The applicants claimed accident benefits arising from the death of a New York resident in an Ontario motor vehicle accident.
The deceased was insured by Aetna under a New York policy with standard benefits, and was an occupant in a vehicle insured by Zurich under an Ontario policy with optional increased death benefits.
The arbitrator held that under section 45(1) of the Insurance Act, the out-of-province policy is deemed to include standard Ontario accident benefits, but the deceased is not deemed to have purchased optional benefits.
Furthermore, under the priority rules in section 268(2), the applicants must seek recourse from the deceased's own insurer (Aetna) and cannot claim the optional benefits from the vehicle's insurer (Zurich).
