Automobile Insurance Contract Mandatory Conditions Regulations
made under Section 159 of the
Insurance Act
R.S.N.S. 1989, c. 231
O.I.C. 2003-456 (October 31, 2003, effective November 1, 2003), N.S. Reg. 181/2003
as amended to O.I.C. 2018-331 (effective December 18, 2018), N.S. Reg. 226/2018
Table of Contents
Please note: this table of contents is provided for convenience of reference and does not form part of the regulations.
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Citation
Mandatory conditions required by Section 112 of the Act
Benefits to be included
Schedule 1: Mandatory Conditions
Schedule 2: Mandatory Medical and Rehabilitation Benefits, and Accident Benefits in Motor
Vehicle Liability Policies
Section B–Accident Benefits Section
Subsection 1 - Medical, Rehabilitation and Funeral Expenses
Part I - Death Benefits
Part II - Loss of Income
Subsection 2A - Supplemental Benefits Respecting Accidents Occurring in Quebec
Subsection 3 - Special Provisions, Definitions, and Exclusions of this Section
(1) “insured person” defined
(2) “physician” defined
(3) Exclusions
(4) Notice and proof of claim
(5) Medical Reports
(6) Release
(7) When moneys payable
(8) Limitation on benefit payable
Citation
1 These regulations may be cited as the Automobile Insurance Contract Mandatory
Conditions Regulations.
Mandatory conditions required by Section 112 of the Act
2 The mandatory conditions required by Section 112 of the Insurance Act to be included in
every automobile insurance contract are set out in Schedule 1.
Benefits to be included
3 The benefits required by Section 140 of the Insurance Act are mandatory conditions that
must be included in every automobile insurance contract, and are set out in Schedule 2.
4 [repealed]
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Schedule 1: Mandatory Conditions
In these mandatory conditions, unless the context otherwise requires, the word “insured” means
a person insured by this contract whether named or not.
1 (1) Material change in risk - The insured named in this contract shall promptly notify
the insurer, or its local agent, in writing, of any change in the risk material to the
contract and within his knowledge.
(2) Without restricting the generality of the foregoing, the words “change in the risk
material to the contract” include
(a) any change in the insurable interest of the insured named in this contract in
the automobile by sale, assignment or otherwise, except through change of
title by succession, death or proceedings under the Bankruptcy Act
(Canada);
and, with respect to insurance against loss of or damage to the automobile,
(b) any mortgage, lien or encumbrance affecting the automobile after the
application for this contract;
(c) any other insurance of the same interest, whether valid or not, covering loss
or damage insured by this contract or any portion thereof.
2 (1) Prohibited use by insured - The insured shall not drive or operate the automobile
(a) unless he is for the time being either authorized by law or qualified to drive
or operate the automobile;
(b) while his license to drive or operate an automobile is suspended or while his
right to obtain a license is suspended or while he is prohibited under order
of any court from driving or operating an automobile;
(c) while he is under the age of sixteen years or under such other age as is
prescribed by the law of the province in which he resides at the time this
contract is made as being the minimum age at which a licence or permit to
drive an automobile may be issued to him;
(d) for any illicit or prohibited trade or transportation; or
(e) in any race or speed test.
(2) Prohibited use by others - The insured shall not permit, suffer, allow or connive at
the use of the automobile
(a) by any person
(i) unless that person is for the time being either authorized by law or
qualified to drive or operate the automobile,
(ii) while that person is under the age of sixteen years or under such
other age as is prescribed by the law of the province in which he
resides at the time this contract is made as being the minimum age at
which a license or permit to drive an automobile may be issued to
him;
(b) by any person who is a member of the household of the insured while his
license to drive or operate an automobile is suspended or while his right to
obtain a license is suspended or while he is prohibited under order of any
court from driving or operating an automobile;
(c) for any illicit or prohibited trade or transportation; or
(d) in any race or speed test.
3 (1) Requirements where loss or damage to persons or property - The insured shall
(a) promptly give to the insurer written notice, with all available particulars, of
any accident involving loss or damage to persons or property, and of any
claim made on account of the accident;
(b) verify by statutory declaration, if required by the insurer, that the claim
arose out of the use or operation of the automobile and that the person
operating or responsible for the operation of the automobile at the time of
the accident is a person insured under this contract; and
(c) forward immediately to the insurer every letter, document, advice or legal
process received by him from or on behalf of the claimant.
(2) The insured shall not
(a) voluntarily assume any liability or settle any claim except at his own cost;
nor
(b) interfere in any negotiations for settlement or in any legal proceeding.
(3) The insured shall, whenever requested by the insurer, aid in securing information
and evidence and the attendance of any witness, and shall co-operate with the
insurer, except in a pecuniary way, in the defence of any action or proceeding or in
the prosecution of any appeal.
4 (1) Requirements where loss or damage to the automobile - Where loss of or damage
to the automobile occurs, the insured shall, if the loss or damage is covered by this
contract,
(a) promptly give notice thereof, in writing to the insurer, with fullest
information obtainable at the time;
(b) at the expense of the insurer, and as far as reasonably possible, protect the
automobile from further loss or damage; and
(c) deliver to the insurer within ninety days after the date of the loss or damage
a statutory declaration stating, to the best of his knowledge or belief, the
place, time, cause and amount of the loss or damage, the interest of the
insured and of all others therein, the encumbrances thereon, all other
insurance, whether valid or not, covering the automobile, and that the loss
or damage did not occur through any wilful act or neglect, procurement,
means or connivance of the insured.
(2) Any further loss or damage accruing to the automobile, directly or indirectly from
a failure to protect it as required under subcondition (1) of this condition, is not
recoverable under this contract.
(3) No repairs, other than those that are immediately necessary for the protection of
the automobile from further loss or damage, shall be undertaken and no physical
evidence of the loss or damage shall be removed
(a) without the written consent of the insurer; or
(b) until the insurer has had a reasonable time to make the examination for
which provision is made in mandatory condition 5.
(4) Examination of insured - The insured shall submit to examination under oath, and
shall produce for examination, at such reasonable place and time as is designated
by the insurer or its representative, all documents in his possession or control that
relate to the matters in question; and he shall permit extracts and copies thereof to
be made.
(5) Insurer liable for cash value of automobile - The insurer shall not be liable for
more than the actual cash value of the automobile at the time any loss or damage
occurs, and the loss or damage shall be ascertained or estimated according to that
actual cash value with proper deduction for depreciation, however caused, and
shall not exceed the amount that it would cost to repair or replace the automobile,
or any part thereof, with material of like kind and quality; but if any part of the
automobile is obsolete and out of stock, the liability of the insurer in respect
thereof shall be limited to the value of that part at the time of loss or damage not
exceeding the maker’s latest list price.
(6) Repair or replacement - Except where an appraisal has been made, the insurer,
instead of making payment, may, within a reasonable time, repair, rebuild or
replace the property damaged or lost with other of like kind and quality, if, within
seven days after the receipt of the proof of loss, it gives written notice of its
intention to do so.
(7) No abandonment; salvage - There can be no abandonment of the automobile to the
insurer without its consent. If the insurer exercises the option to replace the
automobile, or pays the actual cash value of the automobile, the salvage, if any,
shall vest in the insurer.
(8) In case of disagreement - In the event of disagreement as to the nature and extent
of the repairs and replacements required, or as to their adequacy, if effected, or as
to the amount payable in respect of any loss or damage, those questions shall be
determined by appraisal as provided under the Insurance Act before there can be
recovery under this contract, whether the right to recover on the contract is
disputed or not, and independently of all other questions. There shall be no right to
an appraisal until after proof of loss has been delivered and until a specific demand
therefor is made in writing.
5 Inspection of automobile - The insured shall permit the insurer at all reasonable times to
inspect the automobile and its equipment.
6 (1) Time and manner of payment of insurance money - The insurer shall pay the
insurance money for which it is liable under this contract within sixty days after
the proof of loss has been received by it or, where an appraisal is made under
subcondition (8) of mandatory condition 4, within fifteen days after the award is
rendered by the appraisers.
(2) When action may be brought - The insured shall not bring an action to recover the
amount of a claim under this contract unless the requirements of mandatory
conditions 3 and 4 are complied with nor until the amount of the loss has been
ascertained as therein provided, or by a judgment against the insured after trial of
the issue, or by agreement between the parties with the written consent of the
insurer.
(3) Limitation of actions - Every action or proceeding under the contract against the
insurer in respect of a claim for indemnification for liability of the insured for loss
or damage to property of another person or for personal injury to or death of
another person shall be commenced within two years after the liability of the
insured is established by a court of competent jurisdiction and not afterwards.
Every other action or proceeding against the insurer under the contract in respect of
loss or damage to the automobile shall be commenced within two years from the
time the loss or damage was sustained and not afterwards.
7 Who may give notice and proofs of claim - Notice of claim may be given and proofs of
claim may be made by the agent of the insured named in this contract in case of absence
or inability of the insured to give the notice or make the proof, such absence or inability
being satisfactorily accounted for or in the like case, or if the insured refuses to do so, by
a person to whom any part of the insurance money is payable.
8 (1) Termination - This contract may be terminated
(a) by the insurer giving to the insured fifteen days’ notice of termination by
registered mail, or five days’ written notice of termination personally
delivered;
(b) by the insured at any time on request.
(2) Where this contract is terminated by the insurer,
(a) the insurer shall refund the excess of premium actually paid by the insured
over the pro rata premium for the expired time, but, in no event, shall the
pro rata premium for the expired time be deemed to be less than any
minimum retained premium specified; and
(b) the refund shall accompany the notice unless the premium is subject to
adjustment or determination as to amount, in which case the refund shall be
made as soon as practicable.
(3) Where this contract is terminated by the insured, the insurer shall refund as soon as
practicable the excess of premium actually paid by the insured over the short rate
premium for the expired time, but, in no event shall the short rate premium for the
time expired be deemed to be less than any minimum retained premium specified.
(4) The refund may be made by money, postal or express company money order, or by
cheque payable at par.
(5) The fifteen days mentioned in clause (a) of subcondition (1) of this condition
commences to run on the day following the receipt of the registered letter at the
post office to which it is addressed.
9 Notice - Any written notice to the insurer may be delivered at, or sent by registered mail
to, the chief agency or head office of the insurer in this Province. Written notice may be
given to the insured named in this contract by letter personally delivered to him or by
registered mail addressed to him at his latest post office address notified to the insurer.
In this condition the expression “registered” means registered in or outside Canada.
10 (1) Limitation where seat belt not worn - Unless exempt by law from the requirement
in the Motor Vehicle Act to wear a seat belt, where an injured person was not
wearing a seat belt at the time of an incident, there shall be a reduction of at least
twenty-five per cent in damages for bodily injury or death arising directly or
indirectly from the use or operation of an automobile in respect of the incident.
(2) In this condition, “seat belt” has the same meaning as defined in the Motor Vehicle
Act.
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Schedule 2: Mandatory Medical and Rehabilitation Benefits, and Accident Benefits in
Motor Vehicle Liability Policies
Section B–Accident Benefits Section
The Insurer agrees to pay to or with respect to each insured person as defined in this section
who sustains bodily injury or death by an accident arising out of the use or operation of an
automobile:
Subsection 1 - Medical, Rehabilitation and Funeral Expenses
This subsection applies to any accident claim with respect to an accident that occurs on or after
April 1, 2013.
1 (1) In this subsection, “the Protocols Regulations” means the Automobile Accident
Diagnostic and Treatment Protocols Regulations made under the Insurance Act.
(2) To the limit of $50,000 per person, all reasonable expenses incurred within four
years from the date of the accident as a result of the injury for necessary medical,
surgical, dental, chiropractic, hospital, professional nursing and ambulance service
and for any other service within the meaning of insured services under the Health
Services and Insurance Act and for such other services and supplies which are, in
the opinion of the physician of the insured person’s choice and that of the Insurer’s
medical advisor, essential for the treatment, occupational retraining or
rehabilitation of the person, in respect of
(a) an injury to which the Protocols Regulations apply that is diagnosed and
treated in accordance with the Regulations, the expenses payable for any
treatment, supply or service, diagnostic imaging, laboratory testing,
specialized testing, visit, therapy, assessment or making a report, or any
other activity or function authorized under the Protocols Regulations, and
for which payment is made in the manner required by and subject to the
provisions of the Protocols Regulations, notwithstanding anything to the
contrary in this section; and
(b) an injury
(i) to which the Protocols Regulations apply but that is not diagnosed
and treated in accordance with the Protocols Regulations,
(ii) to which the Protocols Regulations cease to apply but for which the
insured person wishes to make a claim under provision (4) (notice
and proof of claim) of Subsection 3 - Special Provisions,
Definitions, and Exclusions of this section, or
(iii) to which this section applies, other than an injury referred to in (i)
and (ii).
2 Subject to provision 3, the Insurer is not liable under this Subsection for those portions
of expenses payable or recoverable under any medical, surgical, dental or hospitalization
plan or law or, except for similar insurance provided under another automobile insurance
contract, under any other insurance contract or certificate issued to or for the benefit or
any insured person.
3 Except for those portions of expenses payable or recoverable under any law, provision 2
does not apply to the expenses payable or recoverable for an injury to which the
Protocols Regulations apply.
4 Funeral expenses incurred up to the amount of $2500 in respect of the death of any one
person.
Subsection 2 - Death Benefits and Loss of Income Payments
This subsection applies to any accident claim with respect to an accident that occurs on or after
April 1, 2012.
Part I - Death Benefits
A. Subject to the provisions of this Part, for death that ensues within 180 days of the
accident or within 104 weeks of the accident if there has been continuous disability
during that period, a payment – based on the status at the date of the accident of the
deceased in a household where a head of the household, spouse or common-law partner
or dependants survive – of the following amounts:
(a) head of the household - $25,000;
(b) spouse of the head of the household – $25,000; and
(c) dependant within the meaning of clauses (b) and (c) of provision (2) of
paragraph B – $5,000.
In addition, with respect to death of the head of the household, where there are two or
more survivors (spouse or common-law partner or dependants) the principal sum
payable is increased $1,000 for each survivor other than the first.
B. For the purposes of this Part,
(1) “spouse or common-law partner of the head of the household” means the spouse or
common-law partner with the lesser income from employment in the twelve
months preceding the date of the accident.;
(2) “dependant” means,
(a) the spouse or common-law partner of the head of the household who
resides with the head of the household;
(b) a person,
(i) under the age of 18 years who resides with and is principally
dependent upon the head of the household or the spouse or common-law partner of the head of the household for financial support,
(ii) 18 years of age or over who, because of mental or physical infirmity,
is principally dependent upon the head of the household or the
spouse or common-law partner of the head of the household for
financial support, or
(iii) 18 years of age or over who, because of full-time attendance at a
school, college or university, is principally dependent upon the head
of the household or the spouse or common-law partner of the head of
the household for financial support, or
(c) a parent or relative,
(i) of the head of the household, or
(ii) of the spouse or common-law partner of the head of the household
residing in the same dwelling premises and principally dependent upon the
head of the household or the spouse or common-law partner of the head of
the household for financial support.
(3) The total amount payable shall be paid to a person who is the head of the
household or the spouse or common-law partner of the head of the household, as
the case may be, if that person survives the deceased by at least 30 days.
(4) The total amount payable with respect to death where no head of the household or
spouse or common-law partner survives the deceased by at least 30 days shall be
divided equally among the surviving dependants.
(5) No amount is payable on death, other than incurred funeral expenses, if no head of
the household or dependant survives the deceased by at least 30 days.
Part II - Loss of Income
Subject to the provisions of this Part, a weekly payment for the loss of income from
employment for the period during which the insured person suffers substantial inability
to perform the essential duties of his occupation or employment, provided,
(a) such person was employed at the date of the accident;
(b) within 30 days from the date of the accident and as a result of the accident
the insured person suffers substantial inability to perform the essential
duties of his occupation or employment for a period of not less then seven
days;
(c) no payments shall be made for any period in excess of 104 weeks except
that if, at the end of the 104 week period, it has been established that such
injury continuously prevents such person from engaging in any occupation
or employment for which he is reasonably suited by education, training or
experience, the Insurer agrees to make such weekly payments for the
duration of such inability to perform the essential duties.
Amount of Weekly Payment – The amount of a weekly payment shall be the lesser of,
(a) $250 per week; or
(b) 80 per cent of the insured person’s gross weekly income from employment,
less any payments for loss of income from employment received by or
available to such person under
(i) the laws of any jurisdiction,
(ii) wage or salary continuation plans available to the person by reason of
his employment, and
(iii) subsection 2A;
but no deduction shall be made for any increase in such payment due to a cost of living
adjustment subsequent to the insured person’s substantial inability to perform the
essential duties of his occupation or employment.
For the purpose of this Part,
(1) there shall be deducted from an insured person’s gross weekly income any
payments received by or available to him from part-time or other employment or
occupation subsequent to the date of the accident;
(2) a principal unpaid housekeeper residing in the household not otherwise engaged in
occupation or employment for wages or profit, if injured, shall be deemed disabled
only if completely incapacitated and unable to perform any of his or her household
duties and, while so incapacitated, shall receive a benefit at the rate of $100 per
week for not more than 52 weeks;
(3) a person shall be deemed to be employed
(a) if actively engaged in an occupation or employment for wages or profit at
the date of the accident; or
(b) if 18 years of age or over and under the age of 65 years, so engaged for any
six months out of the preceding 12 months and in these circumstances shall
be deemed to have suffered loss of income at a rate equal to that of his most
recent employment earnings;
(4) a person receiving a weekly payment who, within 30 days of resuming his
occupation or employment is unable to continue such occupation or employment
as a result of such injury, is not precluded from receiving further weekly
payments;
(5) where the payments for loss of income payable hereunder, together with payments
for loss of income under another contract of insurance other than a contract of
insurance relating to any wage or salary continuation plan available to an insured
person by reason of his employment, exceed the actual loss of income of the
insured person, the insurer is liable only for that proportion of the payments for
loss of income stated in this policy that the actual loss of income of the person
insured bears to the aggregate of the payments for loss of income payable under all
such contracts.
Subsection 2A - Supplemental Benefits Respecting Accidents Occurring in Quebec
This subsection comes into force and is effective only in accordance with a written agreement
between the Government of Nova Scotia and the Government of Quebec or an agency thereof.
A. For the purposes of this Part,
(a) “accident” means an event occurring in Quebec resulting in damage caused
by an automobile, or by the use of an automobile, or by the load of an
automobile, including damage caused by a trailer;
(b) “bodily injury” means physical, psychological or mental injury including
death as well as damage to the clothing worn by the victim at the time of
the accident;
(c) “resident of Nova Scotia” means any person,
(i) who is authorized by law to be or to remain in Canada and is living
and ordinarily present in Nova Scotia, and
(ii) who meets the criteria prescribed in Division II of O.C. 374-78 made
under the Automobile Insurance Act (Quebec), which apply with
necessary modifications,
but does not include a person,
(iii) who is merely touring, passing through or visiting Nova Scotia, or
(iv) who is, at the time of an accident in Quebec, the owner or driver of,
or a passenger in, an automobile registered in Quebec;
(d) “person insured in Quebec” means a resident of Nova Scotia who is
(i) any person while an occupant of the described automobile or of a
newly acquired or temporary substitute automobile as defined in this
policy,
(ii) the insured and, if residing in the same dwelling premises as the
insured, his or her spouse or common-law partner and any dependent
relative of either while an occupant of any other automobile,
(iii) any person, not the occupant of an automobile, who is struck by the
described automobile or a newly acquired or temporary substitute
automobile as defined in this policy,
(iv) the named insured, if an individual, and his or her spouse or
common-law partner and any dependent relative residing in the same
dwelling premises as the named insured, not the occupant of an
automobile who is struck by any other automobile,
(v) if the insured is a corporation, unincorporated association, or
partnership, any employee or partner of the insured for whose regular
use the described automobile is furnished, and his or her spouse or
common-law partner and any dependent relative of either, residing in
the same dwelling premises as such employee or partner, while an
occupant of any other automobile,
(vi) any employee or partner of the insured for whose regular use the
described automobile is furnished, and his or her spouse or common-law partner and any dependent relative of either, residing in the same
dwelling premises as such employee or partner, while not the
occupant of an automobile who is struck by any other automobile,
and
(vii) any other person who,
a. is the occupant of an automobile, or
b. not being the occupant of an automobile, is struck by an
automobile,
driven by a person insured in Quebec as defined in sub-subparagraphs (i) to (vi) of this subparagraph.
B. With respect to bodily injury, as a result of an accident, to a person insured in Quebec
the insurer agrees to make payments under this Part in the same amount and form and
subject to the same conditions as if such person were a resident of Quebec as defined in
the Automobile Insurance Act (Quebec) and the regulations made under that Act and
entitled to payments under that Act and those regulations except that any reference in the
Automobile Insurance Act (Quebec) to a Quebec enactment or a pension plan shall be
replaced by a reference to the Nova Scotia enactment or pension plan which the
Lieutenant Governor in Council of Nova Scotia declares to be an equivalent enactment
or pension plan.
Notwithstanding anything to the contrary, an exclusion or limitation existing in this Schedule B
or in the general provisions, definitions and mandatory conditions of a contract of automobile
insurance shall not apply to a person insured in Quebec as defined in this subsection 2A.
Subsection 3 - Special Provisions, Definitions, and Exclusions of this Section
(1) “insured person” defined
In this section, the words “insured person” mean
(a) any person while an occupant of the described automobile or of a newly
acquired or temporary substitute automobile as defined in this policy;
(b) the insured and, if residing in the same dwelling premises as the insured, his
or her spouse or common-law partner and any dependent relative of either
while an occupant of any other automobile; provided that,
(i) the insured is an individual or are husband and wife,
(ii) such person is not engaged in the business of selling, repairing,
maintaining, servicing, storing, or parking automobiles at the time of
the accident,
(iii) such other automobile is not owned or regularly or frequently used
by the insured or by any person or persons residing in the same
dwelling premises as the insured,
(iv) such other automobile is not owned, hired, or leased by an employer
of the insured or by an employer of any person or persons residing in
the same dwelling premises as the insured,
(v) such other automobile is not used for carrying passengers for
compensation or hire or for commercial delivery;
(c) in subsections 1, 2 and 2A of this section only, any person, not the occupant
of an automobile or of railway rolling-stock that runs on rails, who is struck,
in Canada, by the described automobile or a newly acquired or temporary
substitute automobile as defined in the policy;
(d) in subsections 1, 2 and 2A of this section only, the named insured, if an
individual and his or her spouse or common-law partner and any dependent
relative residing in the same dwelling premises as the named insured, not
the occupant of an automobile or of railway rolling-stock that runs on rails,
who is struck by any other automobile; provided that
(i) such person is not engaged in the business of selling, repairing,
maintaining, servicing, storing, or parking automobiles at the time of
the accident,
(ii) that automobile is not owned or regularly or frequently used by the
insured or by any person or persons residing in the same dwelling
premises as the named insured,
(iii) that automobile is not owned, hired, or leased by an employer of the
insured or by an employer of any person or persons residing in the
same dwelling premises as the named insured;
(e) if the insured is a corporation, unincorporated association, or partnership,
any employee or partner of the insured for whose regular use the described
automobile is furnished, and his or her spouse or common-law partner and
any dependent relative of either, residing in the same dwelling premises as
such employee or partner, while an occupant of any other automobile of the
private passenger or station wagon type; and
(f) in subsections 1, 2 and 2A of this section only, any employee or partner of
the insured, for whose regular use the described automobile is furnished,
and his or her spouse or common-law partner and any dependent relative of
either, residing in the same dwelling premises as such employee or partner,
while not the occupant of an automobile or of railway rolling-stock that runs
on rails, who is struck by any other automobile; provided that,
in respect of (e) and (f) above,
(i) neither such employee nor partner or his or her spouse or common-law partner is the owner of an automobile of the private passenger or
station wagon type,
(ii) the described automobile is of the private passenger or station wagon
type,
(iii) such person is not engaged in the business of selling, repairing,
maintaining, servicing, storing, or parking automobiles at the time of
the accident,
(iv) such other automobile is not owned or regularly or frequently used
by the employee or partner, or by any person or persons residing in
the same dwelling premises as such employee or partner,
(v) such other automobile is not owned, hired, or leased by the insured
or by an employer of any person or persons residing in the same
dwelling premises as such employee or partner of the insured,
in respect of (e) above only,
(vi) such other automobile is not used for carrying passengers for
compensation or hire or for commercial delivery.
(2) “physician” defined
“Physician” means legally qualified medical practitioner.
(3) Exclusions
(a) Except as provided in subsection 2A, the Insurer shall not be liable under
this section for bodily injury to or death of any person,
(i) resulting from the suicide of such person or attempt thereat, whether
sane or insane,
(ii) who is entitled to receive the benefits of any worker's compensation
law or plan,
(iii) caused directly or indirectly by radioactive material;
(b) The Insurer shall not be liable under subsection 1 or Part II of subsection 2
of this section for bodily injury or death,
(i) sustained by any person who, at the time of the accident, was driving
or operating the automobile while in a condition for which they are
convicted of an offence under section 320.14 of the Criminal Code
(Canada) or under or in connection with circumstances for which
they are convicted of an offence under section 320.15 of the Criminal
Code (Canada) unless they establish that their impairment by alcohol
or drug was not the proximate cause of the accident, or
(ii) sustained by any person driving the automobile who is not for the
time being either authorized by law or qualified to drive the
automobile.
(4) Notice and proof of claim
Subject to the Automobile Accident Diagnostic and Treatment Protocols Regulations,
the insured person or his agent, or the person otherwise entitled to make claim or his
agent, shall,
(a) give written notice of claim to the Insurer by delivery thereof or by sending
it by registered mail to the chief agency or head office of the Insurer in the
Province, within 30 days from the date of the accident or as soon as
practicable thereafter;
(b) within 90 days from the date of the accident for which the claim is made, or
as soon as practicable thereafter, furnish to the Insurer such proof of claim
as is reasonably possible in the circumstances of the happening of the
accident and the loss occasioned thereby;
(c) if so required by the Insurer, furnish a certificate as to the cause and nature
of the accident for which the claim is made and as to the duration of the
disability caused thereby from a physician.
(5) Medical Reports
(a) Except as provided in clause (b), the Insurer has the right, and the claimant
must afford the Insurer with an opportunity, to examine the person of the
insured person when and as often as it reasonably requires while the claim
is pending and, in the case of the death of the insured person, to make an
autopsy subject to the law relating to autopsies.
(b) Clause (a) does not apply with respect to an injury while it is treated under
the Automobile Accident Diagnostic and Treatment Protocols Regulations,
and the insurer has no right to independent review of any treatment, supply
or service, diagnostic imaging, laboratory testing, specialized testing, visit,
therapy, assessment, making of a report or other activity or function
authorized under the Automobile Accident Diagnostic and Treatment
Protocols Regulations.
(6) Release
Notwithstanding any release provided for under the relevant sections of the Insurance
Act, the Insurer may demand, as a condition precedent to payment of any amount under
this section of the policy, a release in favour of the insured and the Insurer from liability
to the extent of such payment from the insured person or his personal representative or
any other person.
(7) When moneys payable
(a) Subject to the Automobile Accident Diagnostic and Treatment Protocols
Regulations, all amounts payable under this section, other than benefits
under Part II of subsection 2, shall be paid by the Insurer within 30 days
after it has received proof of claim. The initial benefits for loss of time
under Part II of subsection (2) shall be paid within 30 days after it has
received proof of claim, and payments shall be made thereafter within each
30-day period while the Insurer remains liable for payments if the insured
person, whenever required to do so, furnishes prior to payment proof of
continuing disability.
(b) No person shall bring an action to recover the amount of a claim under this
section unless the requirements of provisions 3 and 4 of this subsection are
complied with, nor until the amount of the loss has been ascertained as
provided in this section.
(c) Every action or proceeding against the Insurer for the recovery of a claim
under this section shall be commenced within one year from the date on
which the cause of action arose and not afterwards.
(8) Limitation on benefit payable
Where a person is entitled to benefits under more than one contract providing insurance
of the type set forth in subsection 1, 2 or 2A, he or his personal representative or any
person claiming through or under him or by virtue of the Fatal Injuries Act or the
Survivorship Act may recover only an amount equal to one benefit.
In so far as applicable the general provisions, definitions, exclusions and mandatory
conditions of the policy also apply.
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Schedule 3: [repealed]
The following regulations are not yet in force and are
not included in the current consolidation: