[M.C] v. Certas Direct Insurance Company, 2025 CanLII 35961

Citation: [M.C] v. Certas Direct Insurance Company, 2025 ONLAT 24-005429/AABS-PI

Licence Appeal Tribunal File Number: 24-005429/AABS

In the matter of an application pursuant to subsection 280(2) of the Insurance Act, RSO 1990, c I.8, in relation to statutory accident benefits.

Between:

[M.C] (A minor by their litigation guardian, [N.N]

Applicant

and

Certas Direct Insurance Company

Respondent

PRELIMINARY ISSUE HEARING DECISION AND ORDER

ADJUDICATOR: Kate Grieves

APPEARANCES:

For the Applicant: Sherilyn J. Pickering, Counsel

For the Respondent: Athina Ionita, Counsel

HEARD: By way of written submissions

OVERVIEW

1[M.C] (a minor by her litigation guardian, [N.N] (the “applicant”), claims entitlement to accident benefit from Certas Direct Insurance Company (the “respondent”) arising out of an accident that occurred on February 27, 2022. The respondent denied that the applicant was entitled to accident benefits on the basis that she was not an “insured person” as defined in the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”) The applicant applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

PRELIMINARY ISSUE

[2] The issue in dispute is: i. Is the applicant an “insured person” as defined in section 3(1) of the Schedule?

RESULT

3The applicant is an “insured person” for the purposes of s. 3(1) of the Schedule.

ANALYSIS

Background and Parties’ Positions

4The applicant was not involved in the subject accident. The applicant’s [relative], [C] was catastrophically injured in an accident on February 27, 2022 when she was 19 years old. The applicant submits that she has suffered from a mental or psychological injury that arose out of a physical injury to [C]. The applicant argues that her own mother, [N.N], has demonstrated a settled intention to treat [C] as a child, meaning that the applicant and [C] are sisters.

5The respondent’s position is that the applicant is not an insured person under the Schedule, and is therefore not entitled to accident benefits.

Does the applicant fall within the definition of “insured person” under the Schedule?

6The applicant was not involved in the accident, was not an occupant of any vehicle involved in the accident, and was not present at the accident scene. Therefore, she is only eligible for accident benefits if she is considered to be one of the individuals listed in section 3(1)(a)(ii) of the Schedule in relation to the injured person: spouse, child, grandchild, parent, grandparent, brother, sister, dependant or spouse’s dependant. The terms “parent”, “child” and “sister” are not defined in the Schedule.

7The respondent submits that cousins are not listed as family members under the Schedule, to be included as insured persons. The applicant does not share a parent with [C], and [C] was not adopted by [N.N].

8The applicant submits that [N.N] was [C]’s guardian and demonstrated a settled intention to treat [C] as a child. The applicant submits that a broad, liberal analysis of their family confirms that there was a parent-child relationship between [N.N] and [C], and therefore [C] and the applicant are sisters.

9Given that the terms are not defined in the Schedule, it is appropriate to resort to the principles of statutory interpretation. The Supreme Court of Canada has outlined the approach one should take when issues of statutory interpretation arise. The “modern approach” has been outlined in numerous Supreme Court of Canada decisions, including Bell ExpressVu Limited Partnership v. Rex, 2002 SCC 42 at para 26, citing the Construction of Statutes (2nd ed 83 1983) at page 87:

Today there is only one principle or approach, namely, the words of an Act are to be read in their entire context and in their grammatical and ordinary sense harmoniously with the scheme of the Act, the object of the Act, and the intention of Parliament.

10I agree that the Schedule is consumer protection and should be given a large and liberal interpretation to ensure the attainment of its object. Ambiguous language should be interpreted in a manner that protects insured persons.

11The applicant submits that the Family Law Act, R.S.O. 1990, c. F.3 (Family Law Act) definition of a parent includes a person who has demonstrated a settled intention to treat a child as a child of his or her family. The applicant points to family law cases in which courts considered individuals who took on a de facto role as a parent, and non-traditional parent-child relationships.

12The applicant argues that the Supreme Court of Canada decision in Chartier v. Chartier, 1999 CanLII 707 (SCC) recognizes that when a person stands in place of a parent to a child, they take on the same rights and responsibilities of a biological parent.

13The applicant relies on Millar v. Aviva, 2024 CanLII 4240 (ON LAT) where the Tribunal considered the inclusive definitions in the Family Law Act to conclude that an insured person included step-parents and step-children.

14The Court of Appeal considered the definition of “insured person” in Taggart (Litigation Guardian of) v. Simmons, 2001 CanLII 24003(ON CA) and took a liberal approach to the term “dependant relative” to include a de facto parent-child relationship even where they were not related by blood, marriage, or adoption.

15The applicant’s submissions and evidence show that the [C] was a dependent of [N.N]’s. [C] moved in with [N.N] and the applicant in 2017 and [N.N] assumed guardianship. She supported [C] financially as a child and as an adult. She was listed as [C]’s guardian in school and signed off on educational matters. [N.N] provided a statutory declaration confirming that [C] was her dependant. The level of care that [N.N] has provided to [C] since the accident, as well as her appointment as guardian for property, personal care and as litigation guardian speaks to the mother-daughter nature of their relationship.

16The Executive Chair of the Tribunal in M.F.Z. v. Aviva Canada, 2017 CanLII 6362 (ON LAT) reiterated the modern approach to statutory interpretation, concluding that the analysis involved a consideration of three factors: the language of the provision, the context in which the language is used, and the purpose of the legislation in which the language is found.

17Adopting a purposive and contextual approach, recognizing the consumer protection nature of the legislation that must be read generously, I find it unlikely that the legislature intended to exclude from the definition of “insured person” those who have demonstrated a settled intention to treat a child as a child of his or her family. [N.N] had a de facto parent-child relationship with [C], as demonstrated by the evidence.

18Black’s Law Dictionary defines the term “sister” as a female who has one parent or both parents in common with another person. Given that I have found that [N.N] is [C]’s mother as contemplated by the Schedule, [C] and the applicant are sisters.

19As [C] and the applicant are sisters, and the applicant has allegedly suffered psychological injuries arising from an accident wherein [C] suffered physical injuries, the applicant is an insured person and thus eligible for benefits under the Schedule.

ORDER

20The applicant is an “insured person” for the purposes of s. 3(1) of the Schedule.

21Given that there are no substantive issues in dispute, the Tribunal file will be closed.