Auto Accidents and Insurance Authority

My wife had an auto accident back in May. It is gradually being dealt with by our insurance company ( by the broker actually). My question is about the legal power of the insurance code OAP1. Evidently this set of rules is the Ten Commandments for the insurance companies and the adjustors seem to take it as 'law'. Does OAP1 have legal standing with the courts where car accidents are concerned? Do the police lay charges or not on the basis of OAP1?Is it recognized as law by MOH rules and regulations in the HTAct?

Insurance companies are overseen by the Financial Services Commission of Ontario. They set the rules that Insurance companies must follow within the Province.

I'm not familiar with the contents of OAP1, but any charges laid by police would be based on the Highway Traffic Act, not insurance regulations. Insurance companies determine fault based on the Fault Determination Rules regulation of the Insurance Act. Link: http://www.canlii.org/en/on/laws/regu/r ... g-668.html

While the rules are typically consistent with the Highway Traffic Act, sometimes the driver who gets charges will not the one who's found to be at fault by the insurance company.

In terms of legal standing, what type of proceeding are you referring to? An HTA matter? Civil matter?

Thanks for your message. A passenger in the car my wife hit has filed a personal injury claim. I haven't hired a lawyer yet and am just staying on top of what the ins. co. adjuster is doing. As far as I can see they go be the rules set out in the OAP1 document which seems to spell out in minute detail the regulations concerning things they feel are reasons to deny coverage for a whole series of things. In the final analysis I guess it is always up to a judge or jury to agree or disagree with them.

Police do not lay charges based on the OAP1. The OAP1 is the Ontario Automobile Policy contract and does not contain "rules".

The OAP1 is the standard policy contract between an insured and their insurer for automobile insurance accross Ontario. It sets out each party's obligations to the contract and policy conditions for coverage. If there is a breach of the conditions, then there is a breach of the contract between you and your insurer. If there is prove that breach of a policy condition has occured then your insurer has the right to deny coverage.

Most of the time breaching a policy condition will result in denial of first party coverages, however, there are certain conditions that if breached may also result in denial of liability coverage as well. I don't know that at this point it is in your best interest to be dealing with your broker, although most are very knowledgeable, you should be speaking to the adjuster directly.

You do have a year to commence an action against your insurer, if that is the way you would like to go. Best is to consult with a lawyer who deal with these type of claims. You may be able to retain a lawyer even if you don't intend to go into litigation. They may also represent you during the settlement of your claim and would be able to deal with any coverage issues on your behalf.

mgonzo: Thanks for your explanation. I think by the time I am finished with this case I will be able to pass a bar exam on insurance law. When this accident occurred my wife's license had expired (unknowingly as she hadn't received a reminder notice from MTO) and the adjuster was of the opinion that the insurance would either be invalid or limited as per the rules set out in OAP1. Given the circumstances I argued that such a decision would be prejudicial and would break the good faith terms of my contract with the broker/ins. co. From there I contacted a lawyer for advice . He has a totally different interpretation of the OAP1 'rules' than does the adjuster. So on it goes and for the present I am between the devil and the deep blue. Any comments? Thanks.

Just a quick update: I got a ruling from the adjuster / Ins. Co. and evidently my lawyer was right. He argues that the OAP1 Section 4.4 rule, "were driving an automobile while not authorized by law to drive;" is 'limited' by the previous 'rule' , "..Knew,or should reasonably have known, that they were operating an automobile ...." As a result the Ins. Co. agreed , ".. it would be prejudicial to me as the owner of the vehicle and registered policy holder to deny full contractual coverage just because my wife was driving while 'unknowingly' holding an expired license. There was also the issue of precedent. In many cases drivers who have accidents are unknowingly driving with an expired license and the ins. co. waives the oversight. In my wife's case she didn't get a renewal reminder from MTO- which they acknowledged by the way . I suppose it matters who the insurer is and the attitude of the broker and adjuster .