Billing completed by a healthcare provider on behalf of an insured may constitute an application for insurance

14. October 2010 0

Forms submitted by chiropractor amounted to an application for insurance by the insureds.

ING Insurance Co. of Canada. v. TD Insurance Meloche Monnex, [2010] O.J. No. 3549, August 24, 2010, Ontario Court of Appeal, E.E. Gillese, R.G. Juriansz and H.S. LaForme JJ.A.

ING appealed from a decision holding that it was the first Insurer to receive a completed benefits application regarding four Claimants. The Claimants were injured in a motor vehicle accident. The driver of the other vehicle was insured with ING and the Claimants with TD. All four Claimants went to the same chiropractor for treatment. The chiropractor sent ING certain forms with respect to the treatment. The question on appeal was whether those forms amounted to a “completed application for benefits” thereby triggering ING’s obligation to pay benefits.

The Court found that an application for accident benefits need not be on a certain form in order to be valid. It need only provide sufficient particulars to reasonably assist the insurer with processing the application, identifying the benefits to which the applicant may be entitled, and assessing the claim. The Court found that the forms filled out by the Claimants contained the information they required to adjust the claim.

This case was digested by Cameron B. Elder of Harper Grey LLP.

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