This consolidation is unofficial and is for reference only.  For the official version of the regulations, consult the original documents on file with the Registry of Regulations, or refer to the Royal Gazette Part II.
Regulations are amended frequently.  Please check the list of Regulations by Act to see if there are any recent amendments to these regulations filed with the Registry that are not yet included in this consolidation.
Although every effort has been made to ensure the accuracy of this electronic version, the Registry of Regulations assumes no responsibility for any discrepancies that may have resulted from reformatting.
This electronic version is copyright © 2011, Province of Nova Scotia, all rights reserved.  It is for your personal use and may not be copied for the purposes of resale in this or any other form.


Automobile Insurance Contract Mandatory Conditions Regulations

made under Section 159 of the

Insurance Act

R.S.N.S. 1989, c. 231

O.I.C. 2003-456 (October 31, 2003, effective November 1, 2003), N.S. Reg. 181/2003

as amended up to O.I.C. 2013-21 (January 22, 2013, effective April 1, 2013), N.S. Reg. 21/2013


Table of Contents


Citation

Mandatory conditions required by Section 112 of the Act

 

Benefits to be included

 

Schedule 1–Mandatory Conditions

 

Schedule 2–Mandatory Medical and Rehabilitation Benefits, and Accident Benefits in Motor Vehicle Liability Policies

Subsection 1 - Medical, Rehabilitation and Funeral Expenses

Subsection 2 - Death Benefits and Loss of Income Payments

Part I - Death Benefits

Part II - Loss of Income

Subsection 2A - Supplemental Benefits Respecting Accidents Occurring in Quebec

Subsection 3 - Special Provisions, Definitions, and Exclusions of this Section

“insured person” defined

“physician” defined

Exclusions

Notice and proof of claim

Medical reports

Release

When moneys payable

Limitation on benefit payable


Citation

1     These regulations may be cited as the Automobile Insurance Contract Mandatory Conditions Regulations.


Mandatory conditions required by Section 112 of the Act

2     The mandatory conditions required by Section 112 of the Insurance Act to be included in every automobile insurance contract are set out in Schedule 1.


Benefits to be included

3     The benefits required by Section 140 of the Insurance Act are mandatory conditions that must be included in every automobile insurance contract, and are set out in Schedule 2.


Section 4 repealed: O.I.C. 2011-432, N.S. Reg. 326/2011.


Schedule 1

Mandatory Conditions


In these mandatory conditions, unless the context otherwise requires, the word “insured” means a person insured by this contract whether named or not.

 

1     (1)    Material change in risk - The insured named in this contract shall promptly notify the insurer, or its local agent, in writing, of any change in the risk material to the contract and within his knowledge.

 

       (2)    Without restricting the generality of the foregoing, the words “change in the risk material to the contract” include

 

                (a)    any change in the insurable interest of the insured named in this contract in the automobile by sale, assignment or otherwise, except through change of title by succession, death or proceedings under the Bankruptcy Act (Canada);

 

and, with respect to insurance against loss of or damage to the automobile,

 

                (b)    any mortgage, lien or encumbrance affecting the automobile after the application for this contract;

 

                (c)    any other insurance of the same interest, whether valid or not, covering loss or damage insured by this contract or any portion thereof.

 

2     (1)    Prohibited use by insured - The insured shall not drive or operate the automobile

 

                (a)    unless he is for the time being either authorized by law or qualified to drive or operate the automobile;

 

                (b)    while his license to drive or operate an automobile is suspended or while his right to obtain a license is suspended or while he is prohibited under order of any court from driving or operating an automobile;

 

                (c)    while he is under the age of sixteen years or under such other age as is prescribed by the law of the province in which he resides at the time this contract is made as being the minimum age at which a licence or permit to drive an automobile may be issued to him;

 

                (d)    for any illicit or prohibited trade or transportation; or

 

                (e)    in any race or speed test.

 

       (2)    Prohibited use by others - The insured shall not permit, suffer, allow or connive at the use of the automobile

 

                (a)    by any person

 

                         (i)     unless that person is for the time being either authorized by law or qualified to drive or operate the automobile,

 

                         (ii)    while that person is under the age of sixteen years or under such other age as is prescribed by the law of the province in which he resides at the time this contract is made as being the minimum age at which a license or permit to drive an automobile may be issued to him;

 

                (b)    by any person who is a member of the household of the insured while his license to drive or operate an automobile is suspended or while his right to obtain a license is suspended or while he is prohibited under order of any court from driving or operating an automobile;

 

                (c)    for any illicit or prohibited trade or transportation; or

 

                (d)    in any race or speed test.

 

3     (1)    Requirements where loss or damage to persons or property - The insured shall

 

                (a)    promptly give to the insurer written notice, with all available particulars, of any accident involving loss or damage to persons or property, and of any claim made on account of the accident;

 

                (b)    verify by statutory declaration, if required by the insurer, that the claim arose out of the use or operation of the automobile and that the person operating or responsible for the operation of the automobile at the time of the accident is a person insured under this contract; and

 

                (c)    forward immediately to the insurer every letter, document, advice or legal process received by him from or on behalf of the claimant.

 

       (2)    The insured shall not

 

                (a)    voluntarily assume any liability or settle any claim except at his own cost; nor

 

                (b)    interfere in any negotiations for settlement or in any legal proceeding.

 

       (3)    The insured shall, whenever requested by the insurer, aid in securing information and evidence and the attendance of any witness, and shall co-operate with the insurer, except in a pecuniary way, in the defence of any action or proceeding or in the prosecution of any appeal.

 

4     (1)    Requirements where loss or damage to the automobile - Where loss of or damage to the automobile occurs, the insured shall, if the loss or damage is covered by this contract,

 

                (a)    promptly give notice thereof, in writing to the insurer, with fullest information obtainable at the time;

 

                (b)    at the expense of the insurer, and as far as reasonably possible, protect the automobile from further loss or damage; and

 

                (c)    deliver to the insurer within ninety days after the date of the loss or damage a statutory declaration stating, to the best of his knowledge or belief, the place, time, cause and amount of the loss or damage, the interest of the insured and of all others therein, the encumbrances thereon, all other insurance, whether valid or not, covering the automobile, and that the loss or damage did not occur through any wilful act or neglect, procurement, means or connivance of the insured.

 

       (2)    Any further loss or damage accruing to the automobile, directly or indirectly from a failure to protect it as required under subcondition (1) of this condition, is not recoverable under this contract.

 

       (3)    No repairs, other than those that are immediately necessary for the protection of the automobile from further loss or damage, shall be undertaken and no physical evidence of the loss or damage shall be removed

 

                (a)    without the written consent of the insurer; or

 

                (b)    until the insurer has had a reasonable time to make the examination for which provision is made in mandatory condition 5.

 

       (4)    Examination of insured - The insured shall submit to examination under oath, and shall produce for examination, at such reasonable place and time as is designated by the insurer or its representative, all documents in his possession or control that relate to the matters in question; and he shall permit extracts and copies thereof to be made.

 

       (5)    Insurer liable for cash value of automobile - The insurer shall not be liable for more than the actual cash value of the automobile at the time any loss or damage occurs, and the loss or damage shall be ascertained or estimated according to that actual cash value with proper deduction for depreciation, however caused, and shall not exceed the amount that it would cost to repair or replace the automobile, or any part thereof, with material of like kind and quality; but if any part of the automobile is obsolete and out of stock, the liability of the insurer in respect thereof shall be limited to the value of that part at the time of loss or damage not exceeding the maker’s latest list price.

 

       (6)    Repair or replacement - Except where an appraisal has been made, the insurer, instead of making payment, may, within a reasonable time, repair, rebuild or replace the property damaged or lost with other of like kind and quality, if, within seven days after the receipt of the proof of loss, it gives written notice of its intention to do so.

 

       (7)    No abandonment; salvage - There can be no abandonment of the automobile to the insurer without its consent. If the insurer exercises the option to replace the automobile, or pays the actual cash value of the automobile, the salvage, if any, shall vest in the insurer.

 

       (8)    In case of disagreement - In the event of disagreement as to the nature and extent of the repairs and replacements required, or as to their adequacy, if effected, or as to the amount payable in respect of any loss or damage, those questions shall be determined by appraisal as provided under the Insurance Act before there can be recovery under this contract, whether the right to recover on the contract is disputed or not, and independently of all other questions. There shall be no right to an appraisal until after proof of loss has been delivered and until a specific demand therefor is made in writing.

 

5     Inspection of automobile - The insured shall permit the insurer at all reasonable times to inspect the automobile and its equipment.

 

6     (1)    Time and manner of payment of insurance money - The insurer shall pay the insurance money for which it is liable under this contract within sixty days after the proof of loss has been received by it or, where an appraisal is made under subcondition (8) of mandatory condition 4, within fifteen days after the award is rendered by the appraisers.

 

       (2)    When action may be brought - The insured shall not bring an action to recover the amount of a claim under this contract unless the requirements of mandatory conditions 3 and 4 are complied with nor until the amount of the loss has been ascertained as therein provided, or by a judgment against the insured after trial of the issue, or by agreement between the parties with the written consent of the insurer.

 

       (3)    Limitation of actions - Every action or proceeding under the contract against the insurer in respect of a claim for indemnification for liability of the insured for loss or damage to property of another person or for personal injury to or death of another person shall be commenced within three years after the liability of the insured is established by a court of competent jurisdiction and not afterwards. Every other action or proceeding against the insurer under the contract in respect of loss or damage to the automobile shall be commenced within three years from the time the loss or damage was sustained and not afterwards.

 

7     Who may give notice and proofs of claim - Notice of claim may be given and proofs of claim may be made by the agent of the insured named in this contract in case of absence or inability of the insured to give the notice or make the proof, such absence or inability being satisfactorily accounted for or in the like case, or if the insured refuses to do so, by a person to whom any part of the insurance money is payable.

 

8     (1)    Termination - This contract may be terminated

 

                (a)    by the insurer giving to the insured fifteen days’ notice of termination by registered mail, or five days’ written notice of termination personally delivered;

 

                (b)    by the insured at any time on request.

 

       (2)    Where this contract is terminated by the insurer,

 

                (a)    the insurer shall refund the excess of premium actually paid by the insured over the pro rata premium for the expired time, but, in no event, shall the pro rata premium for the expired time be deemed to be less than any minimum retained premium specified; and

 

                (b)    the refund shall accompany the notice unless the premium is subject to adjustment or determination as to amount, in which case the refund shall be made as soon as practicable.

 

       (3)    Where this contract is terminated by the insured, the insurer shall refund as soon as practicable the excess of premium actually paid by the insured over the short rate premium for the expired time, but, in no event shall the short rate premium for the time expired be deemed to be less than any minimum retained premium specified.

 

       (4)    The refund may be made by money, postal or express company money order, or by cheque payable at par.

 

       (5)    The fifteen days mentioned in clause (a) of subcondition (1) of this condition commences to run on the day following the receipt of the registered letter at the post office to which it is addressed.

 

9     Notice - Any written notice to the insurer may be delivered at, or sent by registered mail to, the chief agency or head office of the insurer in this Province. Written notice may be given to the insured named in this contract by letter personally delivered to him or by registered mail addressed to him at his latest post office address notified to the insurer. In this condition the expression “registered” means registered in or outside Canada.

 

10   (1)    Limitation where seat belt not worn - Unless exempt by law from the requirement in the Motor Vehicle Act to wear a seat belt, where an injured person was not wearing a seat belt at the time of an incident, there shall be a reduction of at least twenty-five per cent in damages for bodily injury or death arising directly or indirectly from the use or operation of an automobile in respect of the incident.

 

       (2)    In this condition, “seat belt” has the same meaning as defined in the Motor Vehicle Act.

Schedule 1, condition 10 added: O.I.C. 2003-558, N.S. Reg. 227/2003.



Schedule 2

Mandatory Medical and Rehabilitation Benefits, and

Accident Benefits in Motor Vehicle Liability Policies


Accident Benefits Section

Section B


The Insurer agrees to pay to or with respect to each insured person as defined in this section who sustains bodily injury or death by an accident arising out of the use or operation of an automobile:


Subsection 1 - Medical, Rehabilitation and Funeral Expenses

 

This subsection applies to any accident claim with respect to an accident that occurs on or after April 1, 2013.

 

1     (1)    In this subsection, “the Protocols Regulations” means the Automobile Accident Diagnostic and Treatment Protocols Regulations made under the Insurance Act.

 

       (2)    To the limit of $50,000 per person, all reasonable expenses incurred within four years from the date of the accident as a result of the injury for necessary medical, surgical, dental, chiropractic, hospital, professional nursing and ambulance service and for any other service within the meaning of insured services under the Health Services and Insurance Act and for such other services and supplies which are, in the opinion of the physician of the insured person’s choice and that of the Insurer’s medical advisor, essential for the treatment, occupational retraining or rehabilitation of the person, in respect of

 

                (a)    an injury to which the Protocols Regulations apply that is diagnosed and treated in accordance with the Regulations, the expenses payable for any treatment, supply or service, diagnostic imaging, laboratory testing, specialized testing, visit, therapy, assessment or making a report, or any other activity or function authorized under the Protocols Regulations, and for which payment is made in the manner required by and subject to the provisions of the Protocols Regulations, notwithstanding anything to the contrary in this section; and

 

                (b)    an injury

 

                         (i)     to which the Protocols Regulations apply but that is not diagnosed and treated in accordance with the Protocols Regulations,

 

                         (ii)    to which the Protocols Regulations cease to apply but for which the insured person wishes to make a claim under provision (4) (notice and proof of claim) of Subsection 3 - Special Provisions, Definitions, and Exclusions of this section, or

 

                         (iii)   to which this section applies, other than an injury referred to in (i) and (ii).

 

2     Subject to provision 3, the Insurer is not liable under this Subsection for those portions of expenses payable or recoverable under any medical, surgical, dental or hospitalization plan or law or, except for similar insurance provided under another automobile insurance contract, under any other insurance contract or certificate issued to or for the benefit or any insured person.

 

3     Except for those portions of expenses payable or recoverable under any law, provision 2 does not apply to the expenses payable or recoverable for an injury to which the Protocols Regulations apply.

 

4     Funeral expenses incurred up to the amount of $2500 in respect of the death of any one person.

Subsection 1 replaced: O.I.C. 2011-432, N.S. Reg. 326/2011; O.I.C. 2013-21, N.S. Reg. 21/2013.


Subsection 2 - Death Benefits and Loss of Income Payments


This subsection applies to any accident claim with respect to an accident that occurs on or after April 1, 2012.


Part I - Death Benefits

 

A.   Subject to the provisions of this Part, for death that ensues within 180 days of the accident or within 104 weeks of the accident if there has been continuous disability during that period, a payment – based on the status at the date of the accident of the deceased in a household where a head of the household, spouse or common-law partner or dependants survive – of the following amounts:

 

                (a)    head of the household - $25,000;

 

                (b)    spouse of the head of the household – $25,000; and

 

                (c)    dependant within the meaning of clauses (b) and (c) of provision (2) of paragraph B – $5,000.

Schedule 2, Subsection 2, Part I, Paragraph A, clause (c) amended: O.I.C. 2012-274, N.S. Reg. 161/2012.

 

In addition, with respect to death of the head of the household, where there are two or more survivors (spouse or common-law partner or dependants) the principal sum payable is increased $1,000 for each survivor other than the first.

 

B.    For the purposes of this Part,

 

       (1)    “spouse or common-law partner of the head of the household” means the spouse or common-law partner with the lesser income from employment in the twelve months preceding the date of the accident.;

 

       (2)    “dependant” means,

 

                (a)    the spouse or common-law partner of the head of the household who resides with the head of the household;

 

                (b)    a person,

 

                         (i)     under the age of 18 years who resides with and is principally dependent upon the head of the household or the spouse or common-law partner of the head of the household for financial support,

 

                         (ii)    18 years of age or over who, because of mental or physical infirmity, is principally dependent upon the head of the household or the spouse or common-law partner of the head of the household for financial support, or

 

                         (iii)   18 years of age or over who, because of full-time attendance at a school, college or university, is principally dependent upon the head of the household or the spouse or common-law partner of the head of the household for financial support, or

 

                (c)    a parent or relative,

 

                         (i)     of the head of the household, or

 

                         (ii)    of the spouse or common-law partner of the head of the household

 

residing in the same dwelling premises and principally dependent upon the head of the household or the spouse or common-law partner of the head of the household for financial support.

 

       (3)    The total amount payable shall be paid to a person who is the head of the household or the spouse or common-law partner of the head of the household, as the case may be, if that person survives the deceased by at least 30 days.

 

       (4)    The total amount payable with respect to death where no head of the household or spouse or common-law partner survives the deceased by at least 30 days shall be divided equally among the surviving dependants.

 

       (5)    No amount is payable on death, other than incurred funeral expenses, if no head of the household or dependant survives the deceased by at least 30 days.


Part II - Loss of Income

 

Subject to the provisions of this Part, a weekly payment for the loss of income from employment for the period during which the insured person suffers substantial inability to perform the essential duties of his occupation or employment, provided,

 

                (a)    such person was employed at the date of the accident;

 

                (b)    within 30 days from the date of the accident and as a result of the accident the insured person suffers substantial inability to perform the essential duties of his occupation or employment for a period of not less then seven days;

 

                (c)    no payments shall be made for any period in excess of 104 weeks except that if, at the end of the 104 week period, it has been established that such injury continuously prevents such person from engaging in any occupation or employment for which he is reasonably suited by education, training or experience, the Insurer agrees to make such weekly payments for the duration of such inability to perform the essential duties.


       Amount of Weekly Payment – The amount of a weekly payment shall be the lesser of,

 

                (a)    $250 per week; or

 

                (b)    80 per cent of the insured person’s gross weekly income from employment, less any payments for loss of income from employment received by or available to such person under

 

                         (i)     the laws of any jurisdiction,

 

                         (ii)    wage or salary continuation plans available to the person by reason of his employment, and

 

                         (iii)   subsection 2A;

 

but no deduction shall be made for any increase in such payment due to a cost of living adjustment subsequent to the insured person’s substantial inability to perform the essential duties of his occupation or employment.


For the purpose of this Part,

 

       (1)    there shall be deducted from an insured person’s gross weekly income any payments received by or available to him from part-time or other employment or occupation subsequent to the date of the accident;

 

       (2)    a principal unpaid housekeeper residing in the household not otherwise engaged in occupation or employment for wages or profit, if injured, shall be deemed disabled only if completely incapacitated and unable to perform any of his or her household duties and, while so incapacitated, shall receive a benefit at the rate of $100 per week for not more than 52 weeks;

 

       (3)    a person shall be deemed to be employed

 

                (a)    if actively engaged in an occupation or employment for wages or profit at the date of the accident; or

 

                (b)    if 18 years of age or over and under the age of 65 years, so engaged for any six months out of the preceding 12 months and in these circumstances shall be deemed to have suffered loss of income at a rate equal to that of his most recent employment earnings;

 

       (4)    a person receiving a weekly payment who, within 30 days of resuming his occupation or employment is unable to continue such occupation or employment as a result of such injury, is not precluded from receiving further weekly payments;

 

       (5)    where the payments for loss of income payable hereunder, together with payments for loss of income under another contract of insurance other than a contract of insurance relating to any wage or salary continuation plan available to an insured person by reason of his employment, exceed the actual loss of income of the insured person, the insurer is liable only for that proportion of the payments for loss of income stated in this policy that the actual loss of income of the person insured bears to the aggregate of the payments for loss of income payable under all such contracts.

Subsection 2 replaced: O.I.C. 2011-432, N.S. Reg. 326/2011.


Subsection 2A - Supplemental Benefits Respecting Accidents Occurring in Quebec


This subsection comes into force and is effective only in accordance with a written agreement between the Government of Nova Scotia and the Government of Quebec or an agency thereof.

 

A.   For the purposes of this Part,

 

                (a)    “accident” means an event occurring in Quebec resulting in damage caused by an automobile, or by the use of an automobile, or by the load of an automobile, including damage caused by a trailer;

 

                (b)    “bodily injury” means physical, psychological or mental injury including death as well as damage to the clothing worn by the victim at the time of the accident;

 

                (c)    “resident of Nova Scotia” means any person,

 

                         (i)     who is authorized by law to be or to remain in Canada and is living and ordinarily present in Nova Scotia, and

 

                         (ii)    who meets the criteria prescribed in Division II of O.C. 374-78 made under the Automobile Insurance Act (Quebec), which apply with necessary modifications,

 

but does not include a person,

 

                         (iii)   who is merely touring, passing through or visiting Nova Scotia, or

 

                         (iv)   who is, at the time of an accident in Quebec, the owner or driver of, or a passenger in, an automobile registered in Quebec;

 

                (d)    “person insured in Quebec” means a resident of Nova Scotia who is

 

                         (i)     any person while an occupant of the described automobile or of a newly acquired or temporary substitute automobile as defined in this policy,

 

                         (ii)    the insured and, if residing in the same dwelling premises as the insured, his or her spouse or common-law partner and any dependent relative of either while an occupant of any other automobile,

 

                         (iii)   any person, not the occupant of an automobile, who is struck by the described automobile or a newly acquired or temporary substitute automobile as defined in this policy,

 

                         (iv)   the named insured, if an individual, and his or her spouse or common-law partner and any dependent relative residing in the same dwelling premises as the named insured, not the occupant of an automobile who is struck by any other automobile,

 

                         (v)    if the insured is a corporation, unincorporated association, or partnership, any employee or partner of the insured for whose regular use the described automobile is furnished, and his or her spouse or common-law partner and any dependent relative of either, residing in the same dwelling premises as such employee or partner, while an occupant of any other automobile,

 

                         (vi)   any employee or partner of the insured for whose regular use the described automobile is furnished, and his or her spouse or common-law partner and any dependent relative of either, residing in the same dwelling premises as such employee or partner, while not the occupant of an automobile who is struck by any other automobile, and

 

                         (vii)  any other person who,

 

                                  a.      is the occupant of an automobile, or

 

                                  b.     not being the occupant of an automobile, is struck by an automobile,

 

driven by a person insured in Quebec as defined in sub-subparagraphs (i) to (vi) of this subparagraph.

 

B.    With respect to bodily injury, as a result of an accident, to a person insured in Quebec the insurer agrees to make payments under this Part in the same amount and form and subject to the same conditions as if such person were a resident of Quebec as defined in the Automobile Insurance Act (Quebec) and the regulations made under that Act and entitled to payments under that Act and those regulations except that any reference in the Automobile Insurance Act (Quebec) to a Quebec enactment or a pension plan shall be replaced by a reference to the Nova Scotia enactment or pension plan which the Lieutenant Governor in Council of Nova Scotia declares to be an equivalent enactment or pension plan.


Notwithstanding anything to the contrary, an exclusion or limitation existing in this Schedule B or in the general provisions, definitions and mandatory conditions of a contract of automobile insurance shall not apply to a person insured in Quebec as defined in this subsection 2A.


Subsection 3 - Special Provisions, Definitions, and Exclusions of this Section

 

(1)   “insured person” defined

In this section, the words “insured person” mean

 

                (a)    any person while an occupant of the described automobile or of a newly acquired or temporary substitute automobile as defined in this policy;

 

                (b)    the insured and, if residing in the same dwelling premises as the insured, his or her spouse or common-law partner and any dependent relative of either while an occupant of any other automobile; provided that,

 

                         (i)     the insured is an individual or are husband and wife,

 

                         (ii)    such person is not engaged in the business of selling, repairing, maintaining, servicing, storing, or parking automobiles at the time of the accident,

 

                         (iii)   such other automobile is not owned or regularly or frequently used by the insured or by any person or persons residing in the same dwelling premises as the insured,

 

                         (iv)   such other automobile is not owned, hired, or leased by an employer of the insured or by an employer of any person or persons residing in the same dwelling premises as the insured,

 

                         (v)    such other automobile is not used for carrying passengers for compensation or hire or for commercial delivery;

 

                (c)    in subsections 1, 2 and 2A of this section only, any person, not the occupant of an automobile or of railway rolling-stock that runs on rails, who is struck, in Canada, by the described automobile or a newly acquired or temporary substitute automobile as defined in the policy;

 

                (d)    in subsections 1, 2 and 2A of this section only, the named insured, if an individual and his or her spouse or common-law partner and any dependent relative residing in the same dwelling premises as the named insured, not the occupant of an automobile or of railway rolling-stock that runs on rails, who is struck by any other automobile; provided that

 

                         (i)     such person is not engaged in the business of selling, repairing, maintaining, servicing, storing, or parking automobiles at the time of the accident,

 

                         (ii)    that automobile is not owned or regularly or frequently used by the insured or by any person or persons residing in the same dwelling premises as the named insured,

 

                         (iii)   that automobile is not owned, hired, or leased by an employer of the insured or by an employer of any person or persons residing in the same dwelling premises as the named insured;

 

                (e)    if the insured is a corporation, unincorporated association, or partnership, any employee or partner of the insured for whose regular use the described automobile is furnished, and his or her spouse or common-law partner and any dependent relative of either, residing in the same dwelling premises as such employee or partner, while an occupant of any other automobile of the private passenger or station wagon type; and

 

                (f)    in subsections 1, 2 and 2A of this section only, any employee or partner of the insured, for whose regular use the described automobile is furnished, and his or her spouse or common-law partner and any dependent relative of either, residing in the same dwelling premises as such employee or partner, while not the occupant of an automobile or of railway rolling-stock that runs on rails, who is struck by any other automobile; provided that,

 

in respect of (e) and (f) above,

 

                         (i)     neither such employee nor partner or his or her spouse or common-law partner is the owner of an automobile of the private passenger or station wagon type,

 

                         (ii)    the described automobile is of the private passenger or station wagon type,

 

                         (iii)   such person is not engaged in the business of selling, repairing, maintaining, servicing, storing, or parking automobiles at the time of the accident,

 

                         (iv)   such other automobile is not owned or regularly or frequently used by the employee or partner, or by any person or persons residing in the same dwelling premises as such employee or partner,

 

                         (v)    such other automobile is not owned, hired, or leased by the insured or by an employer of any person or persons residing in the same dwelling premises as such employee or partner of the insured,

 

in respect of (e) above only,

 

                         (vi)   such other automobile is not used for carrying passengers for compensation or hire or for commercial delivery.

 

(2)   “physician” defined

“Physician” means legally qualified medical practitioner.

 

(3)   Exclusions

                (a)    Except as provided in subsection 2A, the Insurer shall not be liable under this section for bodily injury to or death of any person,

 

                         (i)     resulting from the suicide of such person or attempt thereat, whether sane or insane,

 

                         (ii)    who is entitled to receive the benefits of any worker's compensation law or plan,

 

                         (iii)   caused directly or indirectly by radioactive material;

 

                (b)    The Insurer shall not be liable under subsection 1 or Part II of subsection 2 of this section for bodily injury or death,

 

                         (i)     sustained by any person who, at the time of the accident, was driving or operating the automobile while in a condition for which he is convicted of an offence under paragraph 253(a) (impaired driving) or paragraph 253(b) (breathalyzer offence) or under or in connection with circumstances for which he is convicted of an offence under subsection 254(2) (refusing road-side test) or subsection 254(3) (refusing breathalyzer) or section 255 (impaired driving causing bodily harm) of the Criminal Code (Canada) unless he establishes that impairment by alcohol or drug was not the proximate cause of the accident, or

 

                         (ii)    sustained by any person driving the automobile who is not for the time being either authorized by law or qualified to drive the automobile.

 

(4)   Notice and proof of claim

Subject to the Automobile Accident Diagnostic and Treatment Protocols Regulations, the insured person or his agent, or the person otherwise entitled to make claim or his agent, shall,

 

                (a)    give written notice of claim to the Insurer by delivery thereof or by sending it by registered mail to the chief agency or head office of the Insurer in the Province, within 30 days from the date of the accident or as soon as practicable thereafter;

 

                (b)    within 90 days from the date of the accident for which the claim is made, or as soon as practicable thereafter, furnish to the Insurer such proof of claim as is reasonably possible in the circumstances of the happening of the accident and the loss occasioned thereby;

 

                (c)    if so required by the Insurer, furnish a certificate as to the cause and nature of the accident for which the claim is made and as to the duration of the disability caused thereby from a physician.

Schedule 2, Subsection 3, provision (4) amended: O.I.C. 2013/21, N.S. Reg. 21/2013.

 

(5)   Medical Reports

                (a)    Except as provided in clause (b), the Insurer has the right, and the claimant must afford the Insurer with an opportunity, to examine the person of the insured person when and as often as it reasonably requires while the claim is pending and, in the case of the death of the insured person, to make an autopsy subject to the law relating to autopsies.

 

                (b)    Clause (a) does not apply with respect to an injury while it is treated under the Automobile Accident Diagnostic and Treatment Protocols Regulations, and the insurer has no right to independent review of any treatment, supply or service, diagnostic imaging, laboratory testing, specialized testing, visit, therapy, assessment, making of a report or other activity or function authorized under the Automobile Accident Diagnostic and Treatment Protocols Regulations.

Schedule 2, Subsection 3, provision (5) replaced: O.I.C. 2013/21, N.S. Reg. 21/2013.

 

(6)   Release

Notwithstanding any release provided for under the relevant sections of the Insurance Act, the Insurer may demand, as a condition precedent to payment of any amount under this section of the policy, a release in favour of the insured and the Insurer from liability to the extent of such payment from the insured person or his personal representative or any other person.

 

(7)   When moneys payable

                (a)    Subject to the Automobile Accident Diagnostic and Treatment Protocols Regulations, all amounts payable under this section, other than benefits under Part II of subsection 2, shall be paid by the Insurer within 30 days after it has received proof of claim. The initial benefits for loss of time under Part II of subsection (2) shall be paid within 30 days after it has received proof of claim, and payments shall be made thereafter within each 30-day period while the Insurer remains liable for payments if the insured person, whenever required to do so, furnishes prior to payment proof of continuing disability.

Schedule 2, Subsection 3, clause (7)(a) amended: O.I.C. 2013/21, N.S. Reg. 21/2013.

 

                (b)    No person shall bring an action to recover the amount of a claim under this section unless the requirements of provisions 3 and 4 of this subsection are complied with, nor until the amount of the loss has been ascertained as provided in this section.

 

                (c)    Every action or proceeding against the Insurer for the recovery of a claim under this section shall be commenced within one year from the date on which the cause of action arose and not afterwards.

 

(8)   Limitation on benefit payable

Where a person is entitled to benefits under more than one contract providing insurance of the type set forth in subsection 1, 2 or 2A, he or his personal representative or any person claiming through or under him or by virtue of the Fatal Injuries Act or the Survivorship Act may recover only an amount equal to one benefit.

 

In so far as applicable the general provisions, definitions, exclusions and mandatory conditions of the policy also apply.


Schedule 2 subheading amended: O.I.C. 2013-21, N.S. Reg. 21/2013.

Schedule 3 repealed: O.I.C. 2011-432, N.S. Reg. 326/2011.