Acts and Regulations

I-12 - Insurance Act

Section 194
Disposition versions

Full text
Statutory conditions
194Subject to section 195, the conditions set forth in this section shall be deemed to be part of every contract other than a contract of group insurance, and the insurer shall ensure that they are printed on or attached to the policy forming part of such contract with the heading “Statutory Conditions”.
STATUTORY CONDITIONS
The Contract
1(1)The application, this policy, any document attached to this policy when issued, and any amendment to the contract agreed upon in writing after the policy is issued, constitute the entire contract, and no agent has authority to change the contract or waive any of its provisions.
Waiver
194(2)The insurer shall be deemed not to have waived any condition of this contract, either in whole or in part, unless the waiver is clearly expressed in writing signed by the insurer.
Copy of Application
194(3)The insurer shall, upon request, furnish to the insured or to a claimant under the contract a copy of the application.
Material Facts
2No statement made by the insured or person insured at the time of application for this contract shall be used in defence of a claim under or to avoid this contract unless it is contained in the application or any other written statements or answers furnished as evidence of insurability.
Changes in Occupation
3(1)If after the contract is issued the person insured engages for compensation in an occupation that is classified by the insurer as more hazardous than that stated in this contract, the liability under this contract is limited to the amount that the premium paid would have purchased for the more hazardous occupation according to the limits, classification of risks and premium rates in use by the insurer at the time the person insured engaged in the more hazardous occupation.
194(2)If the person insured changes his occupation from that stated in this contract to an occupation classified by the insurer as less hazardous and the insurer is so advised in writing, the insurer shall either,
(a) reduce the premium rate; or
(b) issue a policy for the unexpired term of this contract at the lower rate of premium applicable to the less hazardous occupation;
according to the limits, classification of risks, and premium rates used by the insurer at the date of receipt of advice of the change in occupation, and shall refund to the insured the amount by which the unearned premium on this contract exceeds the premium at the lower rate for the unexpired term.
Relation of Earnings to Insurance
4Where the benefits for loss of time payable hereunder either alone or together with any other benefits, compensation or right of payment for or in respect of loss of time due to disability exceed the money value of the time of the person insured, the insurer is liable only for that proportion of the benefits for loss of time stated in this policy that the money value of the time of the person insured reduced by all such other benefits, compensation, or rights of payment other than as are provided under this and similar contracts or as are provided under a contract of group insurance, or a life insurance contract providing disability benefits bears to the aggregate of the benefits for loss of time payable hereunder and under similar contracts and any contract of group insurance or life insurance contract providing disability benefits and the excess premium, if any, for the current term shall be returned to the insured.
Termination by Insured
5The insured may terminate this contract at any time by giving written notice of termination to the insurer by registered mail to its head office or chief agency in the province, or by delivery thereof to an authorized agent of the insurer in the province, and the insurer shall upon surrender of this policy refund the amount of premium paid in excess of the short rate premium calculated to the date of receipt of such notice according to the table in use by the insurer at the time of termination.
Termination by Insurer
6(1)The insurer may terminate this contract at any time by giving written notice of termination to the insured and by refunding concurrently with the giving of notice the amount of premium paid in excess of the pro rata premium for the expired time.
194(2)The notice of termination may be delivered to the insured, or it may be sent by registered mail to the latest address of the insured on the records of the insurer.
194(3)Where the notice of termination is delivered to the insured, five days notice of termination shall be given; where it is mailed to the insured, ten days notice of termination shall be given, and the ten days shall begin on the day following the date of mailing of notice.
Notice and Proof of Claim
7(1)The insured or a person insured, or a beneficiary entitled to make a claim, or the agent of any of them, shall
(a) give written notice of claim to the insurer
(i) by delivery thereof, or by sending it by registered mail to the head office or chief agency of the insurer in the province, or
(ii) by delivery thereof to an authorized agent of the insurer in the province,
not later than thirty days from the date a claim arises under the contract on account of an accident, sickness or disability;
(b) within ninety days from the date a claim arises under the contract on account of an accident, sickness or disability, furnish to the insurer such proof as is reasonably possible in the circumstances of the happening of the accident or the commencement of the sickness or disability and the loss occasioned thereby, the right of the claimant to receive payment, his age, and the age of the beneficiary if relevant; and
(c) if so required by the insurer, furnish a satisfactory certificate as to the cause or nature of the accident, sickness or disability for which claim may be made under the contract and as to the duration of such disability.
Failure to Give Notice or Proof
194(2)Failure to give notice of claim or furnish proof of claim within the time prescribed by this statutory condition does not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible, and in no event later than one year from the date of the accident or the date a claim arises under the contract on account of sickness or disability if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed.
Insurer to Furnish Forms for Proof of Claim
8The insurer shall furnish forms for proof of claim within fifteen days after receiving notice of claim, but where the claimant has not received the forms within that time he may submit his proof of claim in the form of a written statement of the cause or nature of the accident, sickness or disability giving rise to the claim and of the extent of the loss.
Rights of Examination
9As a condition precedent to recovery of insurance moneys under this contract,
(a) the claimant shall afford to the insurer an opportunity to examine the person of the person insured when and so often as it reasonably requires while the claim hereunder is pending; and
(b) in the case of death of the person insured, the insurer may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies.
When Moneys Payable Other Than For Loss of Time
10All moneys payable under this contract, other than benefits for loss of time, shall be paid by the insurer within sixty days after it has received proof of claim.
When Loss of Time Benefits Payable
11The initial benefits for loss of time shall be paid by the insurer within thirty days after it has received proof of claim, and payment shall be made thereafter in accordance with the terms of the contract but not less frequently than once in each succeeding sixty days while the insurer remains liable for the payments if the person insured when required to do so furnishes before payment proof of continuing disability.
Limitation of Actions
12An action or proceeding against the insurer for the recovery of a claim under this contract shall not be commenced more than one year after the date the insurance money became payable or would have become payable if it had been a valid claim.
1968, c.6, s.194; 2008, c.11, s.14
Statutory conditions
194Subject to section 195, the conditions set forth in this section shall be deemed to be part of every contract other than a contract of group insurance, and the insurer shall ensure that they are printed on or attached to the policy forming part of such contract with the heading “Statutory Conditions”.
STATUTORY CONDITIONS
The Contract
1(1)The application, this policy, any document attached to this policy when issued, and any amendment to the contract agreed upon in writing after the policy is issued, constitute the entire contract, and no agent has authority to change the contract or waive any of its provisions.
Waiver
194(2)The insurer shall be deemed not to have waived any condition of this contract, either in whole or in part, unless the waiver is clearly expressed in writing signed by the insurer.
Copy of Application
194(3)The insurer shall, upon request, furnish to the insured or to a claimant under the contract a copy of the application.
Material Facts
2No statement made by the insured or person insured at the time of application for this contract shall be used in defence of a claim under or to avoid this contract unless it is contained in the application or any other written statements or answers furnished as evidence of insurability.
Changes in Occupation
3(1)If after the contract is issued the person insured engages for compensation in an occupation that is classified by the insurer as more hazardous than that stated in this contract, the liability under this contract is limited to the amount that the premium paid would have purchased for the more hazardous occupation according to the limits, classification of risks and premium rates in use by the insurer at the time the person insured engaged in the more hazardous occupation.
194(2)If the person insured changes his occupation from that stated in this contract to an occupation classified by the insurer as less hazardous and the insurer is so advised in writing, the insurer shall either,
(a) reduce the premium rate; or
(b) issue a policy for the unexpired term of this contract at the lower rate of premium applicable to the less hazardous occupation;
according to the limits, classification of risks, and premium rates used by the insurer at the date of receipt of advice of the change in occupation, and shall refund to the insured the amount by which the unearned premium on this contract exceeds the premium at the lower rate for the unexpired term.
Relation of Earnings to Insurance
4Where the benefits for loss of time payable hereunder either alone or together with any other benefits, compensation or right of payment for or in respect of loss of time due to disability exceed the money value of the time of the person insured, the insurer is liable only for that proportion of the benefits for loss of time stated in this policy that the money value of the time of the person insured reduced by all such other benefits, compensation, or rights of payment other than as are provided under this and similar contracts or as are provided under a contract of group insurance, or a life insurance contract providing disability benefits bears to the aggregate of the benefits for loss of time payable hereunder and under similar contracts and any contract of group insurance or life insurance contract providing disability benefits and the excess premium, if any, for the current term shall be returned to the insured.
Termination by Insured
5The insured may terminate this contract at any time by giving written notice of termination to the insurer by registered mail to its head office or chief agency in the province, or by delivery thereof to an authorized agent of the insurer in the province, and the insurer shall upon surrender of this policy refund the amount of premium paid in excess of the short rate premium calculated to the date of receipt of such notice according to the table in use by the insurer at the time of termination.
Termination by Insurer
6(1)The insurer may terminate this contract at any time by giving written notice of termination to the insured and by refunding concurrently with the giving of notice the amount of premium paid in excess of the pro rata premium for the expired time.
194(2)The notice of termination may be delivered to the insured, or it may be sent by registered mail to the latest address of the insured on the records of the insurer.
194(3)Where the notice of termination is delivered to the insured, five days notice of termination shall be given; where it is mailed to the insured, ten days notice of termination shall be given, and the ten days shall begin on the day following the date of mailing of notice.
Notice and Proof of Claim
7(1)The insured or a person insured, or a beneficiary entitled to make a claim, or the agent of any of them, shall
(a) give written notice of claim to the insurer
(i) by delivery thereof, or by sending it by registered mail to the head office or chief agency of the insurer in the province, or
(ii) by delivery thereof to an authorized agent of the insurer in the province,
not later than thirty days from the date a claim arises under the contract on account of an accident, sickness or disability;
(b) within ninety days from the date a claim arises under the contract on account of an accident, sickness or disability, furnish to the insurer such proof as is reasonably possible in the circumstances of the happening of the accident or the commencement of the sickness or disability and the loss occasioned thereby, the right of the claimant to receive payment, his age, and the age of the beneficiary if relevant; and
(c) if so required by the insurer, furnish a satisfactory certificate as to the cause or nature of the accident, sickness or disability for which claim may be made under the contract and as to the duration of such disability.
Failure to Give Notice or Proof
194(2)Failure to give notice of claim or furnish proof of claim within the time prescribed by this statutory condition does not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible, and in no event later than one year from the date of the accident or the date a claim arises under the contract on account of sickness or disability if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed.
Insurer to Furnish Forms for Proof of Claim
8The insurer shall furnish forms for proof of claim within fifteen days after receiving notice of claim, but where the claimant has not received the forms within that time he may submit his proof of claim in the form of a written statement of the cause or nature of the accident, sickness or disability giving rise to the claim and of the extent of the loss.
Rights of Examination
9As a condition precedent to recovery of insurance moneys under this contract,
(a) the claimant shall afford to the insurer an opportunity to examine the person of the person insured when and so often as it reasonably requires while the claim hereunder is pending; and
(b) in the case of death of the person insured, the insurer may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies.
When Moneys Payable Other Than For Loss of Time
10All moneys payable under this contract, other than benefits for loss of time, shall be paid by the insurer within sixty days after it has received proof of claim.
When Loss of Time Benefits Payable
11The initial benefits for loss of time shall be paid by the insurer within thirty days after it has received proof of claim, and payment shall be made thereafter in accordance with the terms of the contract but not less frequently than once in each succeeding sixty days while the insurer remains liable for the payments if the person insured when required to do so furnishes before payment proof of continuing disability.
Limitation of Actions
12An action or proceeding against the insurer for the recovery of a claim under this contract shall not be commenced more than one year after the date the insurance money became payable or would have become payable if it had been a valid claim.
1968, c.6, s.194; 2008, c.11, s.14
Statutory conditions
194Subject to section 195, the conditions set forth in this section shall be deemed to be part of every contract other than a contract of group insurance, and shall be printed on or attached to the policy forming part of such contract with the heading “Statutory Conditions”.
STATUTORY CONDITIONS
The Contract
1(1)The application, this policy, any document attached to this policy when issued, and any amendment to the contract agreed upon in writing after the policy is issued, constitute the entire contract, and no agent has authority to change the contract or waive any of its provisions.
Waiver
194(2)The insurer shall be deemed not to have waived any condition of this contract, either in whole or in part, unless the waiver is clearly expressed in writing signed by the insurer.
Copy of Application
194(3)The insurer shall, upon request, furnish to the insured or to a claimant under the contract a copy of the application.
Material Facts
2No statement made by the insured or person insured at the time of application for this contract shall be used in defence of a claim under or to avoid this contract unless it is contained in the application or any other written statements or answers furnished as evidence of insurability.
Changes in Occupation
3(1)If after the contract is issued the person insured engages for compensation in an occupation that is classified by the insurer as more hazardous than that stated in this contract, the liability under this contract is limited to the amount that the premium paid would have purchased for the more hazardous occupation according to the limits, classification of risks and premium rates in use by the insurer at the time the person insured engaged in the more hazardous occupation.
194(2)If the person insured changes his occupation from that stated in this contract to an occupation classified by the insurer as less hazardous and the insurer is so advised in writing, the insurer shall either,
(a) reduce the premium rate; or
(b) issue a policy for the unexpired term of this contract at the lower rate of premium applicable to the less hazardous occupation;
according to the limits, classification of risks, and premium rates used by the insurer at the date of receipt of advice of the change in occupation, and shall refund to the insured the amount by which the unearned premium on this contract exceeds the premium at the lower rate for the unexpired term.
Relation of Earnings to Insurance
4Where the benefits for loss of time payable hereunder either alone or together with any other benefits, compensation or right of payment for or in respect of loss of time due to disability exceed the money value of the time of the person insured, the insurer is liable only for that proportion of the benefits for loss of time stated in this policy that the money value of the time of the person insured reduced by all such other benefits, compensation, or rights of payment other than as are provided under this and similar contracts or as are provided under a contract of group insurance, or a life insurance contract providing disability benefits bears to the aggregate of the benefits for loss of time payable hereunder and under similar contracts and any contract of group insurance or life insurance contract providing disability benefits and the excess premium, if any, for the current term shall be returned to the insured.
Termination by Insured
5The insured may terminate this contract at any time by giving written notice of termination to the insurer by registered mail to its head office or chief agency in the province, or by delivery thereof to an authorized agent of the insurer in the province, and the insurer shall upon surrender of this policy refund the amount of premium paid in excess of the short rate premium calculated to the date of receipt of such notice according to the table in use by the insurer at the time of termination.
Termination by Insurer
6(1)The insurer may terminate this contract at any time by giving written notice of termination to the insured and by refunding concurrently with the giving of notice the amount of premium paid in excess of the pro rata premium for the expired time.
194(2)The notice of termination may be delivered to the insured, or it may be sent by registered mail to the latest address of the insured on the records of the insurer.
194(3)Where the notice of termination is delivered to the insured, five days notice of termination shall be given; where it is mailed to the insured, ten days notice of termination shall be given, and the ten days shall begin on the day following the date of mailing of notice.
Notice and Proof of Claim
7(1)The insured or a person insured, or a beneficiary entitled to make a claim, or the agent of any of them, shall
(a) give written notice of claim to the insurer
(i) by delivery thereof, or by sending it by registered mail to the head office or chief agency of the insurer in the province, or
(ii) by delivery thereof to an authorized agent of the insurer in the province,
not later than thirty days from the date a claim arises under the contract on account of an accident, sickness or disability;
(b) within ninety days from the date a claim arises under the contract on account of an accident, sickness or disability, furnish to the insurer such proof as is reasonably possible in the circumstances of the happening of the accident or the commencement of the sickness or disability and the loss occasioned thereby, the right of the claimant to receive payment, his age, and the age of the beneficiary if relevant; and
(c) if so required by the insurer, furnish a satisfactory certificate as to the cause or nature of the accident, sickness or disability for which claim may be made under the contract and as to the duration of such disability.
Failure to Give Notice or Proof
194(2)Failure to give notice of claim or furnish proof of claim within the time prescribed by this statutory condition does not invalidate the claim if the notice or proof is given or furnished as soon as reasonably possible, and in no event later than one year from the date of the accident or the date a claim arises under the contract on account of sickness or disability if it is shown that it was not reasonably possible to give notice or furnish proof within the time so prescribed.
Insurer to Furnish Forms for Proof of Claim
8The insurer shall furnish forms for proof of claim within fifteen days after receiving notice of claim, but where the claimant has not received the forms within that time he may submit his proof of claim in the form of a written statement of the cause or nature of the accident, sickness or disability giving rise to the claim and of the extent of the loss.
Rights of Examination
9As a condition precedent to recovery of insurance moneys under this contract,
(a) the claimant shall afford to the insurer an opportunity to examine the person of the person insured when and so often as it reasonably requires while the claim hereunder is pending; and
(b) in the case of death of the person insured, the insurer may require an autopsy subject to any law of the applicable jurisdiction relating to autopsies.
When Moneys Payable Other Than For Loss of Time
10All moneys payable under this contract, other than benefits for loss of time, shall be paid by the insurer within sixty days after it has received proof of claim.
When Loss of Time Benefits Payable
11The initial benefits for loss of time shall be paid by the insurer within thirty days after it has received proof of claim, and payment shall be made thereafter in accordance with the terms of the contract but not less frequently than once in each succeeding sixty days while the insurer remains liable for the payments if the person insured when required to do so furnishes before payment proof of continuing disability.
Limitation of Actions
12An action or proceeding against the insurer for the recovery of a claim under this contract shall not be commenced more than one year after the date the insurance money became payable or would have become payable if it had been a valid claim.
1968, c.6, s.194