CITATION: Wais v. Coachman Insurance Company, 2025 ONSC 5595
DIVISIONAL COURT FILE NO.: No: 691/24
DATE: 2025-10-09
ONTARIO
SUPERIOR COURT OF JUSTICE
DIVISIONAL COURT
KURKE, O’BRIEN, and PINTO JJ.
BETWEEN:
Mir Wais Appellant
– and –
Coachman Insurance Company Respondent
COUNSEL: Slavko Ristich and Jane Cvijan, for the Appellant Michael J. L. White and Mitchell T. Hajnal, for the Respondent
HEARD at Toronto: September 30, 2025
REASONS FOR DECISION
PINTO J.
Overview
[1] The appellant appeals the decision and reconsideration decision (“the Decisions”) of the Licence Appeal Tribunal. The Tribunal found that the appellant was not a named insured, nor driving an insured vehicle, under any insurance policy in effect at the time of a motor vehicle accident pursuant to s. 3(1) of the Statutory Benefits Schedule – Effective September 1, 2010, O. Reg 34/10, as amended (the “SABS”). As a result, the Tribunal determined that the respondent insurance company was not required to assign the appellant a claim number pursuant to s. 32(3)4 of the SABS.
[2] For the reasons that follow, the appeal is dismissed.
Background
[3] The appellant was involved in a motor vehicle accident on August 20, 2021. On September 30, 2021, the appellant submitted an Application for Accident Benefits (“OCF-1”) to the respondent. The respondent did not open an accident benefit claim for the appellant, but rather, by email dated October 7, 2021, informed the appellant that his policy had lapsed. There is no dispute that the respondent was the appellant’s insurer from 2017 until June 10, 2021. The parties disagree as to whether the respondent was required to accept the appellant’s OCF-1 and pay accident benefits, pending the resolution of a priority dispute pursuant to O. Reg. 283/95 – Disputes Between Insurers.
Tribunal Proceedings
[4] The appellant requested that the Tribunal determine whether the appellant was an “insured person” pursuant to s. 3(1) of the SABS, and if the respondent was obligated to provide a claim number pursuant to s. 32(3)4 of the SABS.
[5] In its decision dated October 18, 2024, the Tribunal concluded that:
(a) The appellant was not a named insured in any insurance policy in effect at the time of the accident. Nor was the appellant driving an insured automobile;
(b) The appellant’s policy with the respondent lapsed in June 2021 and the appellant’s insurance broker failed to properly put in place a policy with Nordique Insurance prior to the accident; and
(c) The appellant did not meet the definition of an “insured person”, and the respondent was not required to provide a claim number and pay an award.
[6] In its reconsideration decision dated February 5, 2025, the Tribunal concluded that the appellant had introduced new arguments not raised in the initial hearing about:
(a) The jurisdiction of the Tribunal versus arbitrators under the priority regulation; and
(b) Anyone involved in an accident being an “insured person” by virtue of their recourse to the Motor Accident Vehicle Claims Fund (“the Fund”).
[7] On reconsideration, the Tribunal held that, even if it were to consider the appellant’s new arguments, it would affirm its initial decision.
[8] In its reconsideration decision, the Tribunal found that, although the appellant argued that he had recourse to the Fund, he had not led evidence in support of this claim. The appellant had not shown that recovery was unavailable under subsection (iii) of s. 268(2)1 of the Insurance Act, R.S.O. 1990, c. I.8, as it appeared from the Motor Vehicle Collision Report that there was an additional driver involved in the accident who was insured with Certas Direct Insurance Company. As such, the appellant should have shown that he had no recourse against the insurer of the other automobile involved in the accident before he could claim coverage by the Fund. He had not done so.
Jurisdiction and Standard of Review
[9] This court has jurisdiction over this appeal pursuant to s. 11 of the Licence Appeal Tribunal Act, S.O. 1999, c. 12, Sched. G. Pursuant to s. 11(3), an appeal may be made on a question of law only. The standard of review on questions of law is correctness: Canada (Minister of Citizenship and Immigration) v. Vavilov, 2019 SCC 65, at para. 37.
Discussion
[10] On appeal, the appellant submits that:
(a) The Tribunal erred in law in its interpretation of “insured person” in the SABS; and
(b) the Tribunal breached the principles of procedural fairness.
Appeal on Substantive “Error of Law” Grounds
[11] I find no legal error in the Tribunal’s decisions and would dismiss the appeal on substantive grounds. The appellant is asking this court to endorse a novel interpretation of the SABS that would lead to an unacceptable result where anyone involved in a motor vehicle accident in Ontario could apply to any auto insurance provider and, regardless of whether the person had motor vehicle insurance with, or any nexus to, that provider, the company would have to pay benefits under the SABS, subject to a subsequent priority dispute and determination. The Tribunal rejected such an interpretation and was correct in doing so.
[12] The appellant submits that, on a proper reading of the SABS, the appellant is, in fact, “insured” even though he is not insured by the respondent, or for that matter, any insurance provider. The appellant argues that anyone involved in an accident in Ontario has the SABS coverage because every motor vehicle insurance contract is required by legislation to provide the SABS benefits. Nevertheless, Section 6 of the Motor Vehicle Accident Claims Act, R.S.O. 1990, c. M.41, contemplates that an “insured person” involved in an accident may not have the SABS coverage under a contract issued by a private insurer so, in such circumstances, the Fund steps in as the payor of last resort. Section 268(2) of the Insurance Act outlines priority for liability to pay if an insured applies to the wrong insurer, in order to sort out which insurer is, in fact, liable to pay the SABS. On this argument, the appellant submits the Tribunal committed legal error by considering whether the respondent was liable to pay benefits to the appellant. Rather, he says, the Tribunal should have simply asked whether the appellant was “insured” under the SABS, and the question of the appropriate payor was a downstream question that only an arbitrator under the priority regulation, not the Tribunal, had the exclusive jurisdiction to answer.
[13] I find that the appellant is raising a question of law since he is arguing that the Tribunal misinterpreted the meaning of “insured person” or “insured automobile” under the SABS.
[14] Section 2(1) of the SABS states:
- (1) Except as otherwise provided, the benefits set out in this Regulation shall be provided under every contract evidenced by a motor vehicle liability policy in respect of accidents occurring on or after September 1, 2010.
[15] Under section 3, the “Definitions and interpretation” section, of the SABS:
“insured automobile” means, in respect of a particular motor vehicle liability policy, an automobile covered by the policy;
“insured person” means, in respect of a particular motor vehicle liability policy,
(a) the named insured, any person specified in the policy as a driver of the insured automobile and, if the named insured is an individual, the spouse of the named insured and a dependant of the named insured or of his or her spouse,
(i) if the named insured, specified driver, spouse or dependant is involved in an accident in or outside Ontario that involves the insured automobile or another automobile, or
(ii) if the named insured, specified driver, spouse or dependant is not involved in an accident but suffers psychological or mental injury as a result of an accident in or outside Ontario that results in a physical injury to his or her spouse, child, grandchild, parent, grandparent, brother, sister, dependant or spouse’s dependant,
(b) a person who is involved in an accident involving the insured automobile, if the accident occurs in Ontario, or
(c) a person who is an occupant of the insured automobile and who is a resident of Ontario or was a resident of Ontario at any time during the 60 days before the accident, if the accident occurs outside Ontario.
[16] I agree with the Tribunal in its reconsideration decision that the words “a particular motor vehicle liability policy” in both the definition of “insured automobile” and “insured person” refer to the specific policy insuring the person or the vehicle, and not just any theoretical, potential, or generic motor vehicle liability policy. I agree with the Tribunal’s reasoning that the appellant has not provided any authority for the argument that a “particular” policy “means any indeterminate policy or is a reference to a ‘group’ of insureds that automatically get coverage from the Fund.”
[17] The consequences of adopting the appellant’s expansive interpretation of the SABS would be that every motor vehicle involved in an accident in Ontario would be an “insured automobile” and every occupant in such a vehicle would become an “insured person”, and entitled to the SABS benefits from any insurer in Ontario. In this scenario, the person could seek benefits from any insurance provider in Ontario who would be obliged at first instance to provide accident benefits, subject only to subsequent adjustment in a priority dispute with another insurer or the Fund.
[18] In oral argument, the appellant cited Zurich Insurance Co. v. Chubb Insurance Co. of Canada, 2014 ONCA 400, as supporting the proposition that a person involved in a motor vehicle accident in Ontario could have access to any Ontario motor vehicle insurer for the SABS benefits. In Zurich, the Supreme Court (2015 SCC 19) overturned the Ontario Court of Appeal’s majority decision and adopted as its own the dissenting reasons of Juriansz J.A.
[19] I cannot see how Zurich assists the appellant. Zurich was a “nexus” case concerning a debate about whether Chubb, which had provided optional accidental death and dismemberment (“AD&D”) insurance, was obliged to pay out a claim for benefits under the SABS. The Supreme Court agreed with Juriansz J.A.’s reasoning that Chubb, as the first insurance company to receive a completed application for benefits, was obliged to pay the SABS benefits while disputing coverage. The claimant in Zurich had motor vehicle insurance coverage either through Zurich or Chubb, hence there was a priority dispute. Zurich was not about persons being considered insured under the SABS despite having no coverage.
[20] The appellant’s final argument was that, since the Fund steps in as the payor of last resort, the appellant was, in effect, “insured” under the SABS, and the Tribunal’s Decisions to the contrary were wrong. Recourse to the Fund, however, is not automatic. The Tribunal held that the appellant had the onus and failed to prove that he had met the requirements of s. 268(2)1 of the Insurance Act, namely that he had first exhausted his recourse against all other insurers. The appellant has not suggested any basis to interfere with this conclusion. It therefore cannot be said that the Fund would have insured the appellant, and the appellant’s argument based on the Fund as the appellant’s insurer fails.
[21] In sum, I find that the Tribunal was correct in determining that the appellant did not meet the definition of an “insured person” under the SABS. Consequently, the respondent was not required to provide a claim number and was not liable to pay an award.
Appeal on Grounds of Breach of Procedural Fairness
[22] The appellant submits that he was denied procedural fairness for three reasons:
a) First, he argues the Tribunal prioritized expediency over fairness when it only gave the parties ten double-spaced pages to make their submissions at first instance and on reconsideration;
b) Second, he argues the Tribunal adjudicator did not have sufficient expertise in the subject matter to make the decision as part of the specialized tribunal; and
c) Third, he argues the severity of the adjudicator’s legal error ought to have prompted the Tribunal to invoke its discretion to review its own decision and a failure to do so was a breach of procedural fairness.
[23] I see no merit in the appellant’s submissions. The Tribunal has wide authority to control its own processes. Tribunals, such as the Licence Appeal Tribunal, with the authority to control their own procedures are owed “considerable deference” on procedural rulings: Council of Canadians with Disabilities v. VIA Rail Canada Inc., 2007 SCC 15, [2007] 1 S.C.R. 650, at para. 231. It cannot be shown that page limitations on submissions hampered the appellant in his arguments.
[24] The Tribunal issued a comprehensive decision on reconsideration that canvassed new arguments that the appellant had not made at the initial hearing. The appellant’s argument that the particular adjudicator lacked specific expertise is unwarranted, particularly considering the adjudicator’s comprehensive decision, with which I agree.
[25] Finally, I reject the appellant’s third alleged breach of procedural fairness as unfounded. The appellant claims, in effect, that the Tribunal knew that its underlying decision was so deficient that it ought to have reviewed its decision on its own initiative. The Tribunal granted the appellant two opportunities to presents its arguments and correctly held that the appellant was not an “insured person”.
Conclusion
[26] For the above reasons, I would dismiss the appeal.
[27] Costs in the agreed amount of $5,000 are payable by the appellant to the respondent.
Pinto J.
I agree _______________________________
Kurke J.
I agree _______________________________
O’Brien J.
Released: October 9, 2025
CITATION: Wais v. Coachman Insurance Company, 2025 ONSC 5595
DIVISIONAL COURT FILE NO.: No: 691/24
DATE: 2025-10-09
ONTARIO
SUPERIOR COURT OF JUSTICE
DIVISIONAL COURT
KURKE, O’BRIEN, and PINTO JJ.
BETWEEN:
Mir Wais Appellant
– and –
Coachman Insurance Company Respondent
REASONS FOR DECISION
PINTO J.
Released: October 9, 2025