Insurance Act

CHAPTER 231

OF THE

REVISED STATUTES, 1989

amended 1992, c. 20, s. 28; 1995-96, c. 20; 1998, c. 8, ss. 44-49; 2000, c. 29, ss. 22-24; 2002, c. 5, ss. 31, 32; 2003, c. 11

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An Act to Amend and Consolidate
the Acts Relating to Insurance

Short title

1 This Act may be cited as the Insurance Act. R.S., c. 231, s. 1.

DIVISION OF ACT

Division of Act

2 For convenience of reference only, this Act is divided into Parts as follows:

PartSections

I - General 4-16

II - Insurance Contracts in the

Province 17-35

III - Licenses for Agents 36-52

IV - Licenses for Adjusters 53-63

V - Accident and Sickness

Insurance 64-103

VI - Automobile Insurance 104-159

VII - Fire Insurance 160-172

VIII - Life Insurance 173-226

IX - Marine Insurance 227-316

X - Penalties 317-318

XI - Agreement 319

XII - Self-Insurance Plans 320- 334

R.S., c. 231, s. 2.

INTERPRETATION

Interpretation

3 In this Act,

(a) "accident insurance" means insurance by which the insurer undertakes, otherwise than incidentally to some other class of insurance defined by or under this Act, to pay insurance money in the event of accident to the person or persons insured, but does not include insurance by which the insurer undertakes to pay insurance money both in the event of death by accident and in the event of death from any other cause;

(b) "accidental death insurance" means insurance undertaken by an insurer as part of a contract of life insurance whereby the insurer undertakes to pay an additional amount of insurance money in the event of the death by accident of the person whose life is insured;

(c) "adjuster" means a person who

(i) on behalf of an insurer or an insured, for compensation, directly or indirectly solicits the right to negotiate the settlement of or investigate a loss or claim under a contract or a fidelity, surety or guarantee bond issued by an insurer, or investigates, adjusts or settles any such loss or claim, or

(ii) holds himself out as an adjuster, investigator, consultant or adviser with respect to the settlement of such losses or claims,

but does not include

(iii) a barrister or solicitor acting in the usual course of his profession,

(iv) a trustee or agent of the property insured,

(v) a licensed agent or a salaried employee of an insurer licensed pursuant to Section 6 to carry on the business of insurance in the Province while acting on behalf of such insurer in the adjustment of losses,

(vi) a person who is employed as an appraiser, engineer or other expert solely for the purpose of giving expert advice or evidence, or

(vii) a person who acts as an adjuster of marine losses only;

(d) "agent" means a person who, on behalf of another person, effects, negotiates, solicits or places a contract or renewal thereof;

(e) "business of insurance" means the business of insurance within the meaning of the Canadian and British Insurance Companies Act (Canada) or the Foreign Insurance Companies Act (Canada);

(f) "class of insurance" has the meaning ascribed to it by the regulations made from time to time pursuant to the Canadian and British Insurance Companies Act (Canada);

(fa) "common-law partner" of an individual means another individual who has cohabited with the individual in a conjugal relationship for a period of at least one year, neither of them being a spouse; and

(g) "compensation association" means a body corporate or unincorporated association that has been designated pursuant to the regulations as a compensation association;

(h) "contract" means a contract of insurance and includes a policy, certificate, interim receipt, renewal receipt or writing evidencing the contract, whether sealed or not, and a binding oral agreement;

(i) "disability insurance" means insurance undertaken by an insurer as part of a contract of life insurance whereby the insurer undertakes to pay insurance money or to provide other benefits in the event that the person whose life is insured becomes disabled as a result of bodily injury or disease;

(j) "fraternal society" means a society, order or association incorporated for the purpose of making with its members only and not for profit, contracts of life, accident or sickness insurance in accordance with its constitution, by-laws and rules and this Act;

(k) "insurance" means the undertaking by one person to indemnify another person against loss or liability for loss in respect of a certain risk or peril to which the object of the insurance may be exposed, or to pay a sum of money or other thing of value upon the happening of a certain event and includes life insurance;

(l) "insurance money" includes benefits, surplus, profits, dividends, bonuses and annuities payable by an insurer under a contract;

(m) "insured" means a person who makes a contract with an insurer;

(n) "insurer" means the person, corporation, underwriter, partnership, fraternal or other society, association, or syndicate who undertakes or agrees or offers to undertake a contract;

(o) "life insurance" means insurance whereby an insurer undertakes to pay insurance money

(i) on death,

(ii) on the happening of an event or contingency dependent on human life,

(iii) at a fixed or determinable future time, or

(iv) for a term dependent on human life,

and, without restricting the generality of the foregoing, includes

(v) accidental death insurance but not accident insurance,

(vi) disability insurance, and

(vii) an undertaking entered into by an insurer to provide an annuity or what would be an annuity except that the periodic payments may be unequal in amount and such an undertaking shall be deemed always to have been life insurance;

(p) "person" includes a firm, partnership or corporation;

(q) "policy" means the instrument evidencing a contract;

(r) "premium" means the single or periodical payment to be made for the insurance and includes dues and assessments;

(s) "sickness insurance" means insurance by which the insurer undertakes to pay insurance money in the event of sickness of the person or persons insured, but does not include disability insurance;

(sa) "spouse" means either of a man or woman who are married to each other;

(t) "Superintendent" means the Superintendent of Insurance and includes the Deputy Superintendent of Insurance or such person as the Governor in Council may authorize to perform the duties of the Superintendent. R.S., c. 231, s. 3; 2000, c. 29, s. 22.

PART I

GENERAL

Appointment of Superintendent and Deputy

4 (1) The Governor in Council may appoint persons in the public service to be Superintendent of Insurance and Deputy Superintendent of Insurance.

Appointment of officers and clerks

(2) Such officers and clerks as may be necessary to assist the Superintendent or the Deputy Superintendent may be appointed under the Civil Service Act. R.S., c. 231, s. 4.

Duty of Superintendent

5 (1) The Superintendent has general supervision over the business of insurance in the Province.

Powers of Superintendent

(2) The Superintendent shall secure the enforcement of this Act and, in so doing, may issue such rulings, instructions and orders as he may deem necessary.

Regulations

(3) The Governor in Council may make regulations

(a) respecting the qualifications of insurance agents;

(b) respecting the form and content of courses of study for licenses of insurance agents;

(c) respecting the time and manner of conducting examinations of insurance agents;

(d) prescribing books, accounts and records to be kept and maintained by insurance agents;

(e) respecting fees for licenses and renewals of licenses of any class or kind issued under this Act;

(f) adding to or increasing medical, rehabilitation, loss of income, death and funeral expense benefits and other benefits which are required to be in automobile insurance policies;

(g) determining that exclusions or limitations in the Schedule B to Part VI or in the general provisions, definitions and statutory conditions of a contract of automobile insurance shall not apply to "a person insured in Quebec" as defined in subsection (3) of said Schedule B;

(h) extending the provisions of this Act or any of them to a system or class of insurance not specifically mentioned in this Act;

(i) respecting group insurance contracts or schemes, or any class thereof and, without restricting the generality of the foregoing, prescribing and regulating their terms and conditions, qualifications for membership in groups and respecting the marketing of group insurance contracts or schemes;

(j) respecting the advertising of insurance contracts or any class thereof and, without restricting the generality of the foregoing, prescribing and regulating the form and content of the advertisements and requiring advertisements to be filed and approved by the Superintendent;

(k) designating as compensation associations bodies corporate or unincorporated associations, or both, whose purposes are to provide compensation to policyholders of and eligible claimants on insolvent insurers;

(l) prescribing classes of insurance for the purposes of Section 10 and designating a compensation association for one or more of such classes of insurance;

(m) designating insurers as being adequately covered by a plan of compensation other than that provided by reason of membership in a compensation association;

(n) defining insolvent insurers for the purposes of this Act;

(o) generally for the better carrying out of the provisions of this Act and the more efficient administration of it.

Regulations Act

(4) The exercise by the Governor in Council of the authority contained in subsection (3) shall be regulations within the meaning of the Regulations Act. R.S., c. 231, s. 5.

Requirement for license

6 (1) Notwithstanding any other enactment, no person shall carry on the business of insurance in the Province without a license, issued pursuant to this Section, that is in force.

Offence

(2) Every insurer carrying on the business of insurance in the Province who does not hold a license that is in force is guilty of an offence.

License subject to conditions

(3) The Superintendent may issue a license to an insurer subject to such limitations and conditions as the Superintendent may prescribe.

Suspension or revocation of license

(4) The Superintendent may suspend or revoke a license of an insurer issued pursuant to this Section for misconduct by the insurer or a violation by the insurer of any provision of this Act, the regulations or any federal or provincial enactment applicable to the insurer. R.S., c. 231, s. 6.

Entry and inspection of documents

7 The Superintendent, or a person authorized by the Superintendent, may, from time to time and at all reasonable times, enter upon the business premises of an insurer or upon premises where the insurer's records are kept if it is reasonably necessary to do so in order to determine whether or not this Act, the regulations or any federal or provincial enactment applicable to the insurer are being complied with and may inspect, audit or examine documents therein, and the person occupying or in charge of the premises shall answer all questions pertaining to those matters and shall produce for inspection such documents as the Superintendent, or a person authorized by the Superintendent, may request. R.S., c. 231, s. 7.

Authority to make regulations

8 (1) Where the Canadian and British Insurance Companies Act (Canada) or the Foreign Insurance Companies Act (Canada) does not apply to an insurer, the Governor in Council may make regulations respecting any matters dealt with by those Acts or regulations made pursuant thereto.

Applicability of regulations

(2) Regulations made by the Governor in Council pursuant to subsection (1) may be made applicable in whole or in part to such insurers as the regulations provide.

Regulations Act

(3) The exercise by the Governor in Council of the authority contained in subsection (1) shall be regulations within the meaning of the Regulations Act. R.S., c. 231, s. 8.

Agreements

9 (1) The Minister of Housing and Consumer Affairs, with the approval of the Governor in Council, may enter into agreements with compensation associations relating to a plan for the compensation by compensation associations of policyholders of, and eligible claimants on, insolvent insurers.

Exemption

(2) An agreement pursuant to subsection (1) may exempt a specifically named insurer from membership in the compensation association that is a party to the agreement. R.S., c. 231, s. 9; 1992, c. 14, s. 58.

Membership in compensation association

10 (1) Where a compensation association has been designated by the regulations made pursuant to subsection (3) of Section 5 for any of the classes of insurance prescribed by those regulations then, subject to subsection (2), every insurer, while licensed to carry on that class of insurance and, except for the classes of life and accident and sickness insurance, for one hundred and eighty-three days after ceasing to be so licensed, is a member of that compensation association.

Subsection (1) does not apply

(2) Subsection (1) does not apply to an insurer

(a) that is designated by a regulation made pursuant to clause (m) of subsection (3) of Section 5;

(b) whose business is limited to that of re-insurance; or

(c) that is exempted from membership by an agreement made pursuant to Section 9.

Members bound by by-laws

(3) Every member of a compensation association is bound by the by-laws and memorandum of operation of the compensation association.

Assessments

(4) A member of a compensation association shall pay to the compensation association all assessments and levies made against the member by the compensation association.

Failure to pay assessment

(5) Where a member fails to pay an assessment or levy within thirty days of the mailing of the notice of assessment or levy to the member,

(a) the compensation association may claim the amount of the assessment or levy, with interest, as a debt due from the member; and

(b) the Minister of Housing and Consumer Affairs, on the recommendation of the Superintendent, may cancel the license of the member to carry on the business of insurance.

Obligation continues

(6) A debt due pursuant to subsection (5) does not cease to be due on the termination of the member's membership. R.S., c. 231, s. 10; 1992, c. 14, s. 58; 1998, c. 8, s. 44.

Representing prohibited insurer

11 No person shall do or carry on any part of the business of insurance in the Province on behalf of or as agent for an insurer who is prohibited by Section 6 from carrying on the business of insurance in the Province. R.S., c. 231, s. 11; 1998, c. 8, s. 45.

Exception for provincial insurer

12 (1) This Section does not apply to an insurer having its head office in the Province.

Signature of insurer

(2) No insurer shall insure real or personal property located in the Province against loss of or damage to such property arising from the peril of fire unless the policy, duplicate policy, or contract of fire insurance has been signed or countersigned by an agent licensed under this Act who is a resident of the Province and unless that agent receives the commission or a part thereof not less than five per cent of the premium paid covering that portion of the risk situate in the Province, when the premium is paid.

Exception for common carrier

(3) This Section does not apply in respect of direct insurance covering property in transit that is in the possession and custody of common carriers, or moveable property of such common carriers used or employed by them in their business as common carriers. R.S., c. 231, s. 12.

Exception for life insurance

13 (1) This Section does not apply to a contract of life insurance except with respect to disability insurance undertaken as part of the contract.

Violation of law not always fatal

(2) Unless the contract otherwise provides, a violation of any criminal or other law shall not, ipso facto, render unenforceable a claim for indemnity under a contract except where the violation is committed by the insured, or by another person with the consent of the insured, with intent to bring about loss or damage. R.S., c. 231, s. 13.

Statement of agent or broker

14 An insurer carrying on any part of the business of insurance in the Province shall each year file with the Superintendent a statement verified under oath of its manager or chief agent in the Province, showing the name and residence of every person authorized to act in the Province as agent, sub-agent or broker for the insurer. R.S., c. 231, s. 14.

Policy form to be filed

15 (1) The Superintendent may require an insurer to file with him a copy of any form of policy, any form of application for a policy, or any endorsement, rider or advertising material issued or used by the insurer.

Superintendent may prohibit use of form

(2) Where an insurer issues a policy or uses an application, or endorsement or rider or advertising material that, in the opinion of the Superintendent, is unfair, fraudulent, unduly restrictive or not in the public interest, he may prohibit the insurer from issuing or using that form of policy, application, endorsement, rider or advertising material.

Prohibition

(3) No insurer shall, after being prohibited, pursuant to subsection (2), use any prohibited policy, application, endorsement, rider or advertising material. R.S., c. 231, s. 15.

Substitution of successor

16 Where, under an agreement between an insurer, in this Section called the "continuing insurer," and another insurer, in this Section called the "retiring insurer," in contemplation of the retiring insurer ceasing to do business in the Province, the continuing insurer assumes liability under contracts of insurance specified in the agreement issued by the retiring insurer and the retiring insurer ceases to carry on business in the Province, an insured or other person entitled to rights under those contracts may enforce the rights as though those contracts had been issued by the continuing insurer. R.S., c. 231, s. 16.

PART II

INSURANCE CONTRACTS IN THE PROVINCE

Application of Part

17 Where not inconsistent with some other provision of this Act, this Part applies in respect of every contract other than

(a) a contract of accident and sickness insurance to which Part V applies;

(b) a contract of life insurance to which Part VIII applies; and

(c) a contract of marine insurance to which Part IX applies. R.S., c. 231, s. 17.

Delivery and contents of policy

18 An insurer shall, within a reasonable time after a contract is entered into, deliver to the insured a policy setting out the terms of the contract which shall include

(a) the name or a sufficient description of

(i) the insured, and

(ii) the person to whom the insurance money is payable;

(b) the amount, or the method of determining the amount of the premium;

(c) the subject-matter of the insurance;

(d) the indemnity for which the insurer may become liable;

(e) the event on the happening of which the liability is to accrue;

(f) the date upon which the insurance takes effect; and

(g) the date upon which the insurance terminates or the method by which termination is fixed or to be fixed. R.S., c. 231, s. 18.

Copy of application

19 An insurer shall furnish a copy of the application to the insured at the time the application is signed by the insured. R.S., c. 231, s. 19.

Effect of delivery of policy

20 (1) Where a contract has been delivered, the contract is as binding on the insurer as if the premium had been paid, although it has not been paid, and although delivered by an officer or agent of the insurer who did not have authority to deliver it.

Deduction of unpaid premium

(2) The insurer may deduct the unpaid premium from the amount for which it may become liable under the contract or may sue the insured therefor. R.S., c. 231, s. 20.

Default in paying premium

21 (1) Where a cheque, bill of exchange or promissory note is given, whether originally or by way of renewal, for the whole or part of any premium and the cheque, bill of exchange or promissory note is not honoured according to its tenor, the insurer may terminate the contract forthwith by giving written notice by registered mail.

Payment by registered letter

(2) Where a remittance for or on account of a premium is sent in a registered letter to an insurer and is received by it, the remittance shall be deemed to have been received at the time of the registration of the letter. R.S., c. 231, s. 21.

Assignment of refund of premium

22 (1) Where an insured assigns the right to refund of premium that may accrue by reason of the cancellation or termination of a contract under the terms thereof and notice of the assignment is given by the assignee to the insurer, the insurer shall pay any such refund to the assignee notwithstanding any condition in the contract, whether prescribed under this Act or not, requiring the refund to be paid to the insured or to accompany any notice of cancellation or termination to the insured.

Notice of payment to assignee

(2) Where the condition in the contract dealing with cancellation or termination by the insurer provides that the refund shall accompany the notice of cancellation or termination, the insurer shall include in the notice a statement that in lieu of payment of the refund in accordance with the condition the refund is being paid to the assignee under this Section. R.S., c. 231, s. 22.

Proof of loss form

23 (1) An insurer, immediately upon receipt of a request, and in any event not later than sixty days after receipt of notice of loss, shall furnish to the person insured or person to whom the insurance money is payable forms upon which to make the proof of loss required under the contract.

Failure to comply with subsection (1)

(2) An insurer who neglects or refuses to comply with subsection (1) is guilty of an offence, and, in addition, the provisions of Section 24 shall not be available to the insurer as a defence to an action brought, after such neglect or refusal, for the recovery of money payable under the contract of insurance.

Furnishing form is not admission of valid contract

(3) The insurer, by furnishing forms to make proof of loss, shall not be taken to have admitted that a valid contract is in force or that the loss in question falls within the insurance provided by the contract. R.S., c. 231, s. 23.

Commencement of proceeding

24 No action shall be brought for the recovery of money payable under a contract until the expiration of sixty days after proof, in accordance with the provisions of the contract,

(a) of the loss; or

(b) of the happening of the event upon which the insurance money is to become payable,

or of such shorter period as may be fixed by the contract. R.S., c. 231, s. 24.

Payment to agent or broker

25 Notwithstanding any agreement, condition or stipulation to the contrary, payments in cash in whole or in part to an agent or broker of an insurer of the amount of a premium or an assessment due in respect of a contract issued by the insurer, shall be deemed a payment to the insurer. R.S., c. 231, s. 25.

Agent holds premium in trust

26 (1) An agent who acts in negotiating, or renewing or continuing a contract of insurance other than life insurance, with an authorized or a licensed insurer, and who receives any money or substitute for money as a payment on account of a premium for such a contract from the insured, shall be deemed to hold such payment in trust for the insurer, and, if he fails to pay the payment over to the insurer within fifteen days after written demand made upon him therefor, less his commission and any deductions to which, by the written consent of the company, he is entitled, such failure is prima facie evidence that he has used or applied the payment for a purpose other than paying it over to the insurer.

Agent holds proceeds in trust

(2) An agent who acts in negotiating or renewing or continuing a contract of insurance with an authorized or a licensed insurer, and who receives any money or substitute for money for payment to a person in respect of the contract of insurance shall be deemed to hold such money in trust for the person entitled thereto, and, if he fails to pay the money over to such person within fifteen days after written demand made upon him therefor, less his commission and any deductions to which he is entitled, such failure is prima facie evidence that he has used or applied the money for a purpose other than paying it over to the person entitled.

Agent not to charge payment

(3) No agent shall assign, pledge, hypothecate or mortgage or in any way charge the payment or payments referred to in subsections (1) or (2) whether or not such payment or payments have been received or remain receivable.

Charge on payment is void against beneficial owner

(4) Any assignment, pledge, hypothecation, mortgage or other charge of or on the payment or payments referred to in subsections (1) or (2) is null and void as against the beneficial owner of the payment or payments. R.S., c. 231, s. 26.

Payment into court

27 (1) Where the insurer admits liability for insurance money and it appears to the insurer that

(a) there are adverse claimants;

(b) the whereabouts of a person entitled is unknown; or

(c) there is no person capable of giving and authorized to give a valid discharge therefor, who is willing to do so,

the insurer may, at any time after thirty days from the date of the happening of the event upon which the insurance money becomes payable, apply to the court ex parte for an order for payment of the money into court, and the court may upon such notice, if any, as it thinks necessary make an order accordingly.

Costs

(2) The court may fix the costs incurred in connection with an application or order made under subsection (1) and may order them to be paid out of the insurance money or by the insurer or the applicant or otherwise as it deems just.

Insurer discharged

(3) A payment made pursuant to an order under subsection (1) discharges the insurer to the extent of the amount paid. R.S., c. 231, s. 27.

Action against insurer

28 (1) Where a person incurs a liability for injury or damage to the person or property of another, and is insured against such liability, and fails to satisfy a judgment awarding damages against him in respect of his liability, and an execution against him in respect thereof is returned unsatisfied, the person entitled to the damages may recover by action against the insurer the amount of the judgment up to the face value of the policy, but subject to the same equities as the insurer would have if the judgment had been satisfied.

Section does not apply

(2) This Section does not apply to motor vehicle liability policies. R.S., c. 231, s. 28.

Notice to insured or insurer

29 Subject to any statutory condition, where the mode of giving a notice for any purpose is not provided, the notice may, in the case of notice by an insurer, be given by mailing it by registered letter to the last known address of the insured on its records or, if there is no such record, to the address of the insured given in his application or by delivering it to the insured and, in the case of notice by an insured, be given by mailing it by registered letter to the last known address of the insurer in the Province or failing that by mailing it by registered letter or delivering it to a licensed agent of the insurer. R.S., c. 231, s. 29.

Imperfect compliance

30 An act or omission of an insurer that results in non-compliance or imperfect compliance with a provision of this Act does not render a contract invalid as against an insured. R.S., c. 231, s. 30.

Fire insurance as security

31 (1) Where a contract of fire insurance is given as collateral security to a mortgage or vendor's lien on property, or a contract so given is about to expire and no specific insurer is named in the mortgage or agreement for sale, a condition requiring the mortgagor or purchaser to insure is sufficiently satisfied, save as to the amount, by the production by such mortgagor or purchaser of a subsisting policy of insurance in any insurer authorized to carry on its business in the Province.

Mortgagee not to receive consideration

(2) No mortgagee and no officer or employee of a mortgagee shall receive any commission or other consideration in respect of a contract or renewal thereof under which loss, if any, is payable to the mortgagee.

Payment of commission prohibited

(3) No insurer or insurance agent shall pay, allow or give any commission or other consideration to a mortgagee or officer or employee of a mortgagee in respect of any contract or renewal thereof under which loss, if any, is payable to the mortgagee. R.S., c. 231, s. 31.

Application of Section

32 (1) This Section applies to a contract containing a condition, statutory or otherwise, providing, in the event of difference or disagreement between the insured and insurer, for appraisal to determine the matters specified in the condition.

Selection of appraisers

(2) The appraisal shall be made by two disinterested appraisers, the insured and the insurer each selecting one and the two so chosen then selecting a competent and disinterested umpire.

Determination by appraisers or umpire

(3) The appraisers shall then determine the matters specified in the conditions and, if they fail to agree, they shall submit their differences to the umpire, and the finding in writing of any two determines the matters.

Expense of appraiser and umpire

(4) Each party to the appraisal shall pay the appraiser selected by him and shall bear equally the expense of the appraisal and umpire.

Application to court

(5) Where

(a) a party fails to name an appraiser within seven clear days after being served with written notice so to do;

(b) the appraisers fail to agree upon an umpire within fifteen days after their appointment; or

(c) an appraiser or umpire refuses to act or is incapable of acting or dies,

a judge of the Supreme Court or the county court having jurisdiction in the county or district in which the appraisal is to be made may appoint an appraiser or umpire, as the case may be, upon the application of the insured or of the insurer. R.S., c. 231, s. 32.

Court may relieve against forfeiture

33 Where there has been imperfect compliance with a statutory condition as to the proof of loss to be given by the insured or other matter or thing required to be done or omitted by the insured with respect to the loss, and a consequent forfeiture or avoidance of the insurance in whole or in part, and the court considers it inequitable that the insurance should be forfeited or avoided on that ground, the court may relieve against the forfeiture or avoidance on such terms as it considers just. R.S., c. 231, s. 33.

Canadian dollars

34 Insurance money is payable in the Province in lawful money of Canada. R.S., c. 231, s. 34.

Waiver to be in writing

35 (1) No term or condition of a contract shall be deemed to be waived by the insurer in whole or in part, unless the waiver is stated in writing and signed by a person authorized for that purpose by the insurer.

Forms and conditions not waived by action

(2) Neither the insurer nor the insured shall be deemed to have waived any term or condition of a contract by any act relating to the appraisal of the amount of loss or to the delivery and completion of proofs, or to the investigation or adjustment of any claim under the contract. R.S., c. 231, s. 35.

PART III

LICENSES FOR AGENTS

Licensing of agent

36 (1) The Superintendent may issue to a person who has complied with the requirements of this Part and the regulations a license or licenses of the kind or kinds described in subsection (4).

Partnership or corporation license

(2) A license issued to a partnership or corporation shall be issued in the name of the partnership or corporation.

Limitations and conditions

(3) The license shall be subject to any limitations and conditions the Superintendent prescribes.

Kinds of license

(4) Licenses issued pursuant to this Section are of two kinds, namely,

(a) a life insurance license authorizing the licensee to act as an agent for life and accident and sickness insurance or a life insurance license restricting the licensee to act as an accident and sickness insurance agent only; and

(b) a general insurance license authorizing the licensee to act as an agent for any class or classes of insurance other than those classes authorized under a life insurance license.

Sub-agent or broker

(5) A license for any class of insurance other than life insurance entitles the agent to act as a broker.

Expiration of license

(6) Every license expires at the end of three years after it has been issued or at such time as the Superintendent may determine, but may be renewed on application to the Superintendent and payment of the fee prescribed by the regulations, unless cancelled or suspended by the Superintendent.

Shorter license period

(7) Notwithstanding subsection (6), the Superintendent may determine for a particular license or class of license an expiry date which is less than three years from the date on which it was issued or renewed.

Granting of license

(8) The Superintendent may grant a license where

(a) in the Superintendent's opinion, the applicant is suitable to be licensed and the proposed licensing is not for any reason objectionable;

(b) the applicant passes a qualification examination if one is prescribed by the Superintendent or passes any supplemental examination if the applicant fails the qualification examination and pays any fees associated with the writing of examinations as may be prescribed by the regulations;

(c) the application indicates the name of the insurer who sponsors the applicant;

(d) the Superintendent is satisfied that the applicant intends to hold himself out publicly and carry on business as a bona fide agent; and

(e) the Superintendent is satisfied that the applicant is not in a position to use coercion or undue influence to secure insurance business.

Advisory board

(9) In determining the granting or refusal of an application for a license or renewal of a license, or the suspension or cancellation of a license or the reinstatement of any suspended or cancelled license, the Superintendent may, in any case where the Superintendent deems it proper, nominate an advisory board consisting of three persons, one of whom shall be the Superintendent or another person appointed by the Superintendent, one of whom shall be a representative of insurers and one of whom shall be a representative of agents licensed pursuant to this Act and may refer a matter to the board for hearing and report, and the Superintendent shall take such report into consideration when making a decision pursuant to this Section. R.S., c. 231, s. 36.

Application form

37 An application for a license shall be in the form the Superintendent prescribes and shall be made to the Superintendent. R.S., c. 231, s. 37.

"representative" defined

38 (1) In this Section, "representative" means an officer, employee or shareholder, whether the shares are held in trust or not.

License required

(2) Subject to this Section, no person shall

(a) either on his own account; or

(b) as a member or representative of

(i) a partnership or a corporation, or

(ii) an insurer licensed pursuant to Section 6 to carry on the business of insurance in the Province,

act or offer to act as an agent or broker for any class of insurance unless he holds a license that is in force for that class of insurance.

Exception for agent

(3) A member or representative of an insurer licensed pursuant to Section 6 to carry on the business of insurance in the Province, who does not receive a commission and who acts only in the name of and on behalf of the insurer may, without a license, act as an agent for the insurer.

Exception for fraternal society

(4) A member of a fraternal society may, without a license, solicit insurance contracts on behalf of the society unless he devotes or intends to devote more than one half his time to soliciting such contracts or has in the previous license year solicited and procured life insurance contracts on behalf of the society in an amount in excess of twenty thousand dollars.

Application to be signed

(5) Every application in respect of an insurance license shall be signed by a representative of the insurer who sponsors the applicant.

Return of license

(6) In the event of withdrawal of the sponsorship by the insurer, the agent or broker from whom sponsorship has been withdrawn shall forthwith return the license to the insurer and the insurer shall

(a) within ten business days of receipt, return the license to the Superintendent; and

(b) give the Superintendent the reason for the withdrawal of sponsorship.

Cancellation of license

(7) If an insurer withdraws sponsorship, the license is cancelled.

Authority of life insurance agent

(8) Subject to subsection (9), the license authorizes the holder to act as an agent on behalf of the sponsoring life insurer only, but if the license holder is unable to negotiate insurance on behalf of an applicant for insurance with the sponsoring life insurer, the agent may procure insurance from another insurer if the other insurer obtains in each case the consent in writing of the sponsoring insurer and files a copy of the consent with the Superintendent.

Further authority after two years

(9) After being the holder of a license as a life insurance agent for a continuous and uninterrupted period of not less than two years, and subject to any additional requirements prescribed by regulation, an agent may effect insurance with any other life insurer licensed to carry on business in the Province. R.S., c. 231, s. 38.

No compensation except to licensee

39 (1) No insurer, and no licensed agent shall, directly or indirectly, pay, or allow, or offer or agree to pay or allow, any commission or other compensation or anything of value to any person in respect of the effecting or negotiating or placing of any contract or renewal thereof unless that person holds a license that is in force under this Part.

Exception for broker outside Province

(2) Subsection (1) does not affect the payment by an agent of part of his commission to a licensed broker or agent outside the Province. R.S., c. 231, s. 39.

Premium in policy

40 No insurer and no licensed agent shall, directly or indirectly,

(a) make or attempt to make any agreement in respect of the premium to be paid for a policy other than as set forth in the policy with; or

(b) pay, allow or give, or offer or agree to pay, allow or give

(i) any rebate of the whole or part of the premium stipulated by the policy to, or

(ii) any other consideration intended to be in the nature of a rebate of premium to,

any person insured or applying for insurance. R.S., c. 231, s. 40.

Personal liability of agent or broker

41 An agent or broker is personally liable to the insured on all contracts unlawfully made by or through him directly or indirectly with any insurer not licensed pursuant to Section 6 to carry on the business of insurance in the Province in the same manner as if such agent or broker were the insurer. R.S., c. 231, s. 41.

Misrepresentation of policy prohibited

42 No insurer and no agent shall mislead a person about to insure by misrepresentation of any of the terms of a contract, whether issued by the insurer represented by the agent or issued by any other insurer. R.S., c. 231, s. 42.

Inducing policyholder to lapse or surrender

43 No person shall, by means of a false or misleading representation, procure or induce, or attempt to procure or induce any person to forfeit, lapse or surrender a policy. R.S., c. 231, s. 43.

Disclosure statement

44 Every agent, upon taking an application where replacement of an existing contract of life insurance by another contract of life insurance is intended, shall give the applicant a disclosure statement as prescribed by the regulations. R.S., c. 231, s. 44.

Suspension or cancellation of license

45 (1) Subject to Section 46, a license may be suspended or cancelled by the Superintendent if, after due investigation, the Superintendent determines that the holder of a license has

(a) made a material mis-statement in the application for the license;

(b) violated any provision of this Act or the regulations; or

(c) demonstrated his incompetency or untrustworthiness to act as an insurance agent by anything done or omitted in connection with the business for which the license was granted.

Notification of suspension or cancellation

(2) The Superintendent shall notify the holder of the license by registered mail of the suspension or cancellation of the license pursuant to subsection (1).

Return of license

(3) Upon receipt of the notification referred to in subsection (2), the holder of the license shall forthwith return the license to the Superintendent. R.S., c. 231, s. 45.

Hearing prior to suspension or cancellation

46 (1) Before suspending or cancelling an agent's license pursuant to Section 45, the Superintendent shall fix a time and place for a hearing to review the evidence and shall give the agent fifteen days notice of such hearing.

Service of notice

(2) The notice referred to in subsection (1) shall be delivered personally or by registered mail and shall include the particulars of all evidence in the possession of the Superintendent to be reviewed at the hearing in sufficient detail to enable the agent to respond. R.S., c. 231, s. 46.

Person ceasing to act for insurer

47 (1) Where an agent or broker ceases to act for an insurer, the insurer shall, within ten business days, notify the Superintendent in writing of the fact along with the reason for the termination and, until such notification is received by the Superintendent, the agent or broker shall be deemed to be authorized to act in the Province as agent or broker for the insurer.

Person starting to act for insurer

(2) Where an insurer authorizes a person to act as agent or broker in the Province, it shall notify the Superintendent in writing of the fact. R.S., c. 231, s. 47.

Evidence of licensee status

48 A certificate purporting to be given by the Superintendent that on a day mentioned in the certificate

(a) a person mentioned therein was or was not licensed under this Part;

(b) a person mentioned therein was originally issued a license; or

(c) the license of an agent mentioned therein was renewed, suspended, revived or revoked,

is admissible in evidence without proof of the signature or office of the person purporting to give the certificate and is prima facie proof of the facts stated in the certificate. R.S., c. 231, s. 48.

Investigation

49 (1) The Superintendent, or any person authorized by the Superintendent, may, upon complaint of any interested person, or when the Superintendent or person authorized by the Superintendent deems it necessary without complaint, investigate and inquire into any matter that the Superintendent or person authorized by the Superintendent deems expedient for the due administration of this Act, including the circumstances surrounding any transaction or matter or thing done by any insurer or agent whether licensed or not licensed.

Examination of books and records

(2) For the purpose of an investigation pursuant to subsection (1), the Superintendent or the person authorized by the Superintendent may inquire into and examine the business affairs of the insurer or agent in respect of whom the investigation is being made and may examine and inquire into any books, papers, documents, correspondence, communications, negotiations, transactions, investigations, loans, borrowings and payments to, by, on behalf of or in relation to or connected with the insurer or agent and into any property, assets or things owned, acquired or alienated in whole or in part by such insurer or agent, and the insurer or agent shall be bound to make prompt and explicit answers to any such inquiries.

Copies of documents

(3) When conducting an investigation pursuant to this Section, the Superintendent or the person authorized by the Superintendent to make the investigation may make copies of the documents referred to in subsection (2).

Powers

(4) For the purpose of an investigation pursuant to this Section, the Superintendent and the person authorized by the Superintendent to make the investigation have all the powers of a commissioner appointed pursuant to the Public Inquiries Act. R.S., c. 231, s. 49.

Appeal

50 (1) A person who is dissatisfied with a decision of the Superintendent pursuant to this Part may, within thirty days from the date of the decision, appeal to a judge of the county court who may, upon hearing the appeal which shall be heard in accordance with the Summary Proceedings Act, by order do any one or more of the following things:

(a) dismiss the appeal;

(b) allow the appeal;

(c) allow the appeal subject to terms and conditions;

(d) vary the decision appealed against;

(e) refer the matter back to the Superintendent for further consideration and decision;

(f) award costs of the appeal;

(g) make such other order as to the judge seems just.

Service on Superintendent

(2) The appeal shall be by notice of appeal and a copy thereof shall be served upon the Superintendent not less than ten days before the day on which the motion is returnable.

Calling of witnesses

(3) On the hearing of an appeal any evidence taken before the Superintendent and certified by the Superintendent may, with leave of the judge hearing the appeal, be read and has the like force and effect as if the witness were there examined and any party affected by the appeal may call witnesses and adduce evidence, whether or not the witnesses were called or the evidence adduced at the hearing before the Superintendent, either as to the credibility of witnesses or as to any other fact material to the inquiry.

Further appeal

(4) An appeal lies to the Appeal Division of the Supreme Court from a decision of the county court upon any question of law but such appeal can only be taken by leave of a judge of the Appeal Division given upon an application presented to the judge within thirty days after the rendering of the decision and upon such terms as the judge may determine and notice of such an application shall be given to the Superintendent at least two clear days before the presentation of such application.

Service on Superintendent

(5) Where leave to appeal has been granted, the appeal shall be brought by notice served on the Superintendent within ten days after the leave to appeal has been granted and the notice shall contain the names of the parties and the date of the decision appealed from and such other particulars as the judge granting leave to appeal may require. R.S., c. 231, s. 50.

"council" defined

51 (1) In this Section, "council" means a council established pursuant to subsection (2).

Insurance council

(2) The Governor in Council may provide for the establishment of an Insurance Council or councils and for the appointment of or election of members to the councils.

Powers and duties of council

(3) The Governor in Council may make regulations prescribing the functions, powers and duties of a council established pursuant to subsection (2) and governing the carrying out of those functions and duties and the exercise of those powers.

Powers

(4) Without limiting the generality of subsection (3), the Governor in Council may make regulations granting to a council, on any terms and conditions that the Governor in Council considers appropriate, the power to

(a) accept and exercise powers, functions and responsibilities delegated to it by the Superintendent;

(b) establish the educational, training and other standards and qualifications required for the licensing or registration of agents;

(c) establish and enforce ethical, operational and trade practices for agents;

(d) investigate complaints and adjudicate or mediate disputes regarding services provided by an agent;

(e) make recommendations to government;

(f) fix and collect license, registration or other fees and special fees from applicants, registrants and licensees in the insurance industry that are necessary to allow the council to finance the exercise of its assigned powers;

(g) initiate and engage in programs of consumer protection;

(h) sub-delegate its powers to sub-councils or committees;

(i) make by-laws necessary for its efficient functioning.

Filing of by-laws and rules

(5) A council shall file with the Superintendent every by-law, rule and regulation and amendment thereto made by the council within thirty days of making it.

Approval by Superintendent

(6) The Superintendent shall, within thirty days of receiving a by-law, rule, regulation or amendment pursuant to subsection (5),

(a) advise the council that the Superintendent approves the by-law, rule, regulation or amendment, as the case may be, and fix a date on which the by-law, rule, regulation or amendment comes into force; or

(b) where the Superintendent is of the opinion that the by-law, rule, regulation or amendment, as the case may be, is unacceptable or prejudicial to the public interest, so advise the council.

Coming into force of by-law

(7) No by-law, rule or regulation or amendment thereto made by a council comes into force until the Superintendent fixes a date pursuant to clause (a) of subsection (6).

Review of decision by Superintendent

(8) Every decision of a council is subject to review by the Superintendent on the Superintendent's own initiative or at the request of any interested person.

Appeal

(9) A decision of the Superintendent, as a result of a review pursuant to subsection (8), may be appealed to the Trial Division of the Supreme Court. R.S., c. 231, s. 51.

Regulations

52 (1) With the approval of the Governor in Council, the Superintendent may make regulations

(a) classifying applications for licenses and restricting or prohibiting the licensing of any class of applicant;

(b) providing for the issuing and renewal of licenses and the fees payable on the application for or renewal of licenses;

(c) providing for the holding of examinations and the fees payable for examinations;

(d) prescribing the conditions upon which a license may be refused, revoked, suspended or not renewed;

(e) requiring agents to supply information and make returns to the Superintendent and prescribing the contents of those returns;

(f) requiring an agent to furnish a bond or other security and fixing the amount, form and terms thereof;

(g) requiring and regulating trust accounts and trust records to be maintained by agents;

(h) respecting disclosure statements;

(i) regulating the replacement of an existing life insurance contract by another contract of life insurance and prescribing the duties of insurers and agents in connection with the replacement of a life insurance contract;

(j) prescribing forms and providing for their use;

(k) exempting any person or class of persons from any of the provisions of this Part;

(l) defining any word or expression used but not defined in this Part;

(m) generally to carry out more effectively the intent and purpose of this Part.

Regulations Act

(2) The exercise of the authority contained in subsection (1) shall be regulations within the meaning of the Regulations Act. R.S., c. 231, s. 52.

PART IV

LICENSES FOR ADJUSTERS

Licensing of adjuster

53 (1) Subject to Section 56, the Superintendent may issue to any person a license authorizing the person to act as an adjuster upon

(a) the filing of an application in the form prescribed by the Superintendent;

(b) payment of the fee prescribed by the regulations; and

(c) successful completion of courses or examinations, or both, as prescribed by the regulations.

Probationary license

(2) The Superintendent may, upon payment of the fee prescribed by the regulations, issue to the applicant a license on a probationary basis permitting the applicant to act as an adjuster while under the supervision of a licensed adjuster whose name is filed with the Superintendent and who accepts full responsibility for the applicant.

Partnership or corporation license

(3) A license issued to a partnership or corporation shall be issued in the name of the partnership or corporation.

Requirement for licensed adjuster on staff

(4) A license shall not be issued pursuant to subsection (3) unless the partnership or corporation has a licensed adjuster on staff.

Limitations and conditions

(5) The license shall be subject to the limitations and conditions the Superintendent prescribes. R.S., c. 231, s. 53.

Expiration of license

54 (1) Every license expires at the end of three years after it has been issued or at such other time as the Superintendent may determine, but may be renewed on due application to the Superintendent and payment of the fee prescribed by the regulations, unless previously cancelled or suspended by the Superintendent.

Earlier expiry

(2) Notwithstanding subsection (1), the Superintendent may determine for a particular license or class of license an expiry date which is less than three years from the date on which it was issued or renewed.

Expiration of probationary license

(3) Every probationary license expires at the end of one year after it has been issued or at such other time as the Superintendent may determine, but may be renewed on application to the Superintendent, payment of the fee prescribed by the regulations and satisfaction of the filing requirements prescribed by the regulations, unless previously cancelled or suspended by the Superintendent. R.S., c. 231, s. 54.

Regulations respecting adjusters

55 (1) With the approval of the Governor in Council, the Superintendent may make regulations

(a) respecting the qualifications and classification of adjusters;

(b) respecting probationary adjusters;

(c) providing for licenses for different classes of adjusters;

(d) prescribing fees payable on the application for or renewal of licenses for adjusters;

(e) prescribing the conditions upon which a license may be refused, revoked, suspended or not renewed;

(f) relating to the form and content of courses of study for different classes of adjusters and licenses;

(g) respecting the time and manner of conducting examinations of adjusters and prescribing the fees for such examinations;

(h) prescribing books, accounts and records to be kept and maintained by adjusters;

(i) fixing or limiting the fees or charges that may be made by adjusters;

(j) requiring adjusters to supply information and make returns to the Superintendent and prescribing the contents of those returns;

(k) exempting any person or class of persons from any of the provisions of this Part;

(l) defining any word or expression used but not defined in this Part;

(m) generally for the better carrying out of the provisions of this Part and the more efficient administration of it.

Effective date of regulation

(2) Regulations made under this Section come into force upon publication in the Royal Gazette. R.S., c. 231, s. 55.

Advisory board

56 In determining the granting or refusal of an application for a license or renewal of a license of an adjuster or probationary adjuster, or the suspension or cancellation of a license or the reinstatement of any suspended or cancelled license, the Superintendent may, in any case where the Superintendent deems it proper, nominate an advisory board consisting of three persons, one of whom shall be the Superintendent or another person appointed by him, one of whom shall be a representative of insurers and one of whom shall be a representative of licensed adjusters before which board a hearing may be had and the report made to the Superintendent, and the Superintendent shall take such report into consideration when making a decision. R.S., c. 231, s. 56.

License required

57 (1) No person shall either on his own account or as a member or representative of a partnership or corporation, act or offer to undertake to act, as an adjuster or probationary adjuster unless he is the holder of a license that is in force.

Offence

(2) Subject to subsection (3), unless he holds an adjuster's license that is in force no person shall, on behalf of himself or any other person, directly or indirectly

(a) solicit the right to negotiate or negotiate or attempt to negotiate, for compensation, the settlement of a claim for loss or damage arising out of a motor vehicle accident resulting from bodily injury to or death of any person or damage to property on behalf of a claimant; or

(b) hold himself out as an adjuster, investigator, consultant or otherwise as an adviser, on behalf of any person having a claim against an insured for which indemnity is provided by a motor vehicle liability policy.

Exception for barrister

(3) Subsection (2) does not apply to a barrister or solicitor acting in the usual course of his profession. R.S., c. 231, s. 57.

Suspension or cancellation of license

58 (1) A license may be suspended or cancelled by the Superintendent if, after due investigation, the Superintendent determines that the holder of the license

(a) has made a material mis-statement in the application for the license;

(b) has violated any provision of this Act or the regulations; or

(c) has demonstrated his incompetency or untrustworthiness to act as an adjuster or probationary adjuster, by anything done or omitted in connection with the business for which the license was granted.

Notification of suspension or cancellation

(2) The Superintendent shall notify the adjuster or probationary adjuster by registered mail of the suspension or cancellation of the adjuster's or probationary adjuster's license pursuant to subsection (1).

Return of license

(3) Upon receipt of the notification referred to in subsection (2), the adjuster or probationary adjuster shall forthwith return the license to the Superintendent. R.S., c. 231, s. 58.

Hearing prior to suspension or cancellation

59 (1) Before cancelling or suspending an adjuster's or probationary adjuster's license pursuant to Section 58, the Superintendent shall fix a time and place for a hearing to review the evidence and shall give the adjuster or probationary adjuster fifteen days notice of the hearing.

Delivery of notice

(2) The notice referred to in subsection (1) shall be delivered personally or by registered mail and shall include the particulars of all evidence in the possession of the Superintendent to be reviewed at the hearing in sufficient detail to enable the adjuster or probationary adjuster to respond. R.S., c. 231, s. 59.

Adjuster to notify Superintendent

60 Where a licensed insurance adjuster or a person who holds a license on a probationary basis ceases to act as adjuster either on his own account or as a member or representative of a partnership or corporation, he shall, within ten business days, notify the Superintendent in writing of such fact and the reason for the termination. R.S., c. 231, s. 60.

Evidence of adjuster status

61 A certificate purporting to be given by the Superintendent that on a day mentioned in the certificate

(a) a person mentioned therein was or was not licensed under this Part;

(b) a person mentioned therein was originally issued a license; or

(c) the license of any adjuster mentioned therein was renewed, suspended, revised or revoked,

is admissible in evidence without proof of the signature or office of the person purporting to give the certificate and is prima facie proof of the facts stated in the certificate. R.S., c. 231, s. 61.

Investigation

62 (1) The Superintendent, or any person authorized by the Superintendent, may, upon complaint of any person interested, or when the Superintendent or the person authorized by the Superintendent deems it necessary without complaint, investigate and inquire into any such matter as the Superintendent or the person designated by the Superintendent deems expedient for the due administration of this Act, including the circumstances surrounding any transaction or matter or thing done by an adjuster or probationary adjuster whether licensed or not licensed.

Examination of books and records

(2) For the purpose of an investigation pursuant to subsection (1), the Superintendent or the person authorized by the Superintendent may inquire into and examine the business affairs of the person in respect of whom the investigation is being made, and may examine and inquire into any books, papers, documents, correspondence, communications, negotiations, transactions, investigations, loans, borrowings and payments to, by, on behalf of or in relation to or connected with such person and into any property, assets or things owned, acquired or alienated in whole or in part by such person, and any such person shall be bound to make prompt and explicit answers to any such inquiries.

Copies of documents

(3) The Superintendent, or the person authorized by the Superintendent to make an investigation, may make copies of the documents referred to in subsection (2).

Powers

(4) For the purpose of an investigation pursuant to this Section, the Superintendent or the person authorized by the Superintendent has all the powers of a commissioner appointed pursuant to the Public Inquiries Act. R.S., c. 231, s. 62.

Appeal

63 (1) A person who is dissatisfied with a decision of the Superintendent pursuant to this Part may, within thirty days from the date of the decision, appeal to a judge of the county court who may, upon hearing the appeal which shall be heard in accordance with the Summary Proceedings Act, by order do any one or more of the following things:

(a) dismiss the appeal;

(b) allow the appeal;

(c) allow the appeal subject to terms and conditions;

(d) vary the decision appealed against;

(e) refer the matter back to the Superintendent for further consideration and decision;

(f) award costs of the appeal;

(g) make such other order as to the judge seems just.

Service on Superintendent

(2) The appeal shall be by notice of appeal and a copy thereof shall be served upon the Superintendent not less than ten days before the day on which the motion is returnable.

Calling of witnesses

(3) On the hearing of an appeal any evidence taken before the Superintendent and certified by the Superintendent may, with leave of the judge hearing the appeal, be read and shall have the like force and effect as if the witness were there examined and any party affected by the appeal may call witnesses and adduce evidence, whether or not the witnesses were called or the evidenced adduced at the hearing before the Superintendent, either as to the credibility of witnesses or as to any other fact material to the inquiry.

Further appeal

(4) An appeal lies to the Appeal Division of the Supreme Court from a decision of the county court upon any question of law but such appeal can only be taken by leave of a judge of the Appeal Division given upon an application presented to the judge within thirty days after the rendering of the decision and upon such terms as the judge may determine, and notice of such application to the Superintendent at least two clear days before the presentation of such application.

Service on Superintendent

(5) Where leave to appeal has been granted, the appeal shall be brought by notice served on the Superintendent within ten days after the leave to appeal has been granted and the notice shall contain the names of the parties and the date of the decision appealed from and such other particulars as the judge granting leave to appeal may require. R.S., c. 231, s. 63.

PART V

ACCIDENT AND SICKNESS INSURANCE

Interpretation of Part

64 In this Part,

(a) "application" means a written application for insurance or for the reinstatement of insurance;

(b) "beneficiary" means a person designated or appointed in a contract or by a declaration, other than the insured or his personal representative, to whom or for whose benefit insurance money payable in the event of death by accident is to be paid;

(c) "blanket insurance" means that class of group insurance which covers loss arising from specific hazards incident to or defined by reference to a particular activity or activities;

(d) "contract" means a contract of insurance;

(e) "Court" means the Trial Division of the Supreme Court or a judge thereof;

(f) "creditor's group insurance" means insurance effected by a creditor whereby the lives or well-being, or the lives and well-being, of a number of his debtors are insured severally under a single contract;

(g) "declaration" means an instrument signed by the insured

(i) with respect to which an endorsement is made on the policy,

(ii) that identifies the contract, or

(iii) that describes the insurance or insurance fund or a part thereof,

in which he designates or alters or revokes the designation of his personal representative or a beneficiary as one to whom or for whose benefit shall be paid the insurance money which is payable in the event of death by accident;

(h) "family insurance" means insurance whereby the lives or well-being, or the lives and well-being, of the insured and one or more persons related to him by blood, marriage or adoption are insured under a single contract between an insurer and the insured;

(i) "group insurance" means insurance other than creditor's group insurance and family insurance, whereby the lives or well-being, or the lives and well-being, of a number of persons are insured severally under a single contract between an insurer and an employer or other person;

(j) "group person insured" means a person who is insured under a contract of group insurance and upon whom a right is conferred by the contract, but does not include a person who is insured thereunder as a person dependent upon or related to him;

(k) "instrument" includes a will;

(l) "insurance" means accident insurance, sickness insurance, or accident and sickness insurance;

(m) "insured" means

(i) in the case of group insurance, in the provisions of this Part relating to the designation of beneficiaries or of personal representatives as recipients of insurance money and their rights and status, the group person insured, and

(ii) in all other cases the person who makes a contract with an insurer;

(n) "person insured" means a person in respect of an accident to whom, or in respect of whose sickness, insurance money is payable under a contract, but does not include a group person insured;

(o) "will" includes a codicil. R.S., c. 231, s. 64.

Application of Part

65 (1) Notwithstanding any agreement, condition or stipulation to the contrary, this Part applies to a contract made in the Province on and after the first day of December, 1970, and this Section and Sections 64, 66, 67, 76, 79 to 81, 85 and 87 to 103 apply also to a contract made in the Province before that day.

Application of repealed provisions

(2) Sections 53, 54, 55, 56, 58, 65 and 68 of Part V of Chapter 148 of the Revised Statutes, 1967, in force immediately prior to the first day of December, 1970, apply to a contract made in the Province before that day.

Part does not apply

(3) This Part does not apply to

(a) accidental death insurance;

(b) creditor's group insurance;

(c) disability insurance; or

(d) insurance provided under Section 139 or 140. R.S., c. 231, s. 65.

Application to group insurance contract

66 In the case of a contract of group insurance made with an insurer authorized to transact insurance in the Province at the time the contract was made, this Part applies in determining

(a) the rights and status of beneficiaries and personal representatives as recipients of insurance money, if the group person insured was resident in the Province at the time he became insured; and

(b) the rights and obligations of the group person insured if he was resident in the Province at the time he became insured. R.S., c. 231, s. 66.

Policy to be issued

67 An insurer entering into a contract shall issue a policy. R.S., c. 231, s. 67.

Section does not apply

68 (1) This Section does not apply to

(a) a contract of group insurance; or

(b) a contract made by a fraternal society.

Particulars in policy

(2) An insurer shall set forth the following particulars in the policy:

(a) the name or a sufficient description of the insured and of the person insured;

(b) the amount or the method of determining the amount of the insurance money payable and the conditions under which it becomes payable;

(c) the amount or the method of determining the amount of the premium and the period of grace, if any, within which it may be paid;

(d) the conditions upon which the contract may be reinstated if it lapses; and

(e) the term of the insurance or the method of determining the day upon which the insurance commences and terminates. R.S., c. 231, s. 68.

Condition respecting confinement

69 (1) Where a contract of accident insurance or sickness insurance issued on or after the first day of July, 1976 includes a provision that a benefit is payable to an insured on account of his disability and the provision is conditional on the confinement of the insured, the condition is null and void.

Benefits for hospitalization

(2) Notwithstanding subsection (1), a contract of accident or sickness insurance may provide for

(a) early commencement of loss of time benefits based on the admission to hospital of the person insured;

(b) payment of loss of time benefits during the period of in-patient hospitalization of the person insured;

(c) payment of per diem benefits during the period of in-patient hospitalization of the person insured;

(d) payment of lump sum benefits based on the admission to hospital or the period of in-patient hospitalization of the person insured. R.S., c. 231, s. 69.

Particulars in policy of group insurance

70 In the case of a contract of group insurance, an insurer shall set forth the following particulars in the policy:

(a) the name or a sufficient description of the insured;

(b) the method of determining the group persons insured and persons insured;

(c) the amount or the method of determining the amount of the insurance money payable and the conditions under which it becomes payable;

(d) the period of grace, if any, within which the premium may be paid; and

(e) the term of the insurance or the method of determining the day upon which the insurance commences and terminates. R.S., c. 231, s. 70.

Interpretation of Section

71 (1) In this Section,

(a) "original maximum benefit" means, in relation to a contract of group insurance, the maximum period provided under that contract for the payment of any benefit payable thereunder in respect of loss of income;

(b) "prescribed time period" means, in relation to a contract of group insurance, a continuous period of six months following the termination of the contract or benefit provision therein or such longer continuous period as may be provided in that contract instead of the six month period.

Continuing liability after termination

(2) Where a contract of group insurance or benefit provision therein is terminated, the insurer continues, as though the contract or benefit provision had remained in full force and effect, to be liable, to or in respect of any group person insured under the contract, to pay benefits thereunder relating to

(a) loss of income because of disability;

(b) death;

(c) dismemberment; or

(d) accidental damage to natural teeth,

arising from an accident or sickness that occurred before the termination of the contract or benefit provision, if the disability, death, dismemberment or accidental damage to natural teeth is reported to the insurer within the prescribed time period.

Re-occurring disability

(3) Notwithstanding clause (a) of subsection (2), an insurer does not remain liable, under a contract or benefit provision described in that subsection, to pay a benefit for loss of income for the re-occurrence, after the termination of that contract or benefit provision, of a disability that re-occurs after a continuous period of six months, or such longer period as is provided in the contract, during which the group person insured was not disabled.

Duration of loss of income benefits in subsection (2)

(4) An insurer who is liable under subsection (2) to pay a benefit for loss of income on account of the disability of a group person insured is not liable to pay benefits for any period longer than the period remaining of the original maximum benefit period in respect of the disability of the group person insured.

Effect of "replacing contract" of group insurance

(5) Where a contract of group insurance, herein referred to as the "replacing contract", is entered into within thirty-one days of the termination of another contract of group insurance, herein referred to as the "other contract", and insures the same group or a part of the group insured under the other contract,

(a) the replacing contract shall provide or shall be deemed to provide that any person who was insured under the other contract at the time of its termination is insured under the replacing contract from and after the termination of the other contract, if

(i) the insurance on that person under the other contract terminated solely by reason of the termination of the other contract, and

(ii) the person is a member of a class eligible for insurance under the replacing contract;

(b) every person who was insured under the other contract and who is insured under the replacing contract is entitled to receive credit for satisfaction of any deductible earned before the effective date of the replacing contract; and

(c) no person who was insured under the other contract shall be excluded from eligibility under the replacing contract solely because of not being actively at work on the effective date of the replacing contract,

but if the replacing contract provides that the full benefits required to be paid pursuant to subsection (2) by the insurer of the other contract are to be provided instead under the replacing contract, the insurer of the other contract is not liable to pay any such benefits. R.S., c. 231, s. 71.

Particulars to person covered

72 (1) Except as provided in subsection (2) in the case of a contract of group insurance, an insurer shall issue for delivery by the insured to each group person insured a certificate or other document in which are set forth the following particulars:

(a) the name of the insurer and a sufficient identification of the contract;

(b) the amount or the method of determining the amount of insurance on the group person insured and on any person insured;

(c) the circumstances under which the insurance terminates, and the rights, if any, upon such termination of the group person insured and of any person insured.

Section does not apply

(2) This Section does not apply to a contract of blanket insurance or to a contract of group insurance of a non-renewable type issued for a term of six months or less. R.S., c. 231, s. 72.

Disclosure of exception or reduction

73 (1) Subject to Section 74 and except as otherwise provided in this Section, the insurer shall set forth in the policy every exception or reduction affecting the amount payable under the contract, either in the provision affected by the exception or reduction, or under a heading such as "Exceptions" or "Reductions".

Exception or reduction affecting one provision

(2) Where the exception or reduction affects only one provision in the policy it shall be set forth in that provision.

Exception or reduction not contained in policy

(3) Where the exception or reduction is contained in an endorsement, insertion or rider, the endorsement, insertion or rider shall, unless it affects all amounts payable under the contract, make reference to the provisions in the policy affected by the exception or reduction.

Section 86 exception or reduction

(4) The exception or reduction mentioned in Section 86 need not be set forth in the policy.

Section does not apply

(5) This Section does not apply to a contract made by a fraternal society. R.S., c. 231, s. 73.

Statutory conditions

74 Subject to Section 75, the conditions set forth in the Schedule to this Part 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". R.S., c. 231, s. 74.

Omission of statutory condition

75 (1) Where a statutory condition is not applicable to the benefits provided by the contract it may be omitted from the policy or varied so that it will be applicable.

Omission of certain conditions

(2) Statutory conditions 3, 4 and 9 may be omitted from the policy if the contract does not contain any provisions respecting the matters dealt with therein.

Variation respecting termination by insurer

(3) Statutory conditions 5 and 6 shall be omitted from the policy if the contract does not provide that it may be terminated by the insurer prior to the expiry of any period for which a premium has been accepted.

Variation favourable to insured

(4) Statutory conditions 3, 4, 5, 6 and 9, and subject to the restriction in subsection (5), statutory condition 7, may be varied but if by reason of the variation the contract is less favourable to the insured, a person insured or a beneficiary than it would be if the condition had not been varied, the condition shall be deemed to be included in the policy in the form in which it appears in Section 74.

Variation respecting benefits for loss of time

(5) Clauses (a) and (b) of paragraph (1) of statutory condition 7 may not be varied in policies providing benefits for loss of time.

Variation of period of time

(6) Statutory conditions 10 and 11 may be varied by shortening the periods of time prescribed therein, and statutory condition 12 may be varied by lengthening the period of time prescribed therein.

Reproduction of title required

(7) The title of a statutory condition shall be reproduced in the policy along with the statutory condition, but the number of a statutory condition may be omitted.

Special provision for fraternal society

(8) In the case of a contract made by a fraternal society,

(a) the following provision shall be printed on every policy in substitution for paragraph (1) of statutory condition 1:

1 (1) The contract - This policy, the Act or instrument of incorporation of the society, its constitution, by-laws and rules, and the amendments made from time to time to any of them, the application for the contract and the medical statement of the applicant, constitute the entire contract, and no agent has authority to change the contract or waive any of its provisions.

and

(b) statutory condition 5 shall not be printed on the policy. R.S., c. 231, s. 75.

Notice of statutory conditions

76 In the case of a policy of accident insurance of a non-renewable type issued for a term of six months or less or in relation to a ticket of travel, the statutory conditions need not be printed on or attached to the policy if the policy contains the following notice printed in conspicuous type:

Notwithstanding any other provision herein contained, this contract is subject to the statutory conditions in the Insurance Act respecting contracts of accident insurance.

R.S., c. 231, s. 76; revision corrected 1999.

Effect of delivery of policy or renewal

77 (1) Where a policy evidencing a contract or a certificate evidencing the renewal of a contract is delivered to the insured and the initial premium or, in the case of a renewal certificate, the renewal premium therefor has not been fully paid,

(a) the contract or the renewal thereof evidenced by the certificate is as binding on the insurer as if such premium had been paid although delivered by an officer or an agent of the insurer who did not have authority to deliver it; and

(b) the contract may be terminated for the non-payment of the premium by the insurer upon ten days notice of termination given in writing to the insured and mailed postage prepaid and registered to the latest address of the insured on the records of the insurer and the ten days shall begin on the day following the date of mailing such notice.

Section does not apply

(2) This Section does not apply to a contract of group insurance or to a contract made by a fraternal society. R.S., c. 231, s. 77.

Deduction of unpaid premium

78 (1) An insurer may

(a) deduct unpaid premiums from an amount which it is liable to pay under a contract; or

(b) sue the insured for unpaid premiums.

Default in paying premium

(2) Where a cheque or other bill of exchange or a promissory note or other written promise to pay is given for the whole or part of a premium and payment is not made according to its tenor, the premium or part thereof shall be deemed never to have been paid.

Clause (1)(a) does not apply

(3) Clause (a) of subsection (1) does not apply to a contract of group insurance.

Section does not apply

(4) This Section does not apply to a contract made by a fraternal society. R.S., c. 231, s. 78.

Persons with insurable interest

79 Without restricting the meaning of the expression "insurable interest", a person has an insurable interest in his own life and well-being and in the life and well-being of

(a) his child or grandchild;

(b) his spouse or common-law partner;

(c) any person upon whom he is wholly or in part dependent for, or from whom he is receiving, support or education;

(d) his officer or employee; and

(e) any person in whom he has a pecuniary interest. R.S., c. 231, s. 79; 2000, c. 29, s. 24.

Contract void if no insurable interest

80 (1) Subject to subsection (2), where at the time a contract would otherwise take effect the insured has no insurable interest, the contract is void.

Insurable interest not required

(2) A contract is not void for lack of insurable interest

(a) if it is a contract of group insurance; or

(b) if the person insured has consented in writing to the insurance.

Consent for person under sixteen

(3) Where the person insured is under the age of sixteen years, consent to the insurance may be given by one of his parents or by a person standing in loco parentis to him. R.S., c. 231, s. 80.

POLICIES ON LIVES OF MINORS

Capacity of minor

81 (1) Except in respect of his rights as beneficiary, a minor who has attained the age of sixteen years has the capacity of a person of the age of nineteen years

(a) to make an enforceable contract; and

(b) in respect of a contract.

Beneficiary eighteen years of age

(2) A beneficiary who has attained the age of eighteen years has the capacity of a person of the age of nineteen years to receive insurance money payable to him and to give a valid discharge therefor. R.S., c. 231, s. 81.

MISREPRESENTATION AND

NON-DISCLOSURE

Duty to disclose

82 (1) An applicant for insurance on his own behalf and on behalf of each person to be insured, and each person to be insured, shall disclose to the insurer in any application, on a medical examination, if any, and in any written statements or answers furnished as evidence of insurability, every fact within his knowledge that is material to the insurance and is not so disclosed by the other.

Contract voidable

(2) Subject to Sections 83 and 86, a failure to disclose, or a misrepresentation of, such a fact renders a contract voidable by the insurer.

Disclosure where group insurance

(3) In the case of a contract of group insurance, a failure to disclose or a misrepresentation of such a fact with respect to a group person insured or a person insured under the contract does not render the contract voidable, but if evidence of insurability is specifically requested by the insurer, the insurance in respect of such a person is, subject to Section 83, voidable by the insurer. R.S., c. 231, s. 82.

Contract not voidable

83 (1) Subject to Section 86 and except as provided in subsection (2),

(a) where a contract, including renewals thereof, except a contract of group insurance, has been in effect continuously for two years with respect to a person insured, a failure to disclose or a misrepresentation of a fact with respect to that person required by Section 82 to be disclosed does not, except in the case of fraud, render the contract voidable;

(b) where a contract of group insurance, including renewals thereof, has been in effect continuously for two years with respect to a group person insured or a person insured, a failure to disclose or a misrepresentation of a fact with respect to that group person insured or person insured required by Section 82 to be disclosed does not, except in the case of fraud, render the contract voidable with respect to that group person insured or person insured.

Subsection (1) does not apply

(2) Where a claim arises from a loss incurred or a disability beginning before a contract, including renewals thereof, has been in force for two years with respect to the person in respect of whom the claim is made, subsection (1) does not apply to that claim. R.S., c. 231, s. 83.

Reinstatement

84 Sections 82 and 83 apply mutatis mutandis to a failure at the time of reinstatement of a contract to disclose or a misrepresentation at that time, and the period of two years to which reference is made in Section 83 commences to run in respect of a reinstatement from the date of reinstatement. R.S., c. 231, s. 84.

Prior existence of disease or condition

85 Where a contract contains a general exception or reduction with respect to pre-existing disease or physical conditions and the person insured or group person insured suffers or has suffered from a disease or physical condition that existed before the date the contract came into force with respect to that person and the disease or physical condition is not by name or specific description excluded from the insurance respecting that person,

(a) the prior existence of the disease or physical condition is not, except in the case of fraud, available as a defence against liability in whole or in part for a loss incurred or a disability beginning after the contract, including renewals thereof, has been in force continuously for two years immediately prior to the date of loss incurred or commencement of disability with respect to that person; and

(b) the existence of the disease or physical condition is not, except in the case of fraud, available as a defence against liability in whole or in part if the disease or physical condition was disclosed in the application for the contract. R.S., c. 231, s. 85.

Mis-statement of age

86 (1) Subject to subsections (2) and (3), if the age of the person insured has been mis-stated to the insurer then, at the option of the insurer, either

(a) the benefits payable under the contract shall be increased or decreased to the amount that would have been provided for the same premium at the correct age; or

(b) the premium may be adjusted in accordance with the correct age as of the date the person insured became insured.

Mis-statement of age for group insurance

(2) In the case of a contract of group insurance, if there is a mis-statement to the insurer of the age of a group person insured or person insured, the provisions, if any, of the contract with respect to age or mis-statement of age shall apply.

Where true age to govern

(3) Where the age of a person affects the commencement or termination of the insurance, the true age governs. R.S., c. 231, s. 86.

BENEFICIARIES

Designation of representative or beneficiary

87 (1) Unless otherwise provided in the policy, an insured may, in a contract or by a declaration, designate his personal representative or a beneficiary to receive insurance money payable in the event of death by accident, and may from time to time alter or revoke the designation by declaration.

Designation in invalid will

(2) A designation in an instrument purporting to be a will is not ineffective by reason only of the fact that the instrument is invalid as a will or that the designation is invalid as a bequest under the will.

Designation made after will

(3) A designation in a will is of no effect against a designation made later than the making of the will.

Designation in revoked will

(4) If a designation is contained in a will and subsequently the will is revoked by operation of law or otherwise, the designation is thereby revoked.

Designation in invalid will which is revoked

(5) If a designation is contained in an instrument that purports to be a will and subsequently the instrument, if it had been valid as a will would have been revoked by operation of law or otherwise, the designation is thereby revoked. R.S., c. 231, s. 87.

Deemed designation of personal representative

88 (1) A designation in favour of the "heirs", "next of kin" or "estate", or the use of words of like import in a designation, shall be deemed to be a designation of the personal representative.

Death of beneficiary

(2) Where a beneficiary predeceases the person insured or group person insured, as the case may be, and no disposition of the share of the deceased beneficiary in the insurance money is provided in the contract or by declaration, the share is payable

(a) to the surviving beneficiary;

(b) if there is more than one surviving beneficiary, to the surviving beneficiaries in equal shares; or

(c) if there is no surviving beneficiary, to the insured or group person insured, as the case may be, or his personal representative.

Right to enforce contract

(3) A beneficiary designated under Section 87 may, upon the death by accident of the person insured or group person insured, enforce for his own benefit, and a trustee appointed pursuant to Section 89 may enforce as trustee, the payment of insurance money payable to him, and the payment to the beneficiary or trustee discharges the insurer to the extent of the amount paid, but the insurer may set up any defence that it could have set up against the insured or his personal representative. R.S., c. 231, s. 88; revision corrected 1999.

Trustee for beneficiary

89 An insured may, in contract or by a declaration appoint a trustee for a beneficiary, and may alter or revoke the appointment by a declaration. R.S., c. 231, s. 89.

Notification to insurer respecting payment

90 (1) Until an insurer receives at its head or principal office in Canada an instrument or an order of a Court affecting the right to receive insurance money, or a notarial copy or a copy verified by statutory declaration of any such instrument or order, it may make payment of the insurance money and shall be as fully discharged to the extent of the amount paid as if there were no such instrument or order.

Subsection (1) affects only insurer

(2) Subsection (1) does not affect the rights or interests of any person other than the insurer.

Priority for assignee

(3) Where an assignee of a contract gives notice in writing of the assignment to the insurer at its head or principal office in Canada, he has priority of interest as against

(a) any assignee other than one who gave notice earlier in like manner; and

(b) a beneficiary.

Unconditional assignment

(4) Where a contract is assigned unconditionally and otherwise than as security, the assignee has all the rights and interest given by the contract and by this Part to the insured, and shall be deemed to be the insured.

Assignment may be prohibited

(5) A provision in a contract to the effect that the rights or interests of the insured, or in the case of a contract of group insurance the group person insured, are not assignable, is valid. R.S., c. 231, s. 90.

Entitlement of beneficiary

91 (1) Where a beneficiary is designated, any insurance money payable to him is not, from the time of the happening of the event upon which it becomes payable, part of the estate of the insured, and is not subject to the claims of the creditors of the insured.

Exemption from execution or seizure

(2) While there is in effect a designation of beneficiary in favour of any one or more of a spouse or common-law partner, child, grandchild or parent of the person insured or group person insured, the rights and interests of the insured in the insurance money and in the contract so far as either relate to accidental death benefits are exempt from execution or seizure. R.S., c. 231, s. 91; 2000, c. 29, s. 24.

Enforcement of contract by group person insured

92 A group person insured may, in his own name, enforce a right given by a contract to him, or to a person insured thereunder as a person dependent upon or related to him, subject to any defence available to the insurer against him or such person insured or against the insured. R.S., c. 231, s. 92.

Simultaneous deaths

93 Unless a contract or a declaration otherwise provides, where a person insured or group person insured and a beneficiary die at the same time or in circumstances rendering it uncertain which of them survived the other, the insurance money is payable in accordance with subsection (2) of Section 88 as if the beneficiary had predeceased the person insured or group person insured. R.S., c. 231, s. 93.

Payment into court

94 (1) Where the insurer admits liability for the insurance money or any part thereof, and it appears to the insurer that

(a) there are adverse claimants;

(b) the whereabouts of the person entitled is unknown; or

(c) there is no person capable of giving or authorized to give a valid discharge therefor who is willing to do so,

the insurer may apply ex parte to the Court for an order for payment of money into Court, and the Court may upon such notice, if any, as it deems necessary, make an order accordingly.

Costs

(2) The Court may fix without taxation the costs incurred upon or in connection with any application or order made under subsection (1), and may order the costs to be paid out of the insurance money or by the insurer or otherwise as it deems just.

Insurer discharged

(3) A payment made pursuant to an order under subsection (1) discharges the insurer to the extent of the payment. R.S., c. 231, s. 94.

Payment into court for minor

95 (1) Where an insurer admits liability for insurance money payable to a minor and there is no person capable of giving and authorized to give a valid discharge therefor who is willing to do so, the insurer may at any time after thirty days from the date of the happening of the event upon which the insurance money becomes payable, pay the money less the applicable costs mentioned in subsection (2) into court to the credit of the minor.

Costs

(2) The insurer may retain out of the insurance money for costs incurred upon payment into court under subsection (1), the sum of ten dollars where the amount does not exceed one thousand dollars, and the sum of fifteen dollars in other cases, and payment of the remainder of the money into court discharges the insurer.

Notification

(3) No order is necessary for payment into court under subsection (1), but the accountant or other proper officer shall receive the money upon the insurer filing with him an affidavit showing the amount payable and the name, date of birth and residence of the minor, and upon such payment being made the insurer shall forthwith notify the Minister of Community Services and deliver to him a copy of the affidavit. R.S., c. 231, s. 95.

Payment for beneficiary under disability

96 Where it appears that a representative of a beneficiary who is under disability may, under the law of the domicile of the beneficiary, accept payments on behalf of the beneficiary, the insurer may make payment to the representative and any such payment discharges the insurer to the extent of the amount paid. R.S., c. 231, s. 96.

Payment to authorized person

97 Notwithstanding that insurance money is payable to a person, the insurer may, if the contract so provides, but subject always to the rights of an assignee, pay an amount not exceeding two thousand dollars to

(a) a relative by blood or connection by marriage of a person insured or the group person insured; or

(b) any person appearing to the insurer to be equitably entitled thereto by reason of having incurred expense for the maintenance, medical attendance or burial of a person insured or the group person insured, or to have a claim against the estate of a person insured or the group person insured in relation thereto, and any such payment discharges the insurer to the extent of the amount paid. R.S., c. 231, s. 97.

Place of payment

98 (1) Subject to subsection (2), insurance money is payable in the Province.

Exception for group insurance

(2) In the case of a contract of group insurance, insurance money is payable in the province of Canada in which the group person insured was resident at the time he became insured.

Canadian dollars

(3) Unless a contract otherwise provides, a reference therein to dollars means Canadian dollars whether the contract by its terms provides for payment in Canada or elsewhere.

Payment outside Province

(4) Where a person entitled to receive insurance money is not domiciled in the Province, the insurer may pay the insurance money to that person or to any person who is entitled to receive it on his behalf by the law of the domicile of the payee and any such payment discharges the insurer to the extent of the amount paid.

Payment to personal representative

(5) Where insurance money is by the contract payable to a person who has died or to his personal representative and such deceased person was not at the date of his death domiciled in the Province, the insurer may pay the insurance money to the personal representative of such person appointed under the law of his domicile, and any such payment discharges the insurer to the extent of the amount paid. R.S., c. 231, s. 98.

Claimant may sue in Province

99 Regardless of the place where a contract was made, a claimant who is a resident of the Province may bring an action in the Province if the insurer was authorized to transact insurance in the Province at the time the contract was made or at the time the action is brought. R.S., c. 231, s. 99.

Information affecting insurance money

100 An insurer does not incur any liability for any default, error or omission in giving or withholding information as to any notice or instrument that it has received and that affects the insurance money. R.S., c. 231, s. 100.

Undue prominence to policy term

101 The insurer shall not in the policy give undue prominence to any provision or statutory condition as compared to other provisions or statutory conditions, unless the effect of that provision or statutory condition is to increase the premium or decrease the benefits otherwise provided for in the policy. R.S., c. 231, s. 101.

Imperfect compliance with statutory condition

102 Where there has been imperfect compliance with a statutory condition as to any matter or thing to be done or omitted by the insured, person insured or claimant with respect to the loss insured against and a consequent forfeiture or avoidance of the insurance in whole or in part, and a Court before which a question relating thereto is tried deems it inequitable that the insurance should be forfeited or avoided on that ground, the Court may relieve against the forfeiture or avoidance on such terms as it deems just. R.S., c. 231, s. 102.

Persons not agent of insured

103 No officer, agent, employee or servant of the insurer, and no person soliciting insurance, whether or not he is an agent of the insurer shall, to the prejudice of the insured, person insured or group person insured, be deemed to be the agent of the insured or of the person insured or group person insured in respect of any question arising out of the contract. R.S., c. 231, s. 103.

SCHEDULE TO PART V

STATUTORY CONDITIONS

1 (1) The contract - 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.

(2) Waiver - 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.

(3) Copy of application - The insurer shall, upon request, furnish to the insured or to a claimant under the contract a copy of the application.

2 Material facts - No statement made by the insured or person insured at the time of application for this contact 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.

3 (1) Changes in occupation - 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.

(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.

4 Relation of earnings to insurance - Where the benefits for loss of time payable hereunder, either alone or together with benefits for loss of time under another contract, including a contract of group accident insurance or group sickness insurance or of both and a life insurance contract providing disability insurance, 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 bears to the aggregate of the benefits for loss of time payable under all such contracts and the excess premium, if any, paid by the insured shall be returned to him by the insurer.

5 Termination by insured - The 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.

6 (1) Termination by insurer - 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.

(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 records of the insurer.

(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.

7 (1) Notice and proof of claim - 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.

(2) Failure to give notice or proof - 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.

8 Insurer to furnish forms for proof of claim - The 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.

9 Rights of examination - As 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.

10 When moneys payable other than for loss of time - All 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.

1 1 When loss of time benefits payable - The 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.

12 Limitation of actions - An 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 become payable if it had been a valid claim.

R.S., c. 231, Part V, Sch.

PART VI

AUTOMOBILE INSURANCE

Interpretation of Part

104 In this Part,

(a) "Assigned Risk Plan" means the Nova Scoti