hordruma/ontario_laws_and_regs huggingface dataset:
PART VII ACCIDENT AND SICKNESS INSURANCE
Confinement clauses void
295 (1) Where a contract of accident and sickness insurance issued after November 2, 1973 includes a provision that a benefit is payable to an insured on account of his or her disability and the provision is conditional on the confinement of the insured, the condition does not bind the insured.  2002, c. 18, Sched. H, s. 4 (28). Exceptions (2) Despite subsection (1), a contract of accident and sickness insurance may provide for one or more of the following: 1.  Early commencement of loss of income benefits based on the admission of the person insured into a hospital, long-term care facility or other similar institution. 2.  Payment of loss of income benefits during the period of in-patient hospitalization of the person insured or the period during which the person insured is confined to a long-term care facility or other similar institution. 3.  Payment of daily benefits during the period of in-patient hospitalization of the person insured or the period during which the person insured is confined to a long-term care facility or other similar institution. 4.  Payment of lump sum benefits based on the admission of the person insured into a hospital or during the period of in-patient hospitalization or the admission into or during the period of confinement in a long-term care facility or other similar institution.  2012, c. 8, Sched. 23, s. 38. Section Amendments with date in force (d/m/y) 2002, c. 18, Sched. H, s. 4 (28) - 30/04/2007 2012, c. 8, Sched. 23, s. 38 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Contents of group policy or creditor’s group policy
296 In the case of a contract of group insurance or of creditor’s group insurance, an insurer shall include the following information in the policy: 1.  The name or a sufficient description of the insured. 2.  The method of determining the group persons insured and persons insured. 3.  The amount or the method of determining the amount of the insurance money payable and the conditions under which it becomes payable. 4.  The period of grace, if any, within which the premium may be paid. 5.  The term of the insurance or the method of determining the day upon which the insurance commences and terminates. 6.  In the case of a contract of group insurance, any provision removing or restricting the right of a group person insured to designate persons to whom or for whose benefit insurance money is to be payable. 7.  In the case of a contract of group insurance that replaces another contract of group insurance on some or all of the group person insureds under the replaced contract, whether a designation of a group person insured, a group person insured’s personal representative or a beneficiary as a person to whom or for whose benefit insurance money is to be payable under the replaced contract applies to the replacement contract. 8.  The following statement: Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002. R.S.O. 1990, c. I.8, s. 296; 2012, c. 8, Sched. 23, s. 39; 2013, c. 2, Sched. 8, s. 21. Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 39 (1, 2) - 01/07/2016 2013, c. 2, Sched. 8, s. 21 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Contents of group certificate
298 (1) Except as provided in subsection (2), in the case of a contract of group insurance or of creditor’s group insurance, an insurer shall issue for delivery by the insured to each group person insured or debtor insured a certificate or other document in which the following information shall be included: 1.  The name of the insurer and a sufficient identification of the contract. 2.  The amount or the method of determining the amount of insurance on the group person insured and on any person insured. 3.  The circumstances under which the insurance terminates, and the rights, if any, upon such termination of the group person insured or the debtor insured and of any person insured. 4.  In the case of a contract of group insurance that contains a provision removing or restricting the right of the group person insured to designate persons to whom or for whose benefit insurance money is to be payable, i.  the method of determining the persons to whom or for whose benefit the insurance money is or may be payable, and ii.  the following statement in conspicuous bold type: This policy contains a provision removing or restricting the right of the group person insured to designate persons to whom or for whose benefit insurance money is to be payable. 5.  In the case of a contract of group insurance that replaces another contract of group insurance on some or all of the group persons insured under the replaced contract, whether a designation of a group person insured, a group person insured’s personal representative or a beneficiary as one to whom or for whose benefit insurance money is to be payable under the replaced contract applies to the replacement contract. 6.  The rights of the group person insured, the debtor insured or a claimant under the contract to obtain copies of documents under subsection 293 (5) or (6). 7.  The following statement: Every action or proceeding against an insurer for the recovery of insurance money payable under the contract is absolutely barred unless commenced within the time set out in the Limitations Act, 2002. R.S.O. 1990, c. I.8, s. 298 (1); 2012, c. 8, Sched. 23, s. 41; 2013, c. 2, Sched. 8, s. 22. Exception (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.O. 1990, c. I.8, s. 298 (2). Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 41 (1-3) - 01/07/2016 2013, c. 2, Sched. 8, s. 22 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Exceptions or reduction
299 (1) Subject to section 300 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”. Idem (2) Where the exception or reduction affects only one provision in the policy it shall be set forth in that provision. Idem (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. Idem (4) The exception or reduction mentioned in section 312 need not be set forth in the policy. Idem (5) This section does not apply to a contract made by a fraternal society.  R.S.O. 1990, c. I.8, s. 299.
PART VII ACCIDENT AND SICKNESS INSURANCE
Omission or variation of statutory conditions
301 (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.  R.S.O. 1990, c. I.8, s. 301 (1). Idem (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.  R.S.O. 1990, c. I.8, s. 301 (2). Idem (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.  R.S.O. 1990, c. I.8, s. 301 (3). Idem (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 300.  R.S.O. 1990, c. I.8, s. 301 (4). Idem (5) Clauses (a) and (b) of subcondition 7 (1) may not be varied in policies providing benefits for loss of time.  R.S.O. 1990, c. I.8, s. 301 (5). Idem (6) Statutory conditions 10 and 11 may be varied by shortening the periods of time prescribed therein.  R.S.O. 1990, c. I.8, s. 301 (6); 2002, c. 24, Sched. B, s. 39 (8). Idem (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.  R.S.O. 1990, c. I.8, s. 301 (7). Contract by 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 subcondition 1 (1): The Contract 1. (1) 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.O. 1990, c. I.8, s. 301 (8). Section Amendments with date in force (d/m/y) 2002, c. 24, Sched. B, s. 39 (8) - 01/01/2004
PART VII ACCIDENT AND SICKNESS INSURANCE
Notice of statutory conditions
302 In the case of a policy of accident and sickness 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 a notice to the following effect, printed in conspicuous, bold type: Despite any other provision of this contract, this contract is subject to the statutory conditions in the Insurance Act
respecting contracts of accident and sickness insurance. R.S.O. 1990, c. I.8, s. 302; 2002, c. 18, Sched. H, s. 4 (30); 2012, c. 8, Sched. 23, s. 43. Section Amendments with date in force (d/m/y) 2002, c. 18, Sched. H, s. 4 (30) - 30/04/2007 2012, c. 8, Sched. 23, s. 43 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Declaration as to sufficiency of proof
302.1 (1) Where an insurer admits the validity of the insurance but does not admit the sufficiency of the evidence required by subcondition 7 (1) set out in section 300 and there is no other question in issue except a question under section 302.2, the insurer or the claimant may, before or after action is brought and on at least 30 days notice, apply to the court for a declaration as to the sufficiency of the evidence furnished, and the court may make the declaration or may direct what further evidence is to be furnished and on the furnishing of the evidence may make the declaration or, in special circumstances, may dispense with further evidence and make the declaration.  2012, c. 8, Sched. 23, s. 44. Application (2) This section applies only in respect of a claim for accidental death benefits.  2012, c. 8, Sched. 23, s. 44. Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 44 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Declaration of presumption of death
302.2 Where a claimant alleges that the person whose life is insured should be presumed to be dead and there is no other question in issue except a question under section 302.1, the insurer or the claimant may, before or after action is brought and on at least 30 days notice, apply to the court for a declaration as to presumption of the death, and the court may make the declaration.  2012, c. 8, Sched. 23, s. 44. Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 44 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Court order re payment of insurance money
302.3 (1) On making a declaration under section 302.1 or 302.2, the court may make an order respecting the payment of the insurance money and respecting costs that it considers just, and a declaration or direction or an order made under this subsection is binding on the applicant and on all persons to whom notice of the application has been given.  2012, c. 8, Sched. 23, s. 44. Insurer discharged (2) A payment made under an order made under subsection (1) discharges the insurer to the extent of the amount of the payment.  2012, c. 8, Sched. 23, s. 44. Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 44 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Order stays pending action
302.4 Unless the court orders otherwise, an application made under section 302.1 or 302.2 operates as a stay of any pending action with respect to the insurance money.  2012, c. 8, Sched. 23, s. 44. Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 44 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Order re furnishing of further evidence
302.5 Where the court finds that the evidence given pursuant to statutory condition 7 set out in section 300 is not sufficient or that a presumption of death is not established, it may order that the matters in issue be decided in an action brought or to be brought, or make any other order it considers just respecting further evidence to be given by the claimant, publication of advertisements, further inquiry or any other matter, or respecting costs.  2012, c. 8, Sched. 23, s. 44. Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 44 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Termination for non-payment of initial or renewal premium
303 (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 non-payment of the premium by the insurer giving, (i)  15 days notice of termination by registered mail to the latest address of the insured on the records of the insurer, the 15 days to begin on the day the registered letter or notification of it is delivered to the insured’s address, or (ii)  5 days written notice of termination personally delivered or delivered by prepaid courier to the latest address of the insured on the records of the insurer if there is a record by the person who has delivered it that the notice has been sent.  R.S.O. 1990, c. I.8, s. 303 (1); 2012, c. 8, Sched. 23, s. 45 (1); 2019, c. 7, Sched. 33, s. 9. Exception (2) This section does not apply to a contract made by a fraternal society. 2012, c. 8, Sched. 23, s. 45 (2). Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 45 (1, 2) - 01/07/2016 2019, c. 7, Sched. 33, s. 9 - 01/01/2022
PART VII ACCIDENT AND SICKNESS INSURANCE
Right where premium unpaid
304 (1) An insurer may, (a)  deduct unpaid premiums from an amount that it is liable to pay under a contract; or (b)  sue the insured for unpaid premiums. R.S.O. 1990, c. I.8, s. 304 (1). Where cheque or note for premium not paid (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 the cheque, bill of exchange or promissory note is not honoured according to its tenor, the premium or part thereof shall be deemed never to have been paid. R.S.O. 1990, c. I.8, s. 304 (2); 2012, c. 8, Sched. 23, s. 46 (1). Grace period (2.1) Where a premium, other than a premium referred to in subsection (1), is not fully paid at the time it is due, the premium may be paid within the longer of the following: 1.  A period of grace of 30 days after the date the premium is due. 2.  The period of grace within which the premium may be paid, if any, specified in the contract.  2012, c. 8, Sched. 23, s. 46 (2). Same (2.2) Where the happening of the event upon which the insurance money becomes payable occurs during the period of grace and before the overdue premium is paid, the contract shall be deemed to be in effect as if the premium had been paid at the time it was due and, except in the case of group insurance or of creditor’s group insurance, the amount of the premium may be deducted from the insurance money.  2012, c. 8, Sched. 23, s. 46 (2). Exception (3) Clause (1) (a) does not apply to a contract of group insurance or of creditor’s group insurance. R.S.O. 1990, c. I.8, s. 304 (3); 2012, c. 8, Sched. 23, s. 46 (3). Idem (4) Subsection (1) does not apply to a contract made by a fraternal society. R.S.O. 1990, c. I.8, s. 304 (4); 2012, c. 8, Sched. 23, s. 46 (4). Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 46 (1-4) - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Insurable interest, defined
305 Without restricting the meaning of “insurable interest”, a person, in this section called the “primary person”, has an insurable interest, (a)  in the case of a primary person who is a natural person, in his or her own life and well-being and in the lives and well-being of, (i)  the primary person’s child or grandchild, (ii)  the primary person’s spouse, (iii)  a person on whom the primary person is wholly or partly dependent for, or from whom the primary person is receiving, support or education, (iv)  an employee of the primary person, and (v)  a person in the duration of whose life or in whose well-being the primary person has a pecuniary interest; and (b)  in the case of a primary person that is not a natural person, in the lives and well-being of, (i)  a director, officer or employee of the primary person, and (ii)  a person in the duration of whose life or in whose well-being the primary person has a pecuniary interest.  2012, c. 8, Sched. 23, s. 47. Section Amendments with date in force (d/m/y) 1999, c. 6, s. 31 (11) - 01/03/2000 2005, c. 5, s. 35 (15) - 09/03/2005 2012, c. 8, Sched. 23, s. 47 - 01/07/2016
PART VII ACCIDENT AND SICKNESS INSURANCE
Insurable interest required
306 (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. R.S.O. 1990, c. I.8, s. 306 (1). Exceptions (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. R.S.O. 1990, c. I.8, s. 306 (2). Consent of minors (3) Where the person insured is under the age of sixteen years, consent to the insurance may be given by one of the person’s parents or by a person standing in the role of parent to the person. R.S.O. 1990, c. I.8, s. 306 (3); 2021, c. 4, Sched. 11, s. 19. Section Amendments with date in force (d/m/y) 2021, c. 4, Sched. 11, s. 19 - 19/04/2021 Termination of contract by court
PART VII ACCIDENT AND SICKNESS INSURANCE
Application to court
306.1 (1) A person may make an application to the court if, (a)  the person’s life or well-being, or life and well-being, are insured under a contract; (b)  the person is not the insured under the contract; and (c)  the person reasonably believes that the person’s life or health might be endangered by the insurance on his or her life or well-being, or life and well-being, continuing under that contract.  2012, c. 8, Sched. 23, s. 48. Court order (2) Upon an application being made under subsection (1), the court may make any order it considers just in the circumstances, including, (a)  an order that the insurance on that person under the contract be terminated in accordance with the terms of the contract other than any terms respecting notice of termination; and (b)  an order that the amount of insurance under the contract be reduced.  2012, c. 8, Sched. 23, s. 48. Notice (3) An application under subsection (1) must be made on at least 30 days notice to the insured, the beneficiary, the insurer and any other person the court considers to have an interest in the contract.  2012, c. 8, Sched. 23, s. 48. Same (4) Despite subsection (3), if the court considers it just to do so, it may dispense with the notice to a person other than, (a)  the insurer; or (b)  if the contract is a contract of group insurance or of creditor’s group insurance, the insured. 2020, c. 34, Sched. 7, s. 14. Who is bound by order (5) An order made under subsection (2) binds any person having an interest in the contract.  2012, c. 8, Sched. 23, s. 48. Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 48 - 01/07/2016 2020, c. 34, Sched. 7, s. 14 - 08/12/2020 Policies on Lives of Minors
PART VII ACCIDENT AND SICKNESS INSURANCE
Capacity of minors
307 Except in respect of his or her rights as beneficiary, a minor who has attained the age of sixteen years has the capacity of a person of the age of eighteen years, (a)  to make an enforceable contract; and (b)  in respect of a contract. R.S.O. 1990, c. I.8, s. 307. Misrepresentation and Non-Disclosure
PART VII ACCIDENT AND SICKNESS INSURANCE
Duty to disclose
308 (1) An applicant for insurance on the person’s 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 the person’s knowledge that is material to the insurance and is not so disclosed by the other. R.S.O. 1990, c. I.8, s. 308 (1). Failure to disclose, general (2) Subject to sections 309 and 312 and subsection (3), a failure to disclose, or a misrepresentation of, such a fact renders a contract voidable by the insurer. 2013, c. 2, Sched. 8, s. 24 (1). Failure to disclose, application for change, etc., in contract (3) A failure to disclose, or a misrepresentation of, a fact referred to in subsection (1) relating to evidence of insurability with respect to the following kinds of applications renders the contract voidable by the insurer, but only in relation to the addition, increase or change applied for: 1.  For additional coverage under a contract. 2.  For an increase in insurance under a contract. 3.  For any other change to insurance after the policy is issued. 2013, c. 2, Sched. 8, s. 24 (1). Section Amendments with date in force (d/m/y) 2012, c. 8, Sched. 23, s. 49 - no effect - see 2013, c. 2, Sched. 8, s. 24 (2) - 01/07/2016 2013, c. 2, Sched. 8, s. 24 (1, 2) - 01/07/2016