18.

Same

(11)  If the Superintendent allows the surrender of the licence, the Superintendent may impose conditions relating to the licensee’s business systems and practices or the management of its operations in connection with the surrender. 2013, c. 2, Sched. 8, s. 18.

Proposal to refuse application to surrender

(12)  If the Superintendent proposes to refuse to allow the surrender of the licence, the Superintendent shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18.

Proposal to impose conditions

(13)  If the Superintendent proposes to allow the surrender of the licence and, without the applicant’s consent, to impose conditions in connection with the surrender, the Superintendent shall take the steps required by section 288.7. 2013, c. 2, Sched. 8, s. 18.

Revocation of order suspending licence

(14)  The Superintendent may, at any time, revoke an order or an interim order that suspends a service provider’s licence. 2013, c. 2, Sched. 8, s. 18.

Superintendent’s proposal to refuse application, etc.

288.7  (1)  This section applies if the Superintendent proposes to do any of the following things:

1. Refuse to issue a service provider’s licence to an applicant.

2. Issue a service provider’s licence and, without the applicant’s consent, impose conditions.

3. Amend a service provider’s licence without the licensee’s consent.

4. Revoke a service provider’s licence under subsection 288.6 (1) without the licensee’s consent.

5. Suspend a service provider’s licence under subsection 288.6 (1) without the licensee’s consent.

6. Refuse to allow the surrender of a service provider’s licence.

7. Allow the surrender of a service provider’s licence and, without the applicant’s consent, impose conditions in connection with the surrender. 2013, c. 2, Sched. 8, s. 18.

Notice of proposal

(2)  The Superintendent shall give written notice of the proposal to the applicant or licensee, including the reasons for the proposal; the Superintendent shall also inform the applicant or licensee that he, she or it can request a hearing by the Tribunal about the proposal and shall advise the applicant or licensee about the process for requesting a hearing. 2013, c. 2, Sched. 8, s. 18.

Hearing requested

(3)  If the applicant or licensee requests a hearing in writing within 15 days after the notice under subsection (2) is given, the Tribunal shall hold a hearing. 2013, c. 2, Sched. 8, s. 18.

Order

(4)  The Tribunal may, by order, direct the Superintendent to carry out the proposal, with or without changes, or substitute its opinion for that of the Superintendent, and the Tribunal may impose such conditions as it considers appropriate in the circumstances. 2013, c. 2, Sched. 8, s. 18.

Appeal

(5)  A party to a hearing held by the Tribunal may appeal the order of the Tribunal to the Divisional Court. 2013, c. 2, Sched. 8, s. 18.

Effect of appeal

(6)  An order of the Tribunal takes effect immediately, but if the order is appealed, the Tribunal may grant a stay of the order until the appeal is finally determined. 2013, c. 2, Sched. 8, s. 18.

Hearing not requested

(7)  If the applicant or licensee does not request a hearing, or does not make the request in accordance with subsection (3), the Superintendent may carry out the proposal. 2013, c. 2, Sched. 8, s. 18.

Changes to Statutory Accident Benefits Schedule

Review of this Part

289.  (1)  The Superintendent shall undertake a review of the following matters at least every three years or more often at the request of the Minister:

1. A review of this Part and any related regulations, excluding those made under the paragraphs of subsection 121 (1) that are referred to in paragraph 2.

2. A review of the operation of such regulations made under paragraphs 35, 36 and 36.1 of subsection 121 (1) as the Minister may request. 2013, c. 2, Sched. 8, s. 19.

Report

(2)  The Superintendent shall give a report to the Minister setting out the results of the review, any recommendations made by the Superintendent and such other information as the Minister may request. 2013, c. 2, Sched. 8, s. 19.

Report to the Assembly

(3)  The Minister shall lay the Superintendent’s report before the Assembly at the earliest reasonable opportunity. 2013, c. 2, Sched. 8, s. 19.

Initial review

(4)  The Superintendent shall begin a review under this section no later than 2013. 2013, c. 2, Sched. 8, s. 19.

289.1  Repealed: 2013, c. 2, Sched. 8, s. 19.

PART VII
ACCIDENT AND SICKNESS INSURANCE

Definitions, Part VII

290.  In this Part,

“application” means a written application for insurance or for the reinstatement of insurance; (“proposition”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “application” is amended by striking out “a written application” and substituting “an application”. See: 2012, c. 8, Sched. 23, ss. 33 (1), 77.

“beneficiary” means a person designated or appointed in a contract or by a declaration, other than the insured or the insured’s personal representative, to whom or for whose benefit insurance money payable in the event of death by accident is to be paid; (“bénéficiaire”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “beneficiary” is repealed and the following substituted:

“beneficiary” means a person, other than the insured or the insured’s personal representative, to whom or for whose benefit insurance money is made payable in a contract or by a declaration; (“bénéficiaire”)

See: 2012, c. 8, Sched. 23, ss. 33 (2), 77.

“blanket insurance” means that class of group insurance that covers loss arising from specific hazards incident to or defined by reference to a particular activity or activities; (“assurance globale”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “blanket insurance” is repealed and the following substituted:

“blanket insurance” means group insurance that covers loss,

(a) arising from specific hazards incident to or defined by reference to a particular activity or activities, and

(b) occurring during a limited or specified period not exceeding six months in duration; (“assurance globale”)

See: 2012, c. 8, Sched. 23, ss. 33 (3), 77.

“contract” means a contract of insurance; (“contrat”)

“court” means the Superior Court of Justice or a judge thereof; (“tribunal”)

“creditor’s group insurance” means insurance effected by a creditor whereby the lives or well-being, or the lives and well-being, of a number of the creditor’s debtors are insured severally under a single contract; (“assurance collective de créancier”)

Note: On a day to be named by proclamation of the Lieutenant Governor, section 290 is amended by adding the following definition:

“debtor insured” means a debtor whose life or well-being, or whose life and well-being, are insured under a contract of creditor’s group insurance; (“débiteur assuré”)

See: 2012, c. 8, Sched. 23, ss. 33 (4), 77.

“declaration” means an instrument signed by the insured,

(a) with respect to which an endorsement is made on the policy, or

(b) that identifies the contract, or

(c) that describes the insurance or insurance fund or a part thereof,

in which the insured designates or alters or revokes the designation of the insured’s personal representative or a beneficiary as one to whom or for whose benefit shall be paid the insurance money that is payable in the event of death by accident; (“déclaration”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “declaration” is repealed and the following substituted:

“declaration”, except in sections 302.1, 302.2, 302.3 and 316, means an instrument signed by the insured,

(a) with respect to which an endorsement is made on the policy,

(b) that identifies the contract, or

(c) that describes the insurance or insurance fund or a part thereof,

in which the insured,

(d) designates, or alters or revokes the designation of, the insured, the insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable, or

(e) makes, alters or revokes an appointment under subsection 315 (1) or a nomination referred to in section 317.3; (“déclaration”)

See: 2012, c. 8, Sched. 23, ss. 33 (5), 77.

“family insurance” means insurance whereby the lives or well-being, or the lives and well-being, of the insured and one or more persons related to the insured by blood, marriage or adoption are insured under a single contract between an insurer and the insured; (“assurance familiale”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “family insurance” is amended by striking out “blood, marriage or adoption” and substituting “blood, marriage, conjugal relationship outside marriage or adoption”. See: 2012, c. 8, Sched. 23, ss. 33 (6), 77.

“group insurance” means insurance other than creditor’s group insurance and family insurance, whereby the lives or well-being, or the lives and well-being, of a number of persons are insured severally under a single contract between an insurer and an employer or other person; (“assurance collective”)

“group person insured” means a person who is insured under a contract of group insurance and upon whom a right is conferred by the contract, but does not include a person who is insured thereunder as a person dependent upon or related to him or her; (“personne couverte par une assurance collective”)

Note: On a day to be named by proclamation of the Lieutenant Governor, the definition of “group person insured” is repealed and the following substituted:

“group person insured” means a person (the “primary person”), whose life or well-being, or whose life and well-being, are insured under a contract of group insurance, but does not include a person whose life or well-being, or whose life and well-being, are insured under the contract as a person dependent upon or related to the primary person; (“personne couverte par une assurance collective”)

See: 2012, c. 8, Sched. 23, ss. 33 (7), 77.

“instrument” includes a will; (“acte”)

“insurance” means accident and sickness insurance; (“assurance”)

“insured”,

(a) in the case of group insurance means, in the provisions of this Part relating to the designation of beneficiaries or of personal representatives as recipients of insurance money and their rights and status, the group person insured, and

(b) in all other cases means the person who makes a contract with an insurer; (“assuré”)

“person insured” means a person in respect of an accident to whom, or in respect of whose sickness, insurance money is payable under a contract, but does not include a group person insured; (“personne assurée”)

“will” includes a codicil. (“testament”) R.S.O. 1990, c. I.8, s. 290; 2002, c. 18, Sched. H, s. 4 (25); 2006, c. 19, Sched. C, s. 1 (1).

Application of Part

291.  (1)  Despite any agreement, condition or stipulation to the contrary, this Part applies to contracts made in Ontario on or after the 1st day of October, 1970. R.S.O. 1990, c. I.8, s. 291 (1).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding “but subject to a regulation made under paragraph 26.0.1 of subsection 121 (1)” after “Despite any agreement, condition or stipulation to the contrary”. See: 2012, c. 8, Sched. 23, ss. 34 (1), 77.

Idem

(2)  In the case of contracts made before and in effect on that day,

(a) this section and sections 290, 292, 293, 302, 305, 306, 307 and 311, and sections 313 to 329 of this Part apply; and

Note: On the day section 35 of Schedule 23 to the Strong Action for Ontario Act (Budget Measures), 2012 comes into force, clause (a) is amended by striking out “292, 293” and substituting “292, 292.1, 293”. (See: 2014, c. 7, Sched. 14, ss. 5, 8 (3))

(b) sections 230, 231, 232, 233, 235, 242 and 245 of The Insurance Act, being chapter 190 of the Revised Statutes of Ontario, 1960, as it existed immediately before the 1st day of October, 1970, continue to apply. R.S.O. 1990, c. I.8, s. 291 (2).

Exceptions

(3)  This Part does not apply to,

(a) insurance undertaken by an insurer as part of a contract of life insurance whereby the insurer undertakes to pay an additional amount of insurance money in the event of the death by accident of the person whose life is insured;

(b) creditor’s group insurance;

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (b) is repealed. See: 2012, c. 8, Sched. 23, ss. 34 (2), 77.

(c) insurance undertaken by an insurer as part of a contract of life insurance whereby the insurer undertakes to pay insurance money or to provide other benefits in the event that the person whose life is insured becomes disabled as a result of bodily injury or disease; or

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (c) is amended by adding “except as provided in the regulations” after “injury or disease”. See: 2012, c. 8, Sched. 23, ss. 34 (3), 77.

(d) insurance provided under section 265 or 268. R.S.O. 1990, c. I.8, s. 291 (3); 2002, c. 18, Sched. H, s. 4 (26, 27).

Group insurance

292.  In the case of a contract of group insurance made with an insurer authorized to transact insurance in Ontario at the time the contract was made, this Part applies in determining,

(a) the rights and status of beneficiaries and personal representatives as recipients of insurance money, if the group person insured was resident in Ontario at the time he or she became insured; and

(b) the rights and obligations of the group person insured if the person was resident in Ontario at the time he or she became insured. R.S.O. 1990, c. I.8, s. 292.

Note: On a day to be named by proclamation of the Lieutenant Governor, Part VII is amended by adding the following section:

Application of ss. 126 and 131

292.1  Sections 126 and 131 apply to a contract of accident and sickness insurance. 2012, c. 8, Sched. 23, s. 35.

See: 2012, c. 8, Sched. 23, ss. 35, 77.

Issue of policy

293.  An insurer entering into a contract shall issue a policy. R.S.O. 1990, c. I.8, s. 293.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 293 is repealed and the following substituted:

Insurer to issue policy, furnish documents

293.  (1)  An insurer entering into a contract shall,

(a) issue a policy; and

(b) furnish to the insured the policy and a copy of the insured’s application. 2012, c. 8, Sched. 23, s. 36.

Documents forming contract

(2)  Subject to subsection (3), the provisions in,

(a) the application;

(b) the policy;

(c) any document attached to the policy when issued; and

(d) any amendment to the contract agreed upon in writing after the policy is issued,

constitute the entire contract. 2012, c. 8, Sched. 23, s. 36.

Same — contract by fraternal society

(3)  In the case of a contract made by a fraternal society, the policy, the Act or instrument of incorporation of the society, its constitution, by-laws and rules, and the amendments made from time to time to any of them, the application for the contract and the medical statement of the applicant constitute the entire contract. 2012, c. 8, Sched. 23, s. 36.

Copy of contract, etc.

(4)  Except in the case of a contract of group insurance or of creditor’s group insurance, an insurer, on request, shall furnish to the insured or a claimant under the contract a copy of,

(a) the entire contract as set out in subsection (2) or (3), as applicable; and

(b) any written statement or other record provided to the insurer as evidence of insurability under the contract. 2012, c. 8, Sched. 23, s. 36.

Copy of application, policy, etc. — group insurance

(5)  In the case of a contract of group insurance, an insurer,

(a) on request, shall furnish to a group person insured or claimant under the contract a copy of,

(i) the group person insured’s application, and

(ii) any written statement or other record, not otherwise part of the application, provided to the insurer as evidence of the insurability of the group person insured under the contract;

(b) on request and reasonable notice, shall permit a group person insured or claimant under the contract to examine, and shall furnish to that person, a copy of the policy of group insurance. 2012, c. 8, Sched. 23, s. 36.

Same — creditor’s group insurance

(6)  In the case of a contract of creditor’s group insurance, an insurer,

(a) on request, shall furnish to a debtor insured or claimant under the contract a copy of,

(i) the debtor insured’s application, and

(ii) any written statement or other record, not otherwise part of the application, provided to the insurer as evidence of the insurability of the debtor insured under the contract;

(b) on request and reasonable notice, shall permit a debtor insured or claimant under the contract to examine, and shall furnish to that person, a copy of the policy of creditor’s group insurance. 2012, c. 8, Sched. 23, s. 36.

Reasonable fee

(7)  An insurer may charge a reasonable fee to cover its expenses in furnishing copies of documents under subsection (4), (5) or (6), other than the first copy furnished to each person. 2012, c. 8, Sched. 23, s. 36.

Access to information restricted

(8)  Access to the documents described in clauses (5) (b) and (6) (b) does not extend,

(a) to information contained in those documents that would reveal personal information as defined in the Personal Information Protection and Electronic Documents Act (Canada) or personal health information as defined in the Personal Health Information Protection Act, 2004 about a person without that person’s consent, other than information about,

(i) the group person insured or debtor insured in respect of whom the claim is made, or

(ii) the person who requests the information; or

(b) to information prescribed by the regulations. 2012, c. 8, Sched. 23, s. 36.

Claimant’s access to documents restricted

(9)  A claimant’s access to documents under subsections (4) to (6) extends only to information that is relevant to,

(a) a claim under the contract; or

(b) a denial of such a claim. 2012, c. 8, Sched. 23, s. 36.

See: 2012, c. 8, Sched. 23, ss. 36, 77.

Contents of policy

294.  (1)  This section does not apply to,

(a) a contract of group insurance; or

Note: On a day to be named by proclamation of the Lieutenant Governor, clause (a) is amended. See: 2012, c. 8, Sched. 23, ss. 37 (1), 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by striking out “or” at the end of clause (a) and by adding the following clause:

(a.1) a contract of creditor’s group insurance; or

See: 2012, c. 8, Sched. 23, ss. 37 (1), 77.

(b) a contract made by a fraternal society. R.S.O. 1990, c. I.8, s. 294 (1).

Same

(2)  An insurer shall set forth the following particulars in the policy:

Note: On a day to be named by proclamation of the Lieutenant Governor, the English version of subsection (2) is amended by striking out the portion before paragraph 1 and substituting the following: (See: 2013, c. 2, Sched. 8, ss. 20, 40)

Same

(2)  An insurer shall include the following information in the policy:

1. The name or a sufficient description of the insured and of the person insured.

2. The amount or the method of determining the amount of the insurance money payable and the conditions under which it becomes payable.

3. The amount or the method of determining the amount of the premium and the period of grace, if any, within which it may be paid.

4. The conditions upon which the contract may be reinstated if it lapses.

5. The term of the insurance or the method of determining the day upon which the insurance commences and terminates. R.S.O. 1990, c. I.8, s. 294 (2).

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (2) is amended by adding the following paragraph:

6. The following statement:

Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002.

See: 2012, c. 8, Sched. 23, ss. 37 (2), 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 294 is amended by adding the following subsection:

Notice on front page of policy

(3)  Where a policy contains a provision removing or restricting the right of the insured to designate persons to whom or for whose benefit insurance money is to be payable, the front page of the policy must include the following statement in conspicuous bold type:

This policy contains a provision removing or restricting the right of the insured to designate persons to whom or for whose benefit insurance money is to be payable.

2012, c. 8, Sched. 23, s. 37 (3).

See: 2012, c. 8, Sched. 23, ss. 37 (3), 77.

Confinement clauses void

295.  Where a contract of accident and sickness insurance issued after November 2, 1973 includes a provision that a benefit is payable to an insured on account of his or her disability and the provision is conditional on the confinement of the insured, the condition does not bind the insured. 2002, c. 18, Sched. H, s. 4 (28).

Note: On a day to be named by proclamation of the Lieutenant Governor, section 295 is amended by adding the following subsection:

Exceptions

(2)  Despite subsection (1), a contract of accident and sickness insurance may provide for one or more of the following:

1. Early commencement of loss of income benefits based on the admission of the person insured into a hospital, long-term care facility or other similar institution.

2. Payment of loss of income benefits during the period of in-patient hospitalization of the person insured or the period during which the person insured is confined to a long-term care facility or other similar institution.

3. Payment of daily benefits during the period of in-patient hospitalization of the person insured or the period during which the person insured is confined to a long-term care facility or other similar institution.

4. Payment of lump sum benefits based on the admission of the person insured into a hospital or during the period of in-patient hospitalization or the admission into or during the period of confinement in a long-term care facility or other similar institution. 2012, c. 8, Sched. 23, s. 38.

See: 2012, c. 8, Sched. 23, ss. 38, 77.

Contents of group policy

296.  In the case of a contract of group insurance, an insurer shall set forth the following particulars in the policy:

Note: On a day to be named by proclamation of the Lieutenant Governor, section 296 is amended by striking out the portion before paragraph 1 and substituting the following:

Contents of group policy or creditor’s group policy

296.  In the case of a contract of group insurance or of creditor’s group insurance, an insurer shall set forth the following particulars in the policy:

See: 2012, c. 8, Sched. 23, ss. 39 (1), 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, the English version of section 296, as amended by subsection 39 (1) of Schedule 23 to the Strong Action for Ontario Act (Budget Measures), 2012, is amended by striking out “an insurer shall set forth the following particulars in the policy” in the portion before paragraph 1 and substituting “an insurer shall include the following information in the policy”. (See: 2013, c. 2, Sched. 8, ss. 21, 40)

1. The name or a sufficient description of the insured.

2. The method of determining the group persons insured and persons insured.

3. The amount or the method of determining the amount of the insurance money payable and the conditions under which it becomes payable.

4. The period of grace, if any, within which the premium may be paid.

5. The term of the insurance or the method of determining the day upon which the insurance commences and terminates. R.S.O. 1990, c. I.8, s. 296.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 296 is amended by adding the following paragraphs:

6. In the case of a contract of group insurance, any provision removing or restricting the right of a group person insured to designate persons to whom or for whose benefit insurance money is to be payable.

7. In the case of a contract of group insurance that replaces another contract of group insurance on some or all of the group person insureds under the replaced contract, whether a designation of a group person insured, a group person insured’s personal representative or a beneficiary as a person to whom or for whose benefit insurance money is to be payable under the replaced contract applies to the replacement contract.

8. The following statement:

Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002.

See: 2012, c. 8, Sched. 23, ss. 39 (2), 77.

Continuation of accident and sickness insurance where contract terminated

297.  (1)  Where a contract of group accident and sickness insurance, or a benefit provision therein, is terminated, the insurer continues to be liable to pay to or in respect of any group person insured under the contract benefits under the contract relating to,

(a) loss of income because of disability;

(b) death; or

(c) dismemberment,

arising from an accident or sickness that occurred before the termination of the contract or benefit provision as though the contract or benefit provision had remained in full force and effect; but the insurer is not liable to pay a benefit for loss of income because of disability in respect of the recurrence of disability arising from an accident or sickness that occurred before the termination of the contract or benefit provision if the recurrence occurs after the termination of the contract or benefit provision and after a period of ninety days, or such longer period as is provided in the contract, during which the group person insured was not disabled.

Preservation of rights where contract replaced

(2)  Where a contract of group accident and sickness insurance (herein referred to as the “replacing contract”) is entered into within thirty-one days of the termination of another contract of group accident and sickness insurance (herein referred to as the “other contract”) and insures the same group or a part of the group insured under the other contract,

(a) the replacing contract shall provide or shall be deemed to provide that any person who was insured under the other contract at the time of its termination is insured under the replacing contract from and after the termination of the other contract if,

(i) the insurance on that person under the other contract terminated solely by reason of the termination of the other contract, and

(ii) the person is a member of a class eligible for insurance under the replacing contract;

(b) every person who was insured under the other contract and who is insured under the replacing contract is entitled to receive credit for satisfaction of any deductible earned before the effective date of the replacing contract; and

(c) no person who was insured under the other contract shall be excluded from eligibility under the replacing contract solely because of not being actively at work on the effective date of the replacing contract. R.S.O. 1990, c. I.8, s. 297.

Note: On a day to be named by proclamation of the Lieutenant Governor, section 297 is repealed and the following substituted:

Continuation of accident and sickness insurance where contract terminated

297.  (1)  Where a contract of group accident and sickness insurance, or a benefit provision therein, is terminated, the insurer continues to be liable to pay to or in respect of any group person insured under the contract benefits under the contract relating to,

(a) loss of income because of disability;

(b) death;

(c) dismemberment; or

(d) accidental damage to natural teeth,

arising from an accident or sickness that occurred before the termination of the contract or benefit provision as though the contract or benefit provision had remained in full force and effect; but the insurer is not liable to pay a benefit for loss of income because of disability in respect of the recurrence of disability arising from an accident or sickness that occurred before the termination of the contract or benefit provision if the recurrence occurs after the termination of the contract or benefit provision and after a period of six months, or such longer period as is provided in the contract, during which the group person insured was not disabled. 2012, c. 8, Sched. 23, s. 40.

Time limit on insurer’s liability

(2)  An insurer that is liable under subsection (1) to pay a benefit for loss of income as a result of the disability of a group person insured is not liable to pay the benefit for any period longer than the portion remaining, at the date the disability began, of the maximum period provided under the contract for the payment of a benefit for loss of income in respect of a disability of the group person insured. 2012, c. 8, Sched. 23, s. 40.

Continued coverage under replacement contract

(3)  Where a contract of group accident and sickness insurance, in this section called the “replacement contract”, is entered into within 31 days of the termination of another contract of group accident and sickness insurance, in this section called the “other contract”, and insures the same group or a part of the group insured under the other contract,

(a) the replacement contract shall be deemed to provide that any person who was insured under the other contract at the time of its termination is insured under the replacement contract from and after the termination of the other contract if,

(i) the insurance on that person under the other contract terminated by reason only of the termination of the other contract, and

(ii) the person is a member of a class eligible for insurance under the replacement contract;

(b) every person who was insured under the other contract and who is insured under the replacement contract is entitled to receive credit for satisfaction of any deductible earned before the effective date of the replacement contract; and

(c) no person who was insured under the other contract at the time of its termination may be excluded from eligibility under the replacement contract by reason only of not being actively at work on the effective date of the replacement contract, and, despite subsection (1), if the replacement contract provides that all benefits required to be paid under subsection (1) by the insurer of the other contract are to be paid instead under the replacement contract, the insurer of the other contract is not liable to pay those benefits. 2012, c. 8, Sched. 23, s. 40.

See: 2012, c. 8, Sched. 23, ss. 40, 77.

Contents of group certificate

298.  (1)  Except as provided in subsection (2), in the case of a contract of group insurance an insurer shall issue for delivery by the insured to each group person insured a certificate or other document in which are set forth the following particulars:

Note: On a day to be named by proclamation of the Lieutenant Governor, section 298 is amended by striking out the portion before paragraph 1 and substituting the following:

Contents of group certificate

(1)  Except as provided in subsection (2), in the case of a contract of group insurance or of creditor’s group insurance, an insurer shall issue for delivery by the insured to each group person insured or debtor insured a certificate or other document in which are set out the following particulars:

See: 2012, c. 8, Sched. 23, ss. 41 (1), 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1), as amended by subsection 41 (1) of Schedule 23 to the Strong Action for Ontario Act (Budget Measures), 2012, is amended by striking out “in which are set out the following particulars” in the portion before paragraph 1 and substituting “in which the following information shall be included”. (See: 2013, c. 2, Sched. 8, ss. 22, 40)

1. The name of the insurer and a sufficient identification of the contract.

2. The amount or the method of determining the amount of insurance on the group person insured and on any person insured.

3. The circumstances under which the insurance terminates, and the rights, if any, upon such termination of the group person insured and of any person insured.

Note: On a day to be named by proclamation of the Lieutenant Governor, paragraph 3 is amended by adding “or the debtor insured” after “the group person insured”. See: 2012, c. 8, Sched. 23, ss. 41 (2), 77.

Note: On a day to be named by proclamation of the Lieutenant Governor, subsection (1) is amended by adding the following paragraphs:

4. In the case of a contract of group insurance that contains a provision removing or restricting the right of the group person insured to designate persons to whom or for whose benefit insurance money is to be payable,

i. the method of determining the persons to whom or for whose benefit the insurance money is or may be payable, and

ii. the following statement in conspicuous bold type:

5. In the case of a contract of group insurance that replaces another contract of group insurance on some or all of the group persons insured under the replaced contract, whether a designation of a group person insured, a group person insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable under the replaced contract applies to the replacement contract.

6. The rights of the group person insured, the debtor insured or a claimant under the contract to obtain copies of documents under subsection 293 (5) or (6).

7. The following statement:

Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002.

See: 2012, c. 8, Sched. 23, ss. 41 (3), 77.

Exception

(2)  This section does not apply to a contract of blanket insurance or to a contract of group insurance of a non-renewable type issued for a term of six months or less. R.S.O. 1990, c. I.8, s. 298.

Exceptions or reduction

299.  (1)  Subject to section 300 and except as otherwise provided in this section, the insurer shall set forth in the policy every exception or reduction affecting the amount payable under the contract, either in the provision affected by the exception or reduction, or under a heading such as “Exceptions” or “Reductions”.

Idem

(2)  Where the exception or reduction affects only one provision in the policy it shall be set forth in that provision.

Idem

(3)  Where the exception or reduction is contained in an endorsement, insertion or rider, the endorsement, insertion or rider shall, unless it affects all amounts payable under the contract, make reference to the provisions in the policy affected by the exception or reduction.

Idem

(4)  The exception or reduction mentioned in section 312 need not be set forth in the policy.

Idem

(5)  This section does not apply to a contract made by a fraternal society. R.S.O. 1990, c. I.8, s. 299.

Statutory conditions

300.  Subject to section 301, the conditions set forth in this section shall be deemed to be part of every contract other than a contract of gro