Who’s on the Hook? Understanding Insurance Priority for Your Accident Benefits

If you've been involved in a motor vehicle accident, it's crucial to understand how accident benefits are prioritized, and which insurer is responsible for providing you with the compensation you deserve. Ontario’s Insurance Act outlines a specific “priority” hierarchy that determines the insurer responsible for paying your accident benefits.

Who Pays First?

1. Your Own Insurer: The first step is to seek benefits from your own insurance company. If you have an active auto insurance policy, your insurer is the first in line to cover your accident benefits.
2. The Insurer of the Vehicle You Were In: If you do not have your own insurance, the next step is to seek benefits from the insurer of the vehicle you were in at the time of the accident. This also applies if you were hit as a pedestrian and have no insurance of your own.
3. Other Vehicles Involved: If neither of the above applies (for example, if the vehicle was uninsured), you can seek benefits from the insurer of any other vehicle involved in the accident.
4. Motor Vehicle Accident Claims Fund: If there is no insurance coverage available through the above steps, the last resort is to seek compensation from the Motor Vehicle Accident Claims Fund.

Who Is Covered Under Your Policy?

Your insurance policy may cover more than just you. It can also extend to:

• A spouse or dependent child,
• A person listed as a driver under your policy, or
• Someone who regularly uses your vehicle.

It’s important to understand that you could be covered under multiple policies, depending on the circumstances at the time of the accident.

For example, if you do not have your own policy, you may qualify as a dependent on another policy. A person is dependent upon another if that person is principally dependent for financial support or care by another person.

In addition, dependency is further assessed as to:

1. amount of dependency;
2. duration of dependency;
3. financial or other needs of the alleged dependent; and
4. the ability of the alleged dependent to be self-supporting.

What Happens in a Dispute?

In some cases, multiple insurers may be involved, leading to a dispute over who should pay your benefits. Fortunately, Ontario's accident benefits system is designed to protect you in these situations. The insurer you first approach cannot simply deny your claim and pass you off to another insurer. They are obligated to pay your benefits while any disputes between insurers are resolved.

Timelines and Your Rights

Insurers must follow strict timelines when handling priority disputes:

• 90-Day Investigation Period: Insurers have 90 days to investigate and determine if another insurer should be responsible for your benefits. If they miss this deadline, they may lose the right to dispute their responsibility.
  
  
• One-Year Arbitration Deadline: If insurers cannot agree on who should pay your benefits, the matter must be resolved through arbitration within one year of the initial dispute notice.

Examination Under Oath (EUO)

To help resolve disputes, insurers may request an Examination Under Oath (EUO) from you. This process allows the insurer to ask questions about the accident and your insurance coverage. It’s a crucial part of the investigation process, and your honesty and clarity during the EUO can significantly impact your case.

Takeaway

Navigating the complexities of accident benefits and insurer disputes can be challenging. Understanding the priority order and knowing your rights are essential steps in ensuring you receive the compensation you deserve. If you find yourself in a situation where multiple insurers are involved, remember that the law is designed to protect you and ensure that your benefits are paid promptly.

At Campisi LLP, we are here to assist you through every step of this process. Our experienced team can help you understand your rights, guide you through the claims process, and ensure that you receive the benefits you are entitled to. If you have any questions or concerns, don't hesitate to reach out to us—we're here to help you navigate these challenges with confidence.