C14

Front 1

The Canadian Legal Environment: Systems

Back 1

-Civil Code (QC)
-Basic provisions that governs life in society, relationships among citizens, people and property.
-Governs civil rights, including auto insurance.
-Courts look to the code as a basis for a decision

-Common Law
-Based on Precedent. Exists only in past decisions and has no code or legislation. This makes the law flexible and adaptable to changing circumstances.

Front 2

Precedent

Back 2

Is a legally enforceable decision made by a judge that will guide judges in making subsequent decisions in similar cases

Front 3

The Canadian Legal Environment: Levels: Federal

MC VOID

Back 3

Federal:
-Matters that affect all of Canada
-Criminal Code: Driving Offenses: DUI, Theft, Dangerous Driving
-Conviction VOIDS coverage for the insured driver

Front 4

The Canadian Legal Environment: Levels: Provincial

CARE

Back 4

Provincial:
-Conviction does NOT VOID unless specified
-Auto Insurance falls under provincial jurisdiction
-Rules of the Road: Limits, Patterns, Signs / Signals
-Education, Health, property

Front 5

The Canadian Legal Environment: Levels: Municipal

BEC

Back 5

Municipal:
-Bylaws dealing with local matters
-Enact Parking / Crosswalk / Speed w/i Borders
-Conviction does NOT VOID unless specified

Front 6

The History of Auto Insurance in Canada

HELL 1920 / 1930 MORE

Back 6

-Hazard to life, limb and property
-Extended to the auto itself (fire / theft / collision)
-Legislation developed to govern auto operation
-Largest premium producer is casualty feild
-1920 Stat Cond. provided consistency in settlement
-1930 Standard Wording were to address fine print
-Manditory
-Operation Rules added
-Regardless of Fault AB
-Extended to Income Loss / Other expenses

Front 7

Auto Insurance Distribution

Back 7

1. Private Insurers
-Brokers / Agents
-Direct to the Public (Direct Writing)
-Combo
*AB, NB, NF, NS, ON, PEI, YK, NV, NWT

2. Crown Corporations created by governments (ICBC)
-Brokers / Agents
-Through their own direct sales dep't
-Through other gov't agencies
*BC, MN, SK
-Paid annually / No policy issued

Front 8

Legislation

Back 8

-Controlled by provincial legislation
-ALTA Superintendent of Ins approves all forms
-Varied by approved standard end. or approval by S.I.

Front 9

6 Standard Forms of Auto Policies

LENGDO

Back 9

-SPF1: Standard Owners
-SPF2: Standard Drivers
-SPF4: Standard Garage (0wned, non, clients)
-SPF6: Standard Non-Owned (Use / Operation)
-SPF7: Excess (Excess Liability)
-SPF8: Lessor's Contingent (Bus. that lease long term)

Front 10

Abbreviations

Back 10

SPF - Standard Policy Form
SAF - Standard Application Form
SEF - Standard Endorsement Form
OAP - Onterio Auto Policy
QPF - Quebec Policy Form

Front 11

Forms: Variations

Back 11

-Names. Ex: Ontario (OAP), Quebec (QPF)
-No policy issued for basic compulsory (BC / MN / SK)
-MN / SK require all extensions be of standard and approved form similar in scope to SPF 2 - 4 - 6
-BC optional forms do not have to be approved. They must comply with rules set out in legislation

Front 12

Alberta Auto Insurance: Governing Statutes

ITALIC

Back 12

Insurance Act
Traffic Safety Act
Alberta Hospitals Act
Limitation Act
Insurance
Companies Act

Front 13

Governing Statutes: Insurance Companies Act

ELSE

Back 13

-Enacted by the Federal Gov't
-Licensing and Supervision
-Solvency Standards
-Enforced through the (OSFI)

Front 14

Governing Statutes: Insurance Act

FALSE

Back 14

-Forms used are approved by S.I.
-Administered by the provincial S.I.
-Licenses: Insurers, Agents, Brokers, Adjusters
-Statutory Requirements: contents / procudures
-Examines federally licensed Insrs

Front 15

Governing Statutes: Insurance Act : Fair Practices Amendment

CLAD

Back 15

-Consumer protection
-Limitation periods - Clear Disclosure
-Advance payment on BI provision - through court
-Dispute Resolution - Clear Disclosure

Front 16

Governing Statutes: Traffic Safety Act

Traffic Registration Requires Licensing

Back 16

-TRAFFIC control of vehicles on highways
-REGISTRATION / Licensing of vehicle
-REQUIRES relating to proof of financial responsibility and safety responsibility
-LICENSING of drivers

Front 17

Governing Statutes: Limitations Act

Fixes Extensions 2 Exceptions

Back 17

-FIXES time which plaintiff must commence action
-EXTENSION for cause of action
-2 years - consistent with Ins. Act provisions (July 1/12)
-EXCEPTIONS children, disabled, mentally incompetent

Front 18

Governing Statutes: Alberta Hospitals Act

No Crown Annual

Back 18

-NO longer subrogates for claim resulting from negligent drivers where they are insured by an Alberta Insurer
-CROWN to recover expenses from 3rd party liability Insurers
-ANNUAL submission for their share of the expenses

Front 19

Governing Statutes: Acts vs. Regulation

OLD ACT

Back 19

-Older statutes tend to be all inclusive statements
-Lieutenant Governor has delegated power to make new regulation that will shape the concept
-Difficult to change old (time / cumbersome)
-Act of legislature req to change old
-Can not amend, alter or narrow by regulation
-Tenadancy for new acts to be skeleton documents

Front 20

Legal Concepts / Parties to a Claim

Back 20

Negligence
Onus of proof
Subrogation
Absolute Liability

Insured = 1st Party
Insurer = Second Party
Others = 3rd Party

Front 21

Legal Concepts: Negligence

POO

Back 21

The omission to do something which a reasonable person, guided by those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable person would not do

-Provincial legislation states the negligent are liable
-Owner and Operator have equal liability
-Operator must have owner consent

Front 22

Legal Concepts: Onus of Proof

MODE

Back 22

Means the burden or responsibility of proof, and is sometimes referred to by its Latin term, onus probandi

-Many accident avoid court / use fault chrts
-Onus on the plaintiff (Suer)
-Defendant to show no negligence or lies elsewhere
-Exception for accident involving pedestrians

Front 23

Legal Concepts: Subrogation

Back 23

Is the transfer of legal rights [to an insurer] of someone whose debts or expenses have been paid to pursue recovery from an at-fault party

-Rights can be removed / limited by legislation

Front 24

Legal Concepts: Absolute Liability

Insurers Only Judge Direct Protection

Back 24

The insurer is responsible to pay 3rd party claims even if the insured has breached a policy condition

-INSURERS has right to recover from Insd
-ONLY min. jurisdiction limit required (AB = 200K)
-JUDGE against the insured may be required
-DIRECT right of action for auto liability fr 3rd parties
-PROTECTION of innocent 3rd parties r

Front 25

Legal Concepts: Absolute Liability: Alberta Insurance Act

Can't Assign Any Act

Back 25

-Judgement required for payment
-Leniency in practice

-Section 635 - CANT deny 3rd party right to recover from at fault insd based on certain actions, including:

a)ASSIGN, transfer, cancel, etc after the event
c)ANY contravention of Criminal Code or Statute
b)ACT/default be4/after contravention of the contract

Front 26

Third Party Liability Coverage

Back 26

I

Front 27

1. 3rd Party Liability Coverage - Section A

First Mandatopry Damage Protection In Alberta

Back 27

-First coverage.
-Mandatory coverage
-Damage to a 3rd = two types: (BI) or (PD)
-Protection for accident or claim for BI/D/PD up to limit
-In Alberta, the law states that a person shall not drive or operate a motor vehicle or trailer on the highway unless they have a valid driver’s license and a valid auto insurance policy (SPF 1).

Front 28

3rd Party Liability Coverage - Section A: Insurance Act 608

Back 28

-Insurance Act, Section 608 (e) states the “insured” means the following:
A person insured by a contract whether named or not and includes any person who is stated in a contract (of auto insurance) to be entitled to benefits payable under the insurance mentioned in Section 629 whether described in the contract as an insured person or not.

Front 29

3rd Party Liability Coverage - Section A: SPF 1

Back 29

The SPF 1 states the following:
-The insr agrees to indemnify the insured and, in the same manner and to the same extent as if named herein as the insured every other person who with his consent personally drives the automobile, or personally operates any part thereof, against the liability imposed by law upon the insured or upon any such other person for loss or damage arising from the ownership, use or operation of the vehicle.

Front 30

3rd Party Liability Coverage - Section A - SPF 1

Back 30

-Consent can be express, implied or vicarious.
-“Operating” can mean closing a window, shutting a door, slamming the trunk, or changing a tire etc.
-“Use” may include cleaning a motorcycle, drilling a hole in preparation for the connection of a trailer, spilling an oil load, a passenger grabbing the wheel, or getting out of the car.
-Not including – sleeping in the vehicle, lighting a hibachi in the vehicle, an assault arising out of an accident, or assaulting a passenger causing this person to jump out of a moving vehicle.

Front 31

3rd Party Liability: Definition of Insured

Back 31

-Policyholder; and
-Persons driving with consent.
-Deceased, His or her personal rep or other person having custody of vehicle pending settlement of will
-Where the owner is not an individual, An officer, employee, or partner of the owner, for whose regular use the vehicle described is provided; and
-Members of the household of such officers, employees or partners.

Front 32

3rd Party Liability: Evidence of Insurance

Back 32

-MV liability cards or pink cards serve as evidence of 3rd party liability ins.
-It must be in the veh. and produced on demand
-Proof the policy is in effect w/ at least the min. limits *Name and address of the insurer and insured
*Agency or brokerage name or number
*Policy number
*Effective and Expiry date
*Description of the insured vehicle
-Traffic Safety Act contains a warning for the misuse of the pink card and what to do in the event of an accident.

Front 33

3rd Party Liability: Financial Responsibility

Back 33

-Maintain financial resources to compensate those they injure.
-Most common to satisfy these req. w/pink card.
-Filing proof of financial responsibility: insr files a certificate with Registrar of Motor Vehicles, showing a policy is issued in the name of the person involved, giving a description of the vehicle(s) owned.
-Must cover to min. limits, and guarantees Registrar will be notified in the event of a cancellation.

Front 34

3rd Party Liability: Financial Responsibility Part 2

Back 34

-Persons may need to file proof if previous Criminal Code convictions, or in an accident while uninsured, or in the cases involving underage or elderly drivers.
-SPF 2 – Drivers policy – for drivers that drive but do not own veh.
-Surity bond filed by a licensed surety company or depositing cash, or satisfactory securities, equal to the minimum limits of insurance required in the province for each vehicle owned.

Front 35

3rd Party Liability: Additional Agreements of the Insurer

PRO BIND

Back 35

-Pay all costs taxed against the insd and interest on any part of the judgement that is within the limits of the policy after the judgement has been rendered.
-Reimburse the insd for medical aid as may be necessary at the time of the accident causing injury.
-Outside of the “home” province:
-Be liable for min. limits in the prov. where the accident occurred if limit is higher than policy limits.
-Investigate, negotiate and settle claims.
-Not set up a defence against a claim that might not be set up if the policy were issued in the province or territory where the accident occurred.
-Defend the insd and pay the cost of any civil action.

Front 36

3rd Party Liability: Additional Agreements of the Insured

AR

Back 36

Responsibilities of insured include:
-Appiont Insr irrevocably as the insd attorney to conduct civil defence(s) in actions arising out of the ownership, use, or operation of the automobile.
-Reimburse the insr for all amounts the insr is required to pay because of the provisions of any statute relating to auto ins for which the insurer would not otherwise be liable under the policy.

Front 37

3rd Party Liability: Exclusions

PIECE

Back 37

Property in or upon the auto, or owned, rented by, or in care, custody, control of insd.
Imposed by work comp. law upon the insd.
Employee BI or Death while op or repair of the auto.
Contamination of property being carried in the auto.
Excess of policy limits, subject to provision of Ins Act relating to nuclear energy hazard.

Front 38

3rd Party Liability: Priorities of Payment

BI 95 / 5

Back 38

-Claims for BI have priority.
-In Alta 95% of the min. limits apply ($200,000) to the BI or $190,000, and 5% for PD or $10,000.
-Only applied when the dmg awarded are greater than the limit of 3rd Party Liability purchased.
-Alta Ins. Act stipulates for minimum TPL limits but is silent where the insured has purchased greater limits

Front 39

Accident Benefits

Back 39

-Injury or death from accident = financial burdens
-Incur med / rehab expenses, not earn income.
-Dependents no means of support.
-Collecting from fault party if ins., but it may take mnth or yrs, disputed, settlement reached in court.
-Prior to coverage, at fault = no financial assistance
-coverage = modest assistance w/o regard to fault.
-First no-fault coverage.

Front 40

Accident Benefits: No Fault Concept

Back 40

-Means that claims are settled with an insured without any regard for the traditional legal liability concepts with their owns insurers.
-Origins in accident and health insurance.
-Cover death, dismember, loss of sight etc,
-Limited benefit for low premiums.
-Loss of income coverage was available as a policy or rider by life insrs, not restricted to auto accidents.

Front 41

Accident Benefits: The Evolution of No Fault BI Coverage

Back 41

-AB evolved from medical expense coverage
-Insd had a choice of limits.
-Although Universal Health Care was established, insd financially vulnerable prevents earning a salary
-May incur rehab costs not covered.
-Early stages, AB similar in all provinces.
-Modest limits / immediately available to injured
-Seriously injured deal with immediate expenses and then pursue recovery from an at fault driver

Front 42

No Fault AB Coverage: Threshold

Back 42

Is the degree of injury a claimant must establish before being allowed to commence legal action against the negligent party. It may be a dollar amount or a verbal description of the severity of the injuries.

Issue: High thresholds might encourage lawsuits for larger amounts

Front 43

Accident Benefits: The Evolution of No Fault BI Coverage: No / Limited right to sue

Back 43

-In some prov, the right to sue has been removed or limited to specified circumstances & coverage is greatly enhanced and the limits are increased

QC / MN - No right to sue
ON / SK - Limited right to sue

Front 44

Accident Benefits: Alberta

Back 44

-Mandatory
-Right to sue intact
-Passenger / Driver / Pedestrian

Front 45

Accident Benefits: Alberta: Regulations

Back 45

-Diagnostic and Treatment Protocols
-Minor Injury
-Auto Accident Ins Benefits Amendment
*Sub 1: Medical Payments
*Sub 2:
-Part 1: Death / Grief / Funeral
-Part 2: Total Disability
*Sub 3: Uninsured Motorist Coverage

Front 46

Accident Benefits: Alberta: Regulations: Diagnostic & Treatment Protocol Regulation

Back 46

Identifies minor injuries (sprains, strains, minor whiplash disorders) that can typically be resolved w/i 90 days and outlines specific, pre-approved treatment protocols that will apply. After 90 days treatment will move to regular Section B coverage

Front 47

Accident Benefits: Alberta: Regulations: Minor Injury Regulation

Back 47

Establishes maximum amounts payable for non-economic losses (Pain & Suffering) for minor injuries. Amounts are indexed to the Alberta Consumer Price Index and are adjusted annually.

Front 48

Accident Benefits: Alberta: Regulations: Definitions

Back 48

-Minor Injuries: Sprains, strains, minor whiplash injuries that do not result in a serious impairment

-Serious Impairment is an impairment of a physical or cognitive nature that results in substantial inability to do the essential tasks of one's job, training, education, or normal activities

Front 49

Accident Benefits: Alberta: Regulations: Auto Accident Ins Benefits Amendment: Subsection 1: Medical Payments

Back 49

-Expenses from injuries w/i 2 years of accident
-Reasonable expenses deemed essential per insd and Dr. / Insr med. adviser
-Only covers that not covered by prov / private plans

$50000 Limits per person
$750 Limit for Chiropractor
$250 Limit for Massage / Acupuncture

Front 50

Accident Benefits: Alberta: Regulations: Auto Accident Ins Benefits Amendment: Subsection 2: Part 1: Death, Grief Counseling, and Funeral Benefits

Back 50

Funeral = $5000
Grief = $400 / per Family
Death = Varies

Front 51

Accident Benefits: Alberta: Regulations: Auto Accident Ins Benefits Amendment: Subsection 2: Part 1: Death, Grief Counseling, and Funeral Benefits: Death Benefits

Back 51

$10000 - to HOH / Spouse / Adult Partner
$1000 - dependents under 5 or over 69
$2000 - dependents any other age
$3000 - dependents 10-17
*Reduced by payments made under Total Disability
*Increased when:
-2+ survivors after HOH dies = 20% except 1st
-$15000 to 1st survivor
-$4000 for each remaining survivor
**Paid to someone alive 60 days after death

Front 52

Accident Benefits: Alberta: Regulations: Auto Accident Ins Benefits Amendment: Subsection 2: Part 2: Total Disability

Back 52

-Unable to work if work 6 of last 12 months
-Disability not less than 7 days
-Disability must arise w/i 60 days of accident
= Greater of last 4 weeks 52 weeks
= 80% of gross salary to max of $400 / week
= $165 / week for Principal unpaid housekeeper
*Reduced by amounts from Group Accident Policy / Accident & Sickness Policy / Sick Leave Policy

Front 53

Accident Benefits: Alberta: Regulations: Auto Accident Ins Benefits Amendment: Subsection 2: Part 2: Total Disability: No Fault Jurisdictions

Back 53

No Fault Systems: ON / QC / SK / NB* / MN
-Non-Res not entitled to benefit
-Benefit determined based on degree not at fault

Reciprocal Agreements with Alta (SK / ON / QC / MN)
-Alta insurer pays per the jurisdiction rules where the accident occurred. The Alta resident can not sue in QC / MN and limited in SK / ON
-Available only to resident of Alta
-Insr agrees not to subrogate in SK / MN

Front 54

Section B: AB Benfits: Insured Person (Individual)

Back 54

-any occupant of described / temp / new vehicle or while a pedestrian is struck
-Spouse / Dependent Relative of either, living in same home, while occupants of another auto or while pedestrian and struck provided:
*not selling, repairing, storing, or parking
*not owned or reg used by them or owned, hired, leased by their employer
*Auto is not used for carrying passengers for compensation or for commercial delivery

Front 55

Section B: AB Benefits: Insured Person (business)

Back 55

-Any employee / partner and their spouses / dependent relatives of either, living in the same home while an occupant *provided vehicle is not used for carrying passengers for hire. The same persons are covered while a pedestrian and struck by any other private passenger vehicle provided:
*not selling, repairing, storing, or parking
*not owned or reg used by them nor do they own another vehicle
*Auto is not owned, hired, or leased by them or their employers

Front 56

Section B: AB Benefits: Exclusions Part 1
*Does not apply to death benefits

Back 56

Medical / Total Disability
Injury to any person;
-resulting from suicide or attempt
-entitled to WCB
-for injury or death by speed test or race
-caused directly by sickness or disease
-who is using auto for illicit trade / transport

Front 57

Section B: AB Benefits: Exclusions Part 2

Back 57

Total Disability
The Insurer will not pay anything;
-for injury while driving impaired (Convicted)
-Injury by person under legal age to acquire DL
-Injury or death to anyone not authorized by law or qualified to drive

Front 58

Section B: Ab Benefits: Notice and Proof of Claim

Back 58

Subject to the Diagnostic and Treatment Protocols Regulation the insured is required to;
-w/i 30 days or asap give Insr properly completed claim form containing detail of injury and accident
-Furnish a med. certificate, if required, with respect to a total disability claim

Front 59

Section B: Ab Benefits: Medical Reports

Back 59

Gives the Insurer the right to;
-have claimant physically examined by a duly qualified med. practitioner as often as reasonable required while the claim is pending
-To require an autopsy in the event of death
*No right where injuries are subject to Diagnostic & Treatment Protocols

Front 60

Section B: AB Benefits: Release

Back 60

The Insurer may demand a release prior to payment

Front 61

Section B: AB Benefits: When Moneys Payable

Back 61

Except under Diagnostic & Treatment Protocol;
-w/i 60 days of receiving proof of claim involving Medical Payment, Funeral Benefit, Death Benefit
-w/i 30 days after receiving proof of disability claim involving weekly payment, and every 30 days after
*No action until Medical Reports and Notice and Proof Requirements met
*Action must be commenced within 2 yrs of accident or date Insr refused payment

Front 62

Uninsured Automobile Coverage

Back 62

-Not all accidents caused by Insd or Identified person
-Victems have no way of protecting selves
-Varies province to province
-May be under SPF1 or Own Damage or AB
-In Alta under Subsection 3 of AB Section B of SPF1

Front 63

Define: Uninsured AUtomobile

Back 63

Neither owner or driver therof has applicable collectable bodily injury liability coverage for the ownership, use, operation of the auto.

Front 64

Define: Unidentified Automobile

Back 64

Owner or driver cannot be determined where the automobile causes bodily injury or death to an Insd arising out of physical contact with the auto the Insd was in at the time of the accident (Hit & Run)

Front 65

Uninsured Automobile Coverage: Requirements

Back 65

-Report to police w/i 24 hrs
-Allow Insr to inspect the vehicle the Insd was in
-Uninsured / unidentified person must be at fault
-Legal liability / amount of damage negotiated
-Arbitration Act is not agreed (binding)
-Insd can Institute legal action (Prior to Insr paying) against anyone owner / operating the vehicle involved but mjust provide Insr with copies of the Writ of Summons or process document immediately

Front 66

Uninsured Automobile Coverage: Unsatisfied Judgement Funds

Back 66

-Some jurisdiction have special funds to indemnify
-Some cover bodily Injury only
-Others cover property w/ deductible if person identified
-Can not recover from fund and Insurer
-May compensate where the person has no policy of their own
-Yukon and NWT + 40 states do not have funds

Front 67

Uninsured Automobile Coverage: Alberta: Section B: Subsection 3

Back 67

Protect insured by permitting recovery from their "own Insurer" of amounts which the insured would be entitled to recover from the uninsd / ident owner
*Insr not liable to; any person who has right of recovery under an unsatisfied judgement fund or plan in effect in any jurisdiction of CDN or USA
**However MVA claims act prohibits payment from funds where applicant is legally entitled to receive from any other source

Front 68

Uninsured Automobile Coverage: Alberta: Section B: Subsection 3: Persons Insured

Back 68

i: any occupant of the auto described in policy
ii: Insured, Spouse / Dependent Relative of either, in same home, while occupants other auto provided:
*The insd is an individual or two partners
*not selling, repairing, storing, or parking
*not owned / reg used by the insd or person residing
*Auto not for carrying passengers for compensation
iii: Business: -Any employee / partner and their spouses / dependent relatives of either, living in the same home while an occupant *provided vehicle is not used for carrying passengers for hire.