Neutral Citation: 1994 ONICDRG 112
File No. A-007825
ONTARIO INSURANCE COMMISSION
BETWEEN:
ALICE M. E. MIRON
Applicant
and
OLD REPUBLIC INSURANCE COMPANY
Insurer
DECISION No.1
Issues:
Mr. Roch Maurice Miron was fatally injured in a motor vehicle accident while driving alone, in his own car, on August 17, 1991. Mr. Miron's car was not insured under a motor vehicle liability policy. Mr. Miron is survived by his wife, Alice M.E. Miron, and their three minor children.
The Applicant, Alice M.E. Miron, applied to Old Republic Insurance Company ("Old Republic") for payment of funeral expenses and death benefits for herself and her three children. Old Republic is the Insurer of the only other vehicle involved in the accident.
Old Republic denies any obligation to pay statutory accident benefits to Mrs. Miron or her children under the terms of the Insurance Act, and the Schedule1. Old Republic maintains that Mrs. Miron and her children cannot rely upon the provisions of the Ontario Automobile Policy of insurance, O.P.F. 1 ("O.P.F. 1 standard policy"), issued by Old Republic to its own insured. The parties were unable to resolve their disputes through mediation and Mrs. Miron applied for arbitration under the Insurance Act, R.S.O. 1990, c.I.8, as amended.
Mrs. Miron also claims that a binding settlement regarding the payment of funeral expenses and death benefits was reached. Old Republic denies that the matter was settled. This aspect of the dispute will be considered in a separate hearing.
ISSUE:
The issues before me in this hearing are:
Was the deceased an "insured person" under either the Schedule or the O.P.F. 1 standard policy issued by Old Republic to its own insured?
Is Old Republic required to pay statutory accident benefits to the Applicant and her children on the basis of the Insurance Act, the Schedule, or the O.P.F. 1 standard policy, or some combination thereof?
The Applicant also claims her expenses incurred in the hearing.
Result:
The deceased was an "insured person" under section 2.2.3(g) of the O.P.F. 1 standard policy issued by Old Republic to its own insured.
The Applicant is entitled to benefits under sections 2.15 and 2.16 of that policy.
The Applicant is entitled to her expenses of the hearing.
Hearing:
The hearing was held in Toronto, Ontario, on July 21, 1994, before me, Janice Mackintosh, arbitrator.
Present at the Hearing:
Applicant's
Ruth A. Henneberry
Representative:
Barrister and Solicitor
Insurer's
P. Diane McDowell
Representative:
Barrister and Solicitor
Neither the Applicant nor a representative of the Insurer was in attendance. No witnesses were called.
Counsel for the Applicant filed a brief containing 22 items which are listed in Appendix A. Counsel also sent a letter dated August 15, 1994, with an enclosure addressed to the Motor Vehicle Accident Claims Fund, and a letter dated November 10, 1994, containing further submissions.
Counsel for the Insurer filed a brief containing 25 items which are listed in Appendix B. Counsel also sent a letter dated July 26, 1994, containing further submissions and a letter dated August 29, 1994, to the Motor Vehicle Accident Claims Fund, with a copy addressed to the Dispute Resolution Group.
Other documents before the arbitrator are listed in Appendix C.
Evidence and Findings:
The facts in respect of this issue are not in dispute. For the purposes of this proceeding only, it is agreed that:
Mr. Roch Maurice Miron ("the deceased") was fatally injured as a result of a collision on August 17, 1991, in Ontario.
At the time of the accident, Mr. Miron was driving alone in his own car which was not insured under a motor vehicle liability policy.
The other vehicle involved in the accident was a truck insured under the O.P.F. 1 standard policy issued by Old Republic. Optional benefits were not available under that policy.
Mr. Miron was survived by his wife, Alice M.E. Miron, and their three children. They were all ordinarily resident in Ontario at the time of the accident.
At the time of the accident, Mrs. Miron was the only spouse of Mr. Miron, as defined under section 224(1) of the Insurance Act, and 5.2.4 of the O.P.F. 1 standard policy.
Mrs. Miron and her three children were principally dependent for financial support upon Mr. Miron within the meaning of section 3(2) of the Schedule and 2.2.