Adjuster and Counsel can Handle both the Priority Dispute and LAT Proceeding

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Article Summary

In Mansuri v. Travelers (LAT 20-001365, September 28, 2022), Vice-Chair McGee confirms there is no conflict for an adjuster and their counsel to represent an insurer for both an accident benefits claim and a priority dispute as to which insurer is the priority insurer. 

In Mansuri v. Travelers (LAT 20-001365, September 28, 2022 - not yet on CanLII), Vice-Chair McGee confirms at para. 56 that Personal Insurance Company v. Jia, 2020 ONSC 6361 (CanLII),  does not stand for the proposition that defence counsel cannot represent an Insurer for a claimant’s accident benefits claim and the related priority dispute for that claim. 

There is no conflict as the signed OCF-1 permits the adjuster or counsel to share information and documents to adjust the claim and to determine the priority insurer liable to pay those benefits. Vice-Chair McGee also confirms at para. 60 that if an insured person purports to withdraw the signed consent from the OCF-1, that effectively ends the claim for accident benefits and any related LAT proceeding, as a signed OCF-1 is a precondition for entitlement to statutory accident benefits under s. 32 of the SABS.

In Jia, counsel was removed from the record due to perceived procedural unfairness: at the time they completed the priority EUO under s. 33(9) of the SABS to assess financial dependency, the claimant was not informed of or aware that those answers would also be relied upon to determine whether death benefits were payable based upon the same financial dependency issue. In hindsight, it would have been prudent for the priority EUO notice letter to have informed the insured that the answers would also be relied upon to adjust the funeral benefits claim. Alternatively, the insurer could have brought a motion in advance of the LAT Hearing for an order that the EUO transcript could be relied upon as it was relevant evidence properly shared with the adjuster and counsel pursuant to the signed OCF-1. 

The bottom line? There is no bar to an adjuster or counsel handling both a priority dispute and the related LAT proceeding. This is welcome news as this avoids the duplicate expense of appointing two different adjusters and two different lawyers for the same claim and same or overlapping legal issues. 

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