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RSNL1990 CHAPTER A-2

ACCIDENT AND SICKNESS INSURANCE ACT

Amended:

2001 c42 s2; 2010 c15 ss1-5; 2013 c16 s25

CHAPTER A-2

AN ACT RESPECTING ACCIDENT AND SICKNESS INSURANCE

Analysis


       
1.   Short title

       
2.   Definitions

       
3.   Application of Act

       
4.   Group insurance

       
5.   Issue of policy

       
6.   Contents of policy

       
7.   Confinement clauses void

       
8.   Contents of group policy

       
9.   Termination, etc. of policies

     
10.   Contents of group certificate

     
11.   Exceptions or reductions

     
12.   Statutory conditions

     
13.   Omission or variation of conditions

     
14.   Notice of statutory conditions

     
15.   Termination for non-payment

     
16.   Unpaid premium

     
17.   Insurable interest

     
18.   Lack of insurable interest

     
19.   Capacity of minors

     
20.   Disclosure

     
21.   Incontestability

     
22.   Application of incontestability

     
23.   Pre-existing conditions

     
24.   Misstatement of age

     
25.   Designation of beneficiary

     
26.   Meaning of "heirs"

     
27.   Trustee for beneficiary

     
28.   Documents affecting title

     
29.   Insurance money free from creditors

     
30.   Group person's rights

     
31.   Simultaneous deaths

     
32.   Payment into court

     
33.   Where beneficiary a minor

     
34.   Beneficiary under disability

     
35.   Certain payments

     
36.   Place of payment

     
37.   Action in province

     
38.   Insurer giving information

     
39.   Undue prominence

     
40.   Relief from forfeiture

     
41.   Presumption against agency

     
42.   Policy from a machine

     
43.   Term of trip policy sold from machine


Short title

        1. This Act may be cited as the Accident and Sickness Insurance Act.

1971 No6 s1

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Definitions

        2. In this Act

             (a)  "accident and sickness insurance" means accident and sickness insurance as defined in the Insurance Companies Act ;

             (b)  [Rep. by 2010 c15 s1]

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

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

             (e)  "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;

             (f)  "chief agency" means the principal office or place of business in the province of a foreign company undertaking insurance in the province;

             (g)  "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;

             (h)  "court" means the Trial Division or a judge of the Trial Division;

              (i)  "creditor's group insurance" means insurance effected by a creditor by which the lives or well-being of a number of his or her debtors are insured individually under a single contract;

              (j)  "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 of it,

in which he or she designates or alters or revokes the designation of his or her 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;

             (k)  [Rep. by 2010 c15 s1]

              (l)  "family insurance" means insurance where the lives or well-being of the insured and 1 or more persons related to the insured by blood, marriage or adoption are insured under a single contract between the insurer and the insured;

           (m)  "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 or accident and sickness insurance under which benefits may be paid only to its members or their beneficiaries in accordance with its constitution and laws and this Act;

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

             (o)  "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 under it as a person dependent upon or related to him or her;

             (p)  "head office" means the place where the chief executive officer of an insurance company transacts his or her business;

             (q)  "instrument" includes a will;

              (r)  "insurance" means accident and sickness insurance;

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

              (t)  "insured",

                      (i)  in the case of group insurance, means, in the provisions of this Act 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, means the person who makes a contract with an insurer;

             (u)  "insurer" means the person who undertakes or agrees or offers to undertake a contract;

             (v)  "life insurance" means life insurance as defined in the Insurance Companies Act ;

            (w)  "person" includes a firm, partnership, corporation and an unincorporated society or association;

             (x)  "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;

             (y)  "premium" means a single or periodical payment to be made for insurance, and includes dues and assessments;

             (z)  [Rep. by 2010 c15 s1]

          (aa)  "will" includes a codicil.

1971 No6 s2; 1978 c19 s2; 1979 c51 s2; 1986 c42 Sch A; 2010 c15 s1

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Application of Act

        3. (1) Notwithstanding an agreement, condition or stipulation to the contrary, this Act applies to a contract made in the province after June 30, 1971 and this section and sections 2, 4, 5, 14, 17, 18, 19, 23 and sections 25 to 41 inclusive apply also to a contract made in the province before that day.

             (2)  Sections 5, 6, 7, 10, 12, 19 and 22 of, and the Schedule to, The Accident and Sickness Insurance Act, 1957 in force immediately before July 1, 1971 apply to a contract made in the province before that day.

             (3)  This Act does not apply to

             (a)  insurance undertaken by an insurer as part of a contract of life insurance where the insurer undertakes to pay an additional sum of insurance money in the event of the death by accident of the person whose life is insured;

             (b)  creditor's group insurance;

             (c)  insurance undertaken by an insurer as part of a contract of life insurance where 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; or

             (d)  insurance provided under section 33, 34 or 35 of the Automobile Insurance Act.

1971 No6 s3; 1971 No14 s2; 2010 c15 s2

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Group insurance

        4. In a contract of group insurance made with an insurer authorized to transact insurance in the province at the time the contract was made, this Act applies in determining

             (a)  the rights and status of beneficiaries and personal representatives as recipients of insurance money, where the group person insured was living in the province at the time he or she became insured; and

             (b)  the rights and obligations of the group person insured, where he or she was living in the province at the time he or she became insured.

1971 No6 s4

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Issue of policy

        5. An insurer entering into a contract shall issue a policy.

1971 No6 s5

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Contents of policy

        6. (1) This section does not apply to

             (a)  a contract of group insurance; or

             (b)  a contract made by a fraternal society.

             (2)  An insurer shall set out 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 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 begins and ends.

1971 No6 s6

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Confinement clauses void

        7. Where a contract issued after July 1, 1978 includes a provision that provides that disability benefits shall be payable only during confinement of the insured, the provision does not bind the insured and the benefits in respect of disability under the contract are payable regardless of whether the insured is confined or not.

1978 c59 s1

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Contents of group policy

        8. In a contract of group insurance, an insurer shall set out in the policy

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

             (b)  the method of determining the group persons insured and the 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 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 begins and ends.

1971 No6 s7

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Termination, etc. of policies

        9. (1) In this section

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

             (b)  "prescribed time period" means, in relation to a contract of group insurance, a continuous period of 6 months following the termination of the contract or a benefit provision in it or a longer continuous period that may be provided in that contract instead of the 6 month period.

             (2)  Where a contract of group insurance or a benefit provision in a contract of group insurance is terminated, the insurer continues, as though the contract or benefit provision had remained in full effect, to be liable to or in respect of a group person insured under the contract to pay benefits under the contract 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, where the disability, death, dismemberment or accidental damage to natural teeth is reported to the insurer within the prescribed time period.

             (3)  Notwithstanding 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 recurrence, after the termination of that contract or benefit provision, of a disability that recurs after a continuous period of 6 months, or a longer period that is provided in the contract, during which the group person insured was not disabled.

             (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 a period longer than the period remaining of the original maximum benefit period in respect of the disability of the group person insured.

             (5)  Where a contract of group insurance, in this subsection referred to as the "replacing contract", is entered into within 31 days of the termination of another contract of group insurance, in this subsection 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 considered to provide that a 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 where

                      (i)  the insurance on that person under the other contract terminated solely because 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)  a person who was insured under the other contract and who is insured under the replacing contract is entitled to receive credit for satisfaction of a deductible earned before the effective date of the replacing contract; and

             (c)  a person who was insured under the other contract shall not 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 where the replacing contract provides that the full benefits required to be paid under 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 those benefits.

1978 c59 s2; 1983 c27 s1

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Contents of group certificate

      10. (1) 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 out

             (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 a person insured; and

             (c)  the circumstances under which the insurance terminates, and the rights upon that termination of the group person insured and of a person insured.

             (2)  Notwithstanding subsection (1), 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 6 months or less.

1971 No6 s8

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Exceptions or reductions

      11. (1) The insurer shall set out in the policy exceptions or reductions affecting the amount payable under the contract, either in the provision affected by the exceptions or reductions, or under a heading such as "Exceptions" or "Reductions".

             (2)  Where the exception or reduction affects only 1 provision in the policy, it shall be set out in that provision.

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

             (4)  The exception or reduction mentioned in section 24 need not be set out in the policy.

             (5)  This section does not apply to a contract made by a fraternal society.

1971 No6 s9

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Statutory conditions

      12. Notwithstanding subsection 11(1), the conditions set out in this section shall be considered to be part of a contract other than a contract of group insurance, and shall be printed on or attached to the policy forming part of that contract with the heading "Statutory Conditions".

STATUTORY CONDITIONS

The Contract

        1. (1) The application, this policy, a document attached to this policy when issued, and an amendment to the contract agreed upon in writing after the policy is issued, constitute the entire contract, and an agent has no authority to change the contract or waive its provisions.

Waiver

             (2)  The insurer shall be considered not to have waived a condition of this contract, either in whole or in part, unless the waiver is clearly expressed in writing signed by the insurer.

Copy of Application

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

Material Facts

        2. A statement made by the insured or person insured at the time of application for this contract shall not be used in defence of a claim under or to avoid this contract unless it is contained in the application or other written statements or answers provided as evidence of insurability.

Changes in Occupation

        3. (1) If after the contract is issued the person insured engages for compensation in an occupation that is classified by the insurer as more hazardous than that stated in this contract, the liability under this contract is limited to the amount that the premium paid would have purchased for the more hazardous occupation according to the limits, classification of risks and premium rates in use by the insurer at the time the person insured engaged in the more hazardous occupation.

             (2)  Where the person insured changes his or her occupation from that stated in this contract to an occupation classified by the insurer as less hazardous and the insurer is so advised in writing, the insurer shall either

             (a)  reduce the premium rate; or

             (b)  issue a policy for the unexpired term of this contract at the lower rate of premium applicable to the less hazardous occupation,

according to the limits, classification of risks and premium rates used by the insurer at the date of receipt of advice of the change in occupation, and shall refund to the insured the amount by which the unearned premium on this contract exceeds the premium at the lower rate for the unexpired term.

Relation of Earnings to Insurance

        4. (1) Where the benefits for loss of time payable under this contract, either alone or together with benefits for loss of time under another contract, 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 those contracts and the excess premium paid by the insured shall be returned to him or her by the insurer.

             (2)  The other contract referred to in statutory condition 4(1) may include,

             (a)  a contract of group accident and sickness insurance; or

             (b)  a life insurance contract where 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.

Termination by Insured

        5. The insured may terminate this contract 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 of it 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 that notice according to the table in use by the insurer at the time of termination.

Termination by Insurer

        6. (1) The insurer may terminate this contract 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 proportional 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 the records of the insurer.

             (3)  Where the notice of termination is delivered to the insured, 5 days' notice of termination shall be given; where it is mailed to the insured, 10 days' notice of termination shall be given, and the 10 days shall begin on the day following the date of mailing of notice.

Notice and Proof of Claim

        7. (1) The insured or a person insured, or a beneficiary entitled to make a claim, or the agent of either of them, shall

             (a)  give written notice of claim to the insurer

                      (i)  by delivery of it, or by sending it by registered mail to the head office or chief agency of the insurer in the province, or

                     (ii)  by delivery of it to an authorized agent of the insurer in the province,

not later than 30 days from the date a claim arises under the contract on account of an accident, sickness or disability;

             (b)  within 90 days from the date a claim arises under the contract on account of an accident, sickness or disability, provide to the insurer the proof that is reasonably possible in the circumstances of the happening of the accident or the beginning of the sickness or disability, and the loss occasioned by it, the right of the claimant to receive payment, his or her age, and the age of the beneficiary where relevant; and

             (c)  where so required by the insurer, provide 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 the disability.

Failure to Give Notice or Proof

             (2)  Failure to give notice of claim or provide proof of claim within the time prescribed by this statutory condition does not invalidate the claim if the notice or proof is given or provided as soon as reasonably possible, and in no event later than 1 year from the date of the accident or the date a claim arises under the contract on account of sickness or disability where it is shown that it was not reasonably possible to give notice or provide proof within the time so prescribed.

Insurer to Provide Forms for Proof of Claim

        8. The insurer shall provide forms for proof of claim within 15 days after receiving notice of claim, but where the claimant has not received the forms within that time he or she may submit his or her proof of claim in the form of a written statement of the cause or nature of the accident, sickness or disability giving rise to the claim and of the extent of the loss.

Rights of Examination

        9. As a condition precedent to recovery of insurance money under this contract,

             (a)  the claimant shall give to the insurer an opportunity to examine the person insured when and so often as it reasonably requires while the claim is pending; and

             (b)  in the case of death of the person insured, the insurer may require an autopsy subject to a law of the applicable jurisdiction relating to autopsies.

When Money Payable Other Than for Loss of Time

      10. Money payable under this contract, other than benefits for loss of time, shall be paid by the insurer within 60 days after it has received proof of claim.

When Loss of Time Benefits Payable

      11. The initial benefits for loss of time shall be paid by the insurer within 30 days after it has received proof of claim, and payment shall be made afterwards in accordance with the terms of the contract but not less frequently than once in each succeeding 60 days while the insurer remains liable for the payments if the person insured, when required to do so, provides before payment proof of continuing disability.

Limitations of Actions

      12. An action or proceeding against the insurer for the recovery of a claim under this contract shall not be started more than 1 year after the date the insurance money became payable or would have become payable if it had been a valid claim.

1971 No6 s10; 2010 c15 s3

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Omission or variation of conditions

      13. (1) Notwithstanding section 12, 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.

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

             (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 before the end of a period for which a premium has been accepted.

             (4)  Statutory Conditions 3, 4, 5, 6, 7 and 9 may be varied but where because 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 considered to be included in the policy in the form in which it appears in section 12.

             (5)  Notwithstanding subsection (4), clauses (1)(a) and (b) of Statutory Condition 7 may not be varied in policies providing benefits for loss of time.

             (6)  Statutory Conditions 10 and 11 may be varied by shortening the periods of time prescribed in them, and Statutory Condition 12 may be varied by lengthening the period of time prescribed in it.

             (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.

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

             (a)  the following provision shall be printed on the policy in substitution for Statutory Condition 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 to them, the application for the contract and the medical statement of the applicant constitute the entire contract, and an agent has no authority to change the contract or waive its provisions.";

and

             (b)  Statutory Condition 5 shall not be printed on the policy.

1971 No6 s11

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Notice of statutory conditions

      14. In a policy of accident and sickness insurance of a non-renewable type issued for a term of 6 months or less or in relation to a ticket of travel, the statutory conditions need not be printed on or attached to the policy where the policy contains the following notice printed in conspicuous type:

"Notwithstanding another provision contained in this policy, this contract is subject to the statutory conditions in the Accident and Sickness Insurance Act, respecting contracts of accident and sickness insurance."

2010 c15 s4

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Termination for non-payment

      15. (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, for it has not been fully paid,

             (a)  the contract or the renewal of the contract evidenced by the certificate is as binding on the insurer as if the 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 10 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 10 days shall begin on the day following the date of mailing the notice.

             (2)  This section does not apply to a contract of group insurance or to a contract made by a fraternal society.

1971 No6 s13

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Unpaid premium

      16. (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.

             (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 terms, the premium or part of it shall be considered never to have been paid.

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

             (4)  This section does not apply to a contract made by a fraternal society.

1971 No6 s14

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Insurable interest

      17. A person has an insurable interest in his or her own life and well-being and in the life and well-being of

             (a)  his or her child or grandchild;

             (b)  his or her spouse;

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

             (d)  his or her officer or employee; and

             (e)  a person in whom he or she has a monetary interest.

1971 No6 s15

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Lack of insurable interest

      18. (1) Where, at the time a contract would otherwise take effect, the insured has no insurable interest, the contract is void.

             (2)  Notwithstanding subsection (1), a contract is not void for lack of insurable interest

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

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

             (3)  Where the person insured is under 16 years of age, consent to the insurance may be given by either one of his or her parents or by a person standing in the place of a parent to him or her.

1971 No6 s16

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Capacity of minors

      19. (1) Except in respect of his or her rights as beneficiary, a minor who has reached 16 years of age has the capacity of a person who has reached majority

             (a)  to make an enforceable contract; and

             (b)  in respect of a contract.

             (2)  A beneficiary who has reached 18 years of age has the capacity of a person who has reached majority to receive insurance money payable to him or her and to give a valid discharge for it.

1971 No6 s17

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Disclosure

      20. (1) An applicant for insurance on his or her own behalf and on behalf of each person to be insured, and each person to be insured, shall disclose to the insurer in an application, on a medical examination, and in written statements or answers provided as evidence of insurability, all the facts within his or her knowledge that are material to the insurance and are not so disclosed by the other.

             (2)  A failure to disclose, or a misrepresentation of, a fact renders a contract voidable by the insurer.

             (3)  In the case of a contract of group insurance, a failure to disclose or a misrepresentation of a fact with respect to a group person insured or a person insured under the contract does not render the contract voidable, but where evidence of insurability is specifically requested by the insurer, the insurance in respect of that person is voidable by the insurer.

1971 No6 s18

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Incontestability

      21. (1) Notwithstanding section 20,

             (a)  where a contract, including renewals of it, except a contract of group insurance, has been in effect continuously for 2 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 20 to be disclosed does not, except in the case of fraud, render the contract voidable; and

             (b)  where a contract of group insurance, including renewals of it, has been in effect continuously for 2 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 20 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.

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

1971 No6 s19

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Application of incontestability

      22. Sections 20 and 21 apply with the necessary changes to a failure at the time of reinstatement of a contract to disclose or a misrepresentation at that time, and the period of 2 years to which reference is made in section 21 begins to run in respect of a reinstatement from the date of reinstatement.

1971 No6 s20

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Pre-existing conditions

      23. Where a contract contains a general exception or reduction with respect to pre-existing disease or physical condition 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 of it, has been in force continuously for 2 years immediately before the date of loss incurred or beginning 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.

1971 No6 s21

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Misstatement of age

      24. (1) Where the age of the person insured has been misstated 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.

             (2)  In the case of a contract of group insurance, where there is a misstatement to the insurer of the age of a group person insured or person insured, the provisions of the contract with respect to age or misstatement of age shall apply.

             (3)  Where the age of a person affects the beginning or termination of the insurance, the true age governs.

1971 No6 s22

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Designation of beneficiary

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

             (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.

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

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

             (5)  Where a designation is contained in an instrument that purports to be a will and later the instrument, if it had been valid as a will, would have been revoked by operation of law or otherwise, the designation is revoked.

1971 No6 s23

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Meaning of "heirs"

      26. (1) A designation in favour of the "heirs", "next-of-kin" or "estate", or the use of words of similar meaning in a designation, shall be considered to be a designation of the personal representative.

             (2)  Where a beneficiary predeceases the person insured or group person insured 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)  where there is more than 1 surviving beneficiary, to the surviving beneficiaries in equal shares; or

             (c)  where there is no surviving beneficiary, to the insured or group person insured or his or her personal representative.

             (3)  A beneficiary designated under section 25 may, upon the death by accident of the person insured or group person insured, enforce for his or her own benefit, and a trustee appointed under section 27 may enforce as trustee, the payment of insurance money payable to him or her, and the payment to the beneficiary or trustee discharges the insurer to the extent of the amount paid, but the insurer may set up a defence that it could have set up against the insured or his or her personal representative.

1971 No6 s24

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Trustee for beneficiary

      27. An insured may in a contract or by a declaration appoint a trustee for a beneficiary, and may alter or revoke the appointment by a declaration.

1971 No6 s25

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Documents affecting title

      28. (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 a statutory declaration of that 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 instrument or order.

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

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

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

             (b)  a beneficiary.

             (4)  Where a contract is assigned unconditionally and otherwise than as security, the assignee has the rights and interests given by the contract and by this Act to the insured, and shall be considered to be the insured.

             (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.

1971 No6 s26

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Insurance money free from creditors

      29. (1) Where a beneficiary is designated, insurance money payable to him or her 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.

             (2)  While there is in effect a designation of beneficiary in favour of 1 or more of a spouse, 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 they relate to accidental death benefits are exempt from execution or seizure.

1971 No6 s27

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Group person's rights

      30. A group person insured may, in his or her own name, enforce a right given by a contract to him or her, or to a person insured under it as a person dependent upon or related to him or her, subject to a defence available to the insurer against him or her or the person insured or against the insured.

1971 No6 s28

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Simultaneous deaths

      31. 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 making it uncertain which of them survived the other, the insurance money is payable in accordance with subsection 26(2) as if the beneficiary had predeceased the person insured or group person insured.

1971 No6 s29

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Payment into court

      32. (1) Where the insurer admits liability for the insurance money or a part of it, 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 who is willing to do so,

the insurer may apply to the court for an order for payment of money into court, and the court may upon the notice, that it considers necessary, make an order accordingly.

             (2)  The court may fix without taxation the costs incurred upon or in connection with an 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 considers just.

             (3)  A payment made as a result of an order under subsection (1) discharges the insurer to the extent of the payment.

1971 No6 s30

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Where beneficiary a minor

      33. (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 for it who is willing to do so, the insurer may, after 30 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.

             (2)  The insurer may retain out of the insurance money for costs incurred, upon payment into court under subsection (1), the sum of $10 where the amount does not exceed $1,000, and the sum of $15 in other cases, and payment of the remainder of the money into court discharges the insurer.

             (3)  An order is not necessary for payment into court under subsection (1), but the public trustee shall receive the money upon the insurer filing with him or her an affidavit showing the amount payable and the name, date of birth and residence of the minor, and upon that payment being made the insurer shall notify the provincial director appointed under the Child, Youth and Family Services Act of the province and deliver to him or her a copy of the affidavit.

1971 No6 s31; 2001 c42 s3; 2013 c16 s25

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Beneficiary under disability

      34. 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 that payment discharges the insurer to the extent of the amount paid.

1971 No6 s32

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Certain payments

      35. Notwithstanding that insurance money is payable to a person, the insurer may, where the contract so provides, but subject always to the rights of an assignee, pay an amount not exceeding $2,000 to

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

             (b)  a person appearing to the insurer to be equitably entitled to it because 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,

and that payment discharges the insurer to the extent of the amount paid.

1971 No6 s33

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Place of payment

      36. (1) Insurance money is payable in the province.

             (2)  Notwithstanding subsection (1), in the case of a contract of group insurance, insurance money is payable in the province or territory of Canada in which the group person insured was resident at the time he or she became insured.

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

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

             (5)  Where insurance money is by the contract payable to a person who has died or to his or her personal representative and that deceased person was not at the date of his or her death living in the province, the insurer may pay the insurance money to the personal representative of that person appointed under the law of his or her domicile, and that payment discharges the insurer to the extent of the amount paid.

1971 No6 s34

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Action in province

      37. 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.

1971 No6 s35

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Insurer giving information

      38. An insurer does not incur liability for a default, error or omission in giving or withholding information as to notice or instrument that it has received and that affects the insurance money.

1971 No6 s36

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Undue prominence

      39. The insurer shall not in the policy give undue prominence to a 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.

1971 No6 s37

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Relief from forfeiture

      40. Where there has been imperfect compliance with a statutory condition as to a matter or thing to be done or omitted by the insured, person insured or claimant with respect to the loss insured against and in consequence the insurance is forfeit or set aside in whole or in part, and a court before which a question relating to it is tried considers it inequitable that the insurance should be forfeited or set aside on that ground, the court may grant relief to the injured person insured or claimant on the terms that it considers just.

1971 No6 s38

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Presumption against agency

      41. An officer, agent, employee or servant of the insurer, and a person soliciting insurance, whether or not he or she is an agent of the insurer shall not, to the prejudice of the insured, person insured or group person insured, be considered to be the agent of the insured or of the person insured or group person insured in respect of a question arising out of the contract.

1971 No6 s39

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Policy from a machine

      42. (1) In this section

             (a)  "insurance" means insurance undertaken by an insurer as part of a contract of accident and sickness insurance which insures against loss resulting from bodily injury to, or the death of, a person caused by an accident or under which the insurer undertakes to pay a certain sum or sums of insurance money in the event of bodily injury to, or the death of, a person caused by an accident;

         (a.1)  "machine" means a vending machine where, on depositing in it the premium payable for a policy of insurance, the person to be insured may obtain the policy from it;

             (b)  "permit" means a permit issued under this section and includes a renewal of it; and

             (c)  "superintendent" means the Superintendent of Insurance of the province.

             (2)  Unless an insurer holds a permit which has been issued and is valid under this section the insurer shall not issue a policy of insurance through the medium of a machine.

             (3)  The superintendent may issue or renew a permit to an insurer to operate a machine and the permit shall be in the form that the superintendent determines.

             (4)  An insurer shall secure a permit for each machine he or she operates.

             (5)  The Lieutenant-Governor in Council may fix a fee to be paid by an insurer for a permit and where a fee has been fixed the superintendent shall not issue a permit unless the fee has first been paid.

             (6)  The superintendent may cancel or revoke or refuse to issue or renew a permit without assigning a reason for the cancellation, revocation or refusal.

             (7)  A permit expires on December 31 of the year in which it is issued unless it is cancelled or revoked at an earlier date.

             (8)  The insurer shall display in a conspicuous place near each machine the existing permit issued in respect of that machine.

             (9)  An insurer shall submit to the superintendent a copy of the form of insurance policy that will be issued through the medium of each machine.

          (10)  An insurer shall not issue through the medium of a machine a policy of insurance unless it is on a form which the superintendent has approved.

          (11)  An insurer

             (a)  who issues a policy of insurance through the medium of a machine for which a permit has not been issued;

             (b)  to whom a permit has been issued who does not display it in accordance with subsection (8); or

             (c)  who through the medium of a machine issues a policy of insurance using a form of policy which has not been approved by the superintendent

is guilty of an offence and liable on summary conviction to a fine not exceeding $100 or in default of payment to imprisonment for a term not exceeding 6 months or to both a fine and imprisonment.

          (12)  A person who removes, defaces or otherwise damages or interferes with a permit which is being displayed in accordance with subsection (8) is guilty of an offence and liable on summary conviction to a fine not exceeding $25 or in default of payment to imprisonment for a term not exceeding 3 months or to both a fine and imprisonment.

          (13)  Where the superintendent believes on reasonable grounds that a machine is being operated without a permit or that a form of insurance policy which he or she has not approved is being issued through the medium of the machine he or she may seize the machine and detain it for a period of 6 months following the day of seizure unless during that period proceedings are undertaken under this section and in that case he or she shall detain the machine until the proceedings are finally concluded and then dispose of it in accordance with subsection (14) or (15).

          (14)  Where

             (a)  proceedings are not taken within a period of 6 months following the date of a seizure under subsection (13);

             (b)  proceedings are taken and the insurer charged is acquitted of the charge made against him or her; or

             (c)  no order is made under subsection (15),

the superintendent shall return the machine to the insurer.

          (15)  Where an insurer is convicted of an offence under subsection (11) the court before whom he or she is convicted may, in addition to a penalty imposed under that subsection, order that the machine by means of or in relation to which the offence was committed be forfeited to the Crown to be disposed of as the superintendent directs.

          (16)  An action does not lie against the superintendent for an act done by him or her or by a person acting under his or her direction under this section.

1971 No6 s40

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Term of trip policy sold from machine

      43. (1) Notwithstanding another provision of this Act, the term of a policy issued through the medium of a machine in respect of which a permit has been issued under section 42 may be expressed as the duration of a journey, trip, voyage or flight to be made by the insured by any means of transportation or conveyance.

             (2)  The issue of a policy through the medium of a machine shall constitute delivery of it for the purposes of this Act.

1971 No6 s41