Law's remedial intent to broaden insurance coverage to family members found inapplicable
An adjudicator of the Ontario Licence Appeal Tribunal upheld a prior finding that an applicant was not entitled to request accident benefits since he was not a dependent of his aunt, through whose insurance policy he sought benefits.
In Naim v Co-operators General Insurance Company, 2025 CanLII 66351 (ON LAT), the applicant suffered a fractured spine, other injuries, and ongoing issues as a passenger involved in a single-vehicle accident.
The applicant claimed accident benefits from the respondent insurance company through a policy owned by his aunt. The insurer denied him benefits and argued that he was not his aunt’s dependent.
In December 2024, the adjudicator assessed the applicant’s finances over the 12 months preceding the accident, concluded that he was not principally dependent on his aunt for financial support, and rejected his claim for benefits.
The adjudicator said the applicant met no more than 50 percent of his financial needs. The adjudicator added that the aunt’s support did not exceed the amount he earned for himself or half of his financial needs.
The adjudicator determined that the aunt did not provide the applicant’s housing, given that the applicant’s grandparents owned the home where he lived and she did not pay for household expenses like utilities. The applicant requested a reconsideration.
The same adjudicator of the Ontario Licence Appeal Tribunal dismissed the request for reconsideration upon seeing no factual or legal error, which would have meant the tribunal likely would have reached a different result if not for the mistake.
First, the adjudicator found no error in his market basket measure (MBM) and low-income cut-off (LICO) calculations or his application of the dependency test in Miller v. Safeco Insurance Company of America, 1984 CanLII (ON SC), and Allstate Insurance v ING Insurance et al, 2015 ONSC 4020.
The adjudicator affirmed his finding that the applicant did not meet over 50 percent of his financial needs. Based on the evidence for that period, the adjudicator accepted that the applicant’s financial needs ranged from $22,546–$27,200, while his personal income was $8,131.00.
The adjudicator applied the mathematics in Miller and Allstate using a big-picture approach. The adjudicator gave the applicant the benefit of the doubt by allocating to him all the household expenses paid by his aunt, even though many of these expenses likely did not apply to him.
The adjudicator saw discrepancies between the aunt’s alleged financial contributions and the documented transactions. He explained that the applicant’s banking records failed to reflect the aunt’s allegations that she gave her nephew $600–$1,000 monthly.
Second, the adjudicator said he considered the applicant’s unique transitional circumstances in assessing dependency. The adjudicator added that the applicant was trying to relitigate this issue despite the lack of errors in his approach to this assessment portion.
Next, the adjudicator acknowledged that the legislation’s remedial intent, as provided by Miller, was to broaden insurance coverage to include family members as individuals insured under the policy.
However, the adjudicator explained that the legislative framework’s remedial purpose did not call for him to consider the applicant his aunt’s dependent or allocate expenses to someone when the evidence did not establish that this person was responsible for these expenses.
The adjudicator found that the applicant moved into his grandparents’ home, where his aunt was also residing but was not responsible for the household expenses. The adjudicator deemed it more likely that the applicant depended on his grandparents, not his aunt, given their accommodations for him.
