Have you been offered Optional Benefits?

What happens if you want more coverage than the standard automobile policy offers?  Are you aware of the fact that there are Optional Benefits out there to be purchased?  For many Ontarians, this question is more important than ever given that benefits that used to be included with the standard no-fault automobile insurance policy are no longer included.

No Housekeeping or Home Maintenance Benefits

A good example is housekeeping and home maintenance benefits.  If you were involved in a car accident prior to August 31st, 2010, these benefits were available with a standard policy, up to a maximum of $100/week for a two year period.  For any car accidents after September 1, 2010, these benefits are no longer included in the standard policy (unless you are catastrophically injured).  For more information about these and other changes that were made to the no-fault automobile insurance scheme in 2010, read our series of blogs beginning with our post Understanding No-Fault Insurance Benefits in Ontario.

Optional Benefits

Consider this scenario.  You are involved in a car or motorcycle accident and due to the injuries suffered in the crash you are unable to return to work.  You start receiving Income Replacement Benefits (IRBs) at the rate of $400 per week – only to discover that, based on your individual set of circumstances, if you had purchased Optional Benefits prior to the accident, you would have been entitled to $1000 per week instead.  Suppose further that your insurance broker did not discuss with you in any meaningful way the option to purchase Optional Benefits when you were purchasing your insurance.  Do you have any recourse for this shortfall of $600 per week?

What does the Ontario Court of Appeal say?

A case similar to this factual scenario is the Ontario case of Zefferino v. Meloche Monnex Insurance.  In that case, the injured plaintiff sued the insurance broker, claiming that he would have purchased optional IRBs if they had been properly offered by the broker.  At trial, the judge dismissed the plaintiff’s action on the basis that although the broker had failed in its duty to properly offer the Optional Coverage, the plaintiff could not be successful because the causal connection between the breach of duty and the plaintiff’s loss had not be shown.  In other words, the plaintiff had not provided credible evidence to support his assertion that he would have purchased the Optional Coverage if he had understood what was being offered.  The plaintiff appealed this decision.

At the Ontario Court of Appeal, the plaintiff’s lawyer argued that on a claim arising out of insurance broker negligence, the plaintiff doesn’t need to prove that the omissions of the broker caused the loss – rather, it was enough to show that the broker was negligent and that there was a resulting gap in insurance coverage.  The Ontario Court of Appeal rejected this argument and affirmed the general principle that in order to be successful on a claim like this, the plaintiff must prove that the plaintiff would have purchased the additional insurance, if there had not been a breach of the duty of care.  The full Court of Appeal decision is available here.

Contact Ontario’s Injury Lawyers

Have you been involved in a car accident and have questions about the no fault benefits you  are entitled to receive or whether you may have a potential claim against a broker?  Our team of experienced personal injury lawyers will ensure you are accessing all the benefits you are entitled to receive and ensure that all steps are being taken to advance and protect your rights.  Contact us toll free at 800-563-6348 or fill out our online form for a free initial consultation with an Ontario Injury Lawyer.