Thursday, May 8, 2008

GENERAL EXCLUSIONS

(1) The insurer is not required to pay an income replacement benefit, a non-earner benefit or a benefit under section 20, 21 or 22 in respect of a person who was the driver of an automobile at the time of the accident,
(a) if the driver knew or ought reasonably to have known that he or she was operating the automobile while it was not insured under a motor vehicle liability policy;
(b) if the driver was driving the automobile without a valid driver’s licence;
(c) if the driver is an excluded driver under the contract of automobile insurance; or
(d) if the driver knew or ought reasonably to have known that he or she was operating the automobile without the owner’s consent. O. Reg. 403/96, s. 30 (1).
(2) The insurer is not required to pay an income replacement benefit, a non-earner benefit or a benefit under section 20, 21 or 22,
(a) in respect of any person who has made, or who knows of, a material misrepresentation that induced the insurer to enter into the contract of automobile insurance or who intentionally failed to notify the insurer of a change in the risk material to the contract;
(b) in respect of an occupant of an automobile at the time of the accident who knew or ought reasonably to have known that the driver was operating the automobile without the owner’s consent;
(c) in respect of a person who, at the time of the accident,
(i) was engaged in an act for which the person is convicted of a criminal offence, or
(ii) was an occupant of an automobile that was being used in connection with an act for which the person is convicted of a criminal offence; or
(d) in respect of a person who is convicted under section 254 of the Criminal Code (Canada) of failing to comply with a lawful demand to provide a breath sample in connection with the accident. O. Reg. 403/96, s. 30 (2); O. Reg. 281/03, s. 10 (1).
(3) Clause (2) (b) does not prevent an excluded driver or any other occupant of an automobile driven by the excluded driver from recovering accident benefits under a motor vehicle liability policy in respect of which the excluded driver or other occupant is a named insured. O. Reg. 403/96, s. 30 (3).
(4) If a person sustains an impairment as a result of an accident and,
(a) at the time of the accident, the person was engaged in, or was an occupant of an automobile that was being used in connection with, an act for which the person is charged with a criminal offence; or
(b) The person is charged under section 254 of the Criminal Code (Canada) with failing to comply with a lawful demand to provide a breath sample in connection with the accident,
the insurer shall hold in trust any amounts payable under an income replacement benefit, a non-earner benefit or a benefit under section 20, 21 or 22 until the charge is finally disposed of, at which time the amounts and any income on the amounts,
(c) Shall be returned to the insurer, if the person is found guilty of the offence or an included offence; or
(d) Shall be paid to the person entitled to the payment, if the person is not found guilty of the offence or an included offence. O. Reg. 403/96, s. 30 (4).
(5) In this section,
“Criminal offence” means,
(a) Operating an automobile while the ability to operate the automobile is impaired by alcohol or a drug,
(b) Operating an automobile while the concentration of alcohol in the operator’s blood exceeds the limit permitted by law,
(c) Failing to comply with a lawful demand to provide a breath sample, or
(d) Any other criminal offence, whether or not the offence is related to the operation of an automobile. O. Reg. 403/96, s. 30 (5); O. Reg. 281/03, s. 10 (2).


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