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Summary judgment dismissing accidental death insurance claim where accident not proven.
The insurer brought a motion for summary judgment dismissing a claim for accidental death and dismemberment benefits following the insured’s fatal fall from a condominium balcony.
The estate alleged the death was accidental and further claimed the insurer breached its duty of good faith by denying coverage.
The court held that the claimant bears the burden of establishing, on a balance of probabilities, that the death resulted from an accident within the meaning of the policy.
After reviewing the surrounding circumstances and physical evidence, the court found the accidental fall theory was not supported and that the plaintiff could not prove accidental death.
The insurer’s denial of benefits was also found to be reasonable and not made in bad faith.
Appeal dismissed; settlement agreement did not override the disability policy's CPP benefit offset provision.
The appellant was receiving long-term disability benefits from the respondent insurer.
The parties had previously settled a dispute regarding the calculation of benefits, executing Minutes of Settlement and a Release that affirmed the policy continued to apply.
The appellant later received retroactive Canada Pension Plan (CPP) disability benefits, and the insurer sought to deduct these from her long-term disability benefits as a direct offset under the policy.
The appellant applied for a declaration that the Minutes of Settlement precluded this deduction.
The application judge dismissed the application, finding the settlement did not modify the policy's CPP offset provision.
The Court of Appeal upheld the decision, confirming that the contractual interpretation was correct and the policy's offset provisions remained in effect.
