Licence Appeal Tribunal File Number: 24-010675/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:
[DD]
(By their litigation guardian, [AK])
Applicant
and
Primmum Insurance Company
Respondent
DECISION
ADJUDICATOR:
Nadia Mauro
APPEARANCES:
For the Applicant:
Thomas Dugas, Counsel
For the Respondent:
Matthew Owen, Counsel
HEARD:
By way of written submissions
OVERVIEW
1[DD], the applicant, sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”) as a result of an accident on March 6, 2022, leading to the fatality of his brother. The applicant was denied benefits by the respondent, Primmum Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. Is the applicant entitled to $16,250.00 for death benefits submitted April 24, 2023?
ii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant is not entitled to a death benefit, interest, or an award.
ANALYSIS
Background
4On approximately March 6, 2022, the applicant’s brother, [V], died in a motor vehicle accident. At the time of the accident [V] was 21 years old.
Death Benefits and Dependency
5Section 26(2) of the Schedule states that an insurer shall provide a death benefit payment of $25,000.00 to the insured person’s spouse and $10,000.00 to each of the insured person’s dependents in respect of an insured person who dies as a result of an accident.
6Pursuant to s. 3(7)(b) of the Schedule “a person is a dependant of an individual if the person is principally dependent for financial support or care on the individual or the individual’s spouse.” The leading case on this point is Miller v. Safeco Insurance Co. of America, 1985 CanLII 2022 (ONCA), wherein the Ontario Court of Appeal identified four factors to be considered when determining dependency: the amount of the dependency, the duration of dependency; the financial and other needs of the alleged dependent; and the ability of the alleged dependent to be self-supporting.
7While the issues before me are for a death benefit and an award, the applicant’s case ultimately hinges on whether he is considered a dependent pursuant to s.3(7)(b) of the Schedule.
The applicant was not principally dependent
8The applicant submits that as [V]’s disabled brother he suffered an emotional loss of his only brother and financial support that he reasonably expected to receive from him in the future. The applicant submits that due to his disability, he is unable to live independently, earn a living, and his care needs are significant and ongoing. The applicant submits that he resides with his parents, and prior to his brother’s passing, [V] was a primary source of emotional support and expected primary source of financial income.
9The respondent submits that there is no evidence about where the applicant was living at the time of the accident, whether he had any sources of income, whether he was capable of living independently, or the extent to which he is able to complete activities of daily living. The respondent submits that, in the applicant’s submissions, he admits that he was not principally dependent on his brother at the time of his death.
10While I am sympathetic to the tragic passing of the applicant’s brother, submissions are not evidence. The only evidence that the applicant has provided, other than the accident report, death certificate, and disability certificate, are “photographs with various dates”. It is not clear who is in the photos, when the photos were taken, or how they satisfy the legal test of dependency.
11I agree with the respondent that there is a lack of evidence to support the applicant’s claimed circumstances. While the applicant submits, in his reply submissions, that he was not financially independent and relied on the family unit, including [V], to meet his daily needs, the applicant has not provided any evidence to support this assertion. The applicant has not provided any evidence of financial transactions that would support he was receiving any payment from the deceased. It is also not clear how much financial assistance the deceased provided to the applicant or how much of the deceased’s financial assistance would contribute to the applicant’s daily living expenses. The applicant does not make submissions or provide evidence to support the frequency and duration of the financial assistance, nor the amount of financial assistance to establish that he was “principally dependent” financially on [V].
12I acknowledge that the evidence supports that the applicant has a disability. However, as I have indicated above, submissions are not evidence. The applicant has not provided any evidence to support that [V] provided any physical or emotional care. I find that the applicant’s submissions are vague and do not engage with any specific details that would provide clarity on how [V] provided physical care or emotional support, such that the applicant was “principally dependent” on his brother at the time of the accident.
13Based on the evidence before me, I find that the applicant has not demonstrated that he was principally dependent on the insured for financial support or care in accordance with s.3(7)(b). As such, I find that the applicant is not entitled to a death benefit.
Interest
14As there are no overdue benefits, the applicant is not entitled to interest pursuant to s. 51 of the Schedule.
Award
15The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits.
16As there are no overdue benefits, the applicant is not entitled to an award.
ORDER
17I find that:
i. The applicant is not entitled to a death benefit;
ii. The applicant is not entitled to interest pursuant to s. 51 of the Schedule;
iii. The respondent is not liable to pay an award; and
iv. The application is dismissed.
Released: March 16, 2026
Nadia Mauro
Adjudicator