Insurance Act Priority Rules

The arbitrators recognized that the purpose of subsection 3(1) is to encourage insurers to appropriately investigate priority issues and to be proactive in dealing with such disputes. Subsection 3(1) allows the wholesale insurer to take over the matter earlier as soon as it is satisfied that it has priority (and allows for faster arbitration in the event of a dispute). Subsection 268(2) of the Ontario Insurance Act contains a preponderance order that determines which insurer is liable and liable to pay accident benefits to a claimant following a motor vehicle accident: (2) The following rules apply in determining who is subject to the Act who is liable to pay for accidents: The Liability Act contains rules relating to the priority of insurance for persons injured in motor vehicle accidents. And for each accident, there may be multiple no-fault insurers classified to pay benefits regardless of the injured person`s liability. But it`s not always clear which insurer has the highest priority. Michigan No Fault Law has consistently recognized this reality, stating that it is inappropriate for a no-fault insurer to delay a no-fault claim otherwise payable solely on the basis that another insurer might be higher in the applicable order of priority. The recent Michigan Supreme Court decision in Griffin v. Trumbull Insurance Company___Mich___ (2022) reinforces this principle. Until recently, the priority of coverage between different insurance policies covering the same insured or supplemental insured for the same risk was determined solely by examining the „Other Insurance” provisions and the applicable insurance policy endorsements, regardless of the contractual indemnification obligations of the underlying commercial contract. Previously, the courts drew a clear line between the application of insurance policy provisions between and between insurers and contractual indemnification obligations in the commercial contract.

That has now changed. Recent decisions, discussed below, now take into account the commercial operator`s indemnification obligations to the owner and/or general contractor when determining the priority of coverage between insurers. Owners and general contractors should now be able to make a claim for coverage under subcontractors` insurance based on their indemnification agreement despite excessive „other insurance” in subcontractors` master policies. The first priority decision was Cattrysse v. The Westminster Mutual Fire Insurance Company,[1] which existed prior to the enactment of the regulation. The applicant had applied to both Westminster Mutual Fire Insurance Company and Anglo Canada General Insurance Company. Both insurers argued that they were not Mr. Cattrysse`s insurer. As a result, the claimant was compelled to participate in arbitration proceedings against each individual in order to recover the services owed to him. It was an expensive and cumbersome process that, without the good grace of the insurers involved, would have meant that Mr. Cattrysse would have been left without benefits until the conclusion of the arbitration and subsequent appeal. It is cases like this that have led to the priority settlement of disputes.

(a) Conduct an appropriate investigation to determine whether other insurers or insurers are required to pay benefits to the Fund on a priority basis; And to help insurers examine priorities, lawmakers have added a valuable tool: sworn auditing. As of September 1, 2010, the paying insurer may issue an investigation decision of the applicant to consider priority issues. Therefore, the Employment Investigation Decision, which is available under section 33 of the Statutory Accident Benefits Schedule (SABS), is not „burned”. An EU investigation order may be requested during the 90-day termination period or at any time during the dispute. In this article, I discuss the insurer`s obligations to give timely notice of a priority conflict under sections 3 and 3.1 of Regulation O 283/95 and the consequences of default. Under the new law, the insurer regardless of the fault of the vehicle concerned is no longer in the order of precedence. Today, no-fault providers must pay medical providers in the following order: 10. (1) If an insurer who is notified under section 3 contests its obligation to pay on the basis that other insurers, other than the insurer that terminated the section, have the same or higher priority under section 268 of the Act, the insurer shall notify the other insurers. Ontario Regulation 283/95, § 10 (1).

The second important finding is that insurers should never refuse to accept a completed claim from a claimant. As I will explain in a later article, case law has developed an exception that would allow an insurer to refuse a claim only if there is an insufficient relationship between the claimant and the insurer. But it`s very risky (and potentially very expensive) to reject an application and try to rely on the Nexus test.