out for death by suicide if suicide occurs after black out period Reinstatement restarts any blackout period: s. 56(2) VIII. CLAIMS PROCESS 1. Introduction BB, p. 193 Several steps must be followed before an insured can expect to recover benefits under an insurance K Insured must advise the insurer of the loss and of the claim Insurer must investigate, verify and respond Different rights and duties are used to facilitate this process Imposed by common-law, by statute or by contract This all applies only after an insurance K has been properly formed (have a valid K) Post-loss Obligations of the insured Duties to provide notice of loss; Provide proof of loss; Cooperate with insurer Fulfill all obligation to good faith standard Ability of court to relive an insured from consequences of a breach of these obligations Relief against forfeiture Waiver Estoppel obligation to respond to claim Insurer’s Legal principles in assigning value ability to sue insurer for coverage under policy Insured’s 2. Obligations of an Insured Making a Claim Notice of Loss Issue Where Ratio Notes Obligation Marcoux Insured is obligated to give insurer timely notification of loss and their intention to make a claim Rationale Marcoux Avoids prejudice to insurer re: investigation and SCC 1948 defence: Timely investigation Determine grounds to contest any claim, if any Preserves insurer’s salvage interest Triggering Event Marcoux Subjective/Objective Assessment: Actual date of Insured’s subjective belief loss or when reasonable person in the position of irrelevant. the insured would have reason to believe claim possible. Length of time BCIA s. 29 General insurance Ks: Where gives time limit, easy to to notify after stat cond. 6 (1) On the happening of any loss of or damage to know. triggering event insured property, the insured must, if the loss or damage is covered by the contract, Meaning of “immediately” or (a) immediately give notice in writing to the insurer “promptly”
out for death by suicide if suicide occurs after black out period Reinstatement restarts any blackout period: s. 56(2) VIII. CLAIMS PROCESS 1. Introduction BB, p. 193 Several steps must be followed before an insured can expect to recover benefits under an insurance K Insured must advise the insurer of the loss and of the claim Insurer must investigate, verify and respond Different rights and duties are used to facilitate this process Imposed by common-law, by statute or by contract This all applies only after an insurance K has been properly formed (have a valid K) Post-loss Obligations of the insured Duties to provide notice of loss; Provide proof of loss; Cooperate with insurer Fulfill all obligation to good faith standard Ability of court to relive an insured from consequences of a breach of these obligations Relief against forfeiture Waiver Estoppel Insurer’s obligation to respond to claim Legal principles in assigning value Insured’s ability to sue insurer for coverage under policy 2. Obligations of an Insured Making a Claim Notice of Loss Issue Where Ratio Notes Obligation Marcoux Insured is obligated to give insurer timely notification of loss and their intention to make a claim Rationale Marcoux SCC 1948 Avoids prejudice to insurer re: investigation and defence: Timely investigation Determine grounds to contest any claim, if any Preserves insurer’s salvage interest Triggering Event Marcoux Subjective/Objective Assessment: Actual date of loss or when reasonable person in the position of the insured would have reason to believe claim possible. Insured’s subjective belief irrelevant. Length of time to notify after triggering event BCIA s. 29 stat cond. 6 General insurance Ks: (1) On the happening of any loss of or damage to insured property, the insured must, if the loss or damage is covered by the contract, (a) immediately give notice in writing to the insurer Where gives time limit, easy to know. Meaning of “immediately” or “promptly”