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Defences of Misrepresentation and
Nondisclosure
Larry Gilbertson
Angela Emerson
Considering the industry-wide concern about the rising incidence
of insurance fraud, it is worthwhile to review recent developments
which may affect the defences of misrepresentation and omission,
both at common law, and under Fire Statutory Condition 1, which
is contained in section 148 of the Insurance Act1
of Ontario, and which reads as follows:
"148. - (1)
The conditions set forth in this section shall be deemed to
be part of every contract in force in Ontario and shall be
printed in English or French in every policy with the heading
"Statutory Conditions" or "Conditions légales,"
as may be appropriate, and no variation or omission of or
addition to any statutory condition is binding on the insured."
(2) In this section,
"policy" does not include interim receipts or binders.
Statutory Conditions
1. If a person applying
for insurance falsely describes the property to the prejudice
of the insurer, or misrepresents or fraudulently omits to
communicate any circumstance that is material to be made known
to the insurer in order to enable it to judge the risk to
be undertaken, the contract is void as to any property in
relation to which the misrepresentation or omission is material."
The insurance acts
of many other provinces contain the same type of Statutory Condition.
It will be appreciated
that Section 143(1) of the Insurance Act stipulates that
Part IV of the Act entitled "Fire Insurance"
which contains the Statutory Conditions restricts the application
of that part of the Act as follows:
"143. - (1)
This Part applies to insurance against loss of or damage to
property arising from the peril of fire in any contract made
in Ontario except,
(a) insurance falling
within the classes of aircraft, automobile, boiler and machinery,
inland transportation, marine, plate glass, sprinkler leakage
and theft insurance;
(b) where the subject matter of the insurance is rents, charges
or loss of profits;
( c) where the peril of fire is an incidental peril to the coverage
provided; or
(d) where the subject
matter of the insurance is property that is insured by an
insurer or group of insurers primarily as a nuclear risk under
a policy covering against loss of or damage to the property
resulting from nuclear reaction or nuclear radiation and from
other perils."
Nevertheless, if the
Statutory Conditions are physically incorporated and incorporated
clearly by reference into a policy of insurance falling into
such other classes, a court may well hold that the Statutory
Conditions, including Statutory Condition 1 entitled "Misrepresentation,"
do constitute a part of the insurance contract and are binding
on the assured and the insurer, not by virtue of the Insurance
Act, but by virtue of clear reference and physical incorporation
within the contract itself. Generally speaking, a court will
accept this conclusion if the incorporating provision within
the policy is clear and unambiguous. In the Ontario Court of
Appeal case of Sever v. Economical Mutual Insurance Co.,2
the following incorporating provision was found inadequate
to support the insurer's contention that the Statutory Conditions
should apply:
"Conditions
Applicable to the Various Coverages Provided Herein
The Conditions herein
set forth under the title Statutory Conditions apply with
respect to insurance provided under Forms specifically covering
Fire and Extended Coverage Perils.
Statutory Conditions
1, 3, 4, 5, and 15 only apply to Forms specifically covering
Liability for Bodily Injury or Property Damage, Medical Payments
and Residence Voluntary Compensation.
All of the Conditions
herein set forth under the titles Statutory Conditions and
Additional Conditions apply with respect to insurance provided
Under All Other Forms except as they may be modified or supplemented
by the Forms or Endorsements attached."
The Ontario Court
of Appeal concluded that the reference to "All Other Forms"
either did not extend to all of the insured perils under the
policy, or at the very least was ambiguous, meaning the above-cited
provision would be construed contra proferentem, i.e.
it would be interpreted against the insurer as the drafter of
the contract.
The following incorporating
provisions, on the other hand, have been held to be clear and
unambiguous:
"Conditions
Applicable to the Various Coverages Provided Herein In respect
of your Personal Liability Protection (including Residence
Voluntary Compensation when added) - Statutory Conditions
1, 3, 4, 5 and 15 only, apply. Otherwise all of the Conditions
set forth under the titles Statutory Conditions and Additional
Conditions apply with respect to all of the perils insured
by this policy except as these Conditions may be modified
or supplemented by the Forms or Endorsements attached."
3
and
"Conditions - The Statutory Conditions apply to the peril
of fire and as modified or supplemented by riders or
endorsements attached apply as policy conditions to all other
perils insured by this policy." 4
It will be noted that
the above cited incorporating provisions both make reference
to insured "perils" as that to which the Statutory
Conditions incorporated as contractual conditions will apply.
Interestingly, the British Columbia Court of Appeal in the case
of Dressew Supply Ltd. v. Laurentian Pacific Insurance Co.
et al.; Mindell v. Canadian Northern Shield Insurance Co.,5
felt the Ontario Court of Appeal case of Sever was wrongly
decided, and that the insurer's incorporating provision should
have been found clear and unambiguous.
While the cases referred to so
far deal with efforts by insurers to incorporate Statutory Condition
1 and other statutory conditions contractually, it must be appreciated
there is a certain disadvantage to doing so. The reason is that
omissions must be fraudulent to allow the insurer to void the
contract under Statutory Condition 1, whereas at common law
omissions need not be fraudulent to justify the insurer voiding
the contract.6
Under Statutory Condition 1, it
will be noted that while omissions must be fraudulent in order
to provide the insurer with the option of rendering the policy
void, misrepresentations can be innocent or fraudulent. One
of the only requirements that both omissions and misrepresentations
share, with respect to Statutory Condition 1, is that they be
material, meaning that if the true facts had been known, they
would have led a reasonable underwriter to decline coverage,
or charge a higher premium.7
In McLean v. The
Paul Revere Life Insurance Company,8 Madam
Justice Prowse stated that with respect to the requirement of
materiality for misrepresentations and omissions, same must
be determined objectively, and need not be related to the loss
or damage which later becomes the subject of a claim, but rather
need only be material with respect to an assessment of the risk
at the time of the formation of the contract. This means the
subjective intentions or motives of the assured in either omitting
or misrepresenting certain facts, are of no significance with
respect to determining the materiality of the misrepresentations
or omissions.
In McLean, the
assured, when applying for accident and sickness insurance,
omitted to inform the agent of the insurance company about her
prior diagnosis and treatment for a mental disorder. She said
she did not disclose her prior medical history because she did
not believe same was relevant in any way to her application
for insurance. She argued that her attendances before psychiatrists
and psychologists took place in the context of a criminal proceeding
in which the psychiatrists and psychologists were retained simply
to provide her with a defence to criminal charges. In other
words, she felt her past medical history was irrelevant to her
application for insurance, as she said she never did suffer
from any form of mental or nervous disorder or illness.
Madam Justice Prowse
held that the assured's disagreement with the diagnosis did
not change the fact the diagnosis was made. She therefore concluded
that since questions pertaining to past diagnoses and treatment
were put to the assured, and because the assured was extremely
sophisticated, it must have crossed her mind that her past medical
contacts were in fact caught by the questions in the application
forms, and would therefore constitute information used by the
insurer to address issues pertaining to coverage and premium.
On this ground, Madam Justice Prowse ruled the assured's omissions
were in fact fraudulent.
Madam Justice Prowse
turned lastly to the issue of materiality. She adopted the test
of materiality as was set out in Kruska v. Manufacturers
Life Insurance Company by Mr. Justice Finch,9
who stated:
"The test of
materiality is whether the facts in question `would influence
the judgment of a prudent (or reasonable) insurer in fixing
the premium or in deciding whether to accept the risk'. .
. The test is objective in the sense that it refers to any
prudent insurer in the normal practice of that sort of insurance
business. The opinion or belief of the insured as to materiality
is irrelevant. The reason for this is that if it were otherwise,
material information could be suppressed and it would be very
difficult to show that the insured thought the information
to be material; whereas if the insured's belief is not relevant,
it will be in his interest to disclose all information within
his reach."
Madam Justice Prowse
accepted the evidence of the insurance company that it would
not have accepted the risk, had it known of the assured's past
medical history, and held that because the assured's belief
as to the materiality of the non-disclosed information was irrelevant,
the insurance policy in question was void ab initio at
the insurer’s option.
In the recent case
of Kehoe v. British Columbia Insurance Co.,10 the
British Columbia Court of Appeal commented on the test for materiality
and the evidentiary requirements for proving same. The fact
situation in Kehoe involved an assured who sued the insurer
for $60,000 plus pre-judgment interest as indemnity for the
loss he sustained as a result of a burglary at his home in Coquitlam,
B.C.
The assured formerly
owned a home in Vancouver, in connection with which he claimed
indemnity for five losses. Following the fifth loss, the assured
notified his insurance agent of his intention to move and requested
his policy be endorsed so it would cover his new home in Coquitlam.
The policy was so endorsed. Later however, the insurance
agent advised him
that this insurer would only renew his policy if the deductible
was increased from $200 to $5,000, and if he installed a monitored
burglar alarm.
The assured was unhappy
with these terms, hence he sought insurance with a new insurer,
namely, the British Columbia Insurance Company. Over the telephone,
the assured provided the British Columbia Insurance Company
employee, Mr. Shun, with the information necessary to fill out
a standard application for a residential policy.
The trial Judge held
that Mr. Shun had questioned the assured with respect to previous
claims, and that the assured had replied: "Not here";
or "Not at this address." Mr. Shun misinterpreted
this reply to mean: "None," and subsequently wrote
this answer on the application form. The assured testified at
trial that he signed the application form completed by Mr. Shun
without reading same, explaining he had been in a hurry. He
said this was why he had overlooked the fact that on the application
form the query regarding previous losses was answered with the
word "None."
The British Columbia
Insurance Company demonstrated to the trial Judge that an applicant's
claims history would be considered by it, as well as by other
insurers, as information material to assessing the risk. The
insurance company also proved that such practice was in accordance
with the general practice of the insurance industry. The issue
which arose on appeal was whether the British Columbia Insurance
Company also had to prove that this underwriting practice was
"reasonable." The trial Judge held that such an evidentiary
burden did lie with the insurance company, and as that burden
had not been satisfied, avoidance of the policy on the basis
of a material misrepresentation could not be allowed.
The British Columbia
Court of Appeal, however, held that Henwood v. Prudential
Insurance Company of America,11 a decision
of the Supreme Court of Canada, clearly stood for the proposition
that no such evidentiary burden rested with the insurer. Mr.
Justice Ritchie in Henwood stated:
"Although the evidence of
expert witnesses as to whether or not other insurance companies
consider a question to be `material', is admissible and may
be relevant in such a case as this, I do not think that when
no evidence whatever has been adduced to suggest that the
respondent's practice is anything but reasonable, it is seized
with the burden of proving the practice of other insurers
. . . If the matters here concealed had been truly disclosed
they would undoubtedly have influenced the respondent company
in stipulating for a higher premium and as there is no evidence
to suggest that this was unreasonable or that other insurance
companies would have followed a different course; I am satisfied
that, on the evidence before us, it has been shown affirmatively
that untrue answers. . . were material to the risk. This is
enough to avoid the policy."12
On the basis of Mr.
Justice Ritchie's ruling, the Court of Appeal in Kehoe held
that the trial Judge had erred in law in holding that the test
for establishing materiality required the insurer to prove its
underwriting practices were reasonable. It was therefore held
that because the British Columbia Insurance Company had demonstrated
its own underwriting practices, and moreover, had even demonstrated
that other insurers, and the industry in general, applied a
similar standard, it was inappropriate to consider the British
Columbia Insurance Company, in the absence of evidence to the
contrary, as other than a reasonable insurer.
There are two further
interesting aspects to the Kehoe decision. The first
concerns the issue of what may properly be considered a misrepresentation.
The second concerns an insurer's right to rely on the defence
of misrepresentation where the agent misinterprets the assured's
answer to a question on the application concerning previous
claims, and the assured signs the application with a mistake
thereon attributable to the agent, without having read same.
With respect to the
first aspect, the trial Judge held that the assured, in responding:
"Not here," or "Not at this address," with
respect to queries concerning previous claims, did so with full
knowledge that the insurer regarded him as a high risk. The
trial Judge held, the assured had adopted the strategy in the
hope that the British Columbia Insurance Company would not investigate
his answer further and find he had told a "half-truth"
and thereby misrepresented the true state of affairs.
The Court of Appeal
found there was evidence to support the trial Judge's finding,
and therefore, in the absence of palpable error, the Judge's
finding must stand. Mr. Justice Wallace further added:
". . . the defence of a
literally true answer to an ambiguous question cannot prevail
to assist an applicant for insurance who knowingly adopts
the strategy of misrepresenting his claim history to obtain
coverage on terms he knew would not have otherwise been available
had he told the whole truth." 13
It is submitted that
such a pragmatic view of misrepresentation is in accordance
with the spirit of "utmost good faith," which at common
law governs the relations between parties to insuring agreements.
With respect to the second aspect,
the insurer's right to rely on the defence of misrepresentation
when the actual material misrepresentation on the application
is attributable to the agent, Mr. Justice Wallace held that
by signing the application, regardless of whether or not he
read it, the assured had made the answers contained therein
his own. Mr. Justice Wallace adopted the statement of Mr. Justice
Locke in Van Schilt v. Gore Mutual Insurance Co.: l4
"The law is
clear that in contracts uberrimae fidei the fact that
a question is asked in the form makes the answer material.
There is also a duty on the applicant to use reasonable diligence
and to see that the answers are correctly written, and whether
he read the form or not the law treats him as having adopted
it: Biggar v. Rock Life Assur. Co., [1902] 1 K.B. 516."
It is interesting
to note the British Columbia Court of Appeal did not consider
whether Mr. Shun was the agent of the insurer or the assured
in coming to its decision, particularly since Mr. Shun was in
fact an employee of the insurer. More interesting still is the
fact that the British Columbia Court of Appeal relied upon the
above cited statement of Mr. Justice Locke in the Van Schilt
case, when in fact Mr. Justice Locke's statement was contrary
to the majority reasoning of Mr. Justice Carrothers, with whom
Mr. Justice Craig concurred. Mr. Justice Carrothers stated in
the Van Schilt case that:
". . . the general rule
is that an insured who has signed a basis clause, as in this
case, is bound by his answers and the onus of proof is on
him to establish that, despite the actual wording of the application
form, he did not, in fact, give the answer written down and
attributed to him." 15
In effect, the majority of the
British Columbia Court of Appeal in the Van Schilt case
considered that where a mistake originates with the agent alone,
and such is proven to the satisfaction of the Court, the agent
will be considered the agent of the insurer. Consequently, the
insurer will not be able to rely on the defence of misrepresentation,
but must rather honour the policy, and seek indemnity from the
agent where possible. Based on the facts in the Van Schilt
case however, the Court held the misrepresentation originated
with the assured. Therefore, the insurer was entitled to rely
on the defence of misrepresentation, and void the policy ab
initio.
In the British Columbia
Supreme Court decision of Allstate Insurance Company of
Canada v. Wong's Insurance Services Ltd.,16 a
decision handed down, interestingly enough, just two days before
the British Columbia Court of Appeal judgment in Kehoe, Mr.
Justice Brenner adopted the majority reasons in the Van Schilt
case, as he was bound to do. He stated:
"In Van
Schilt the incorrect answers originated with the insured.
The form was filled out by the agent and then passed to the
insured for execution. He says he chose not to read the completed
form. In the case at bar, the erroneous information originated
with the agent. The form was blank when the insured signed
it and he did so at the agent's request. In my view Van
Schilt turns on the finding that the erroneous information
originated with the insured and the case stands for the proposition
that where an agent fills out an application form with inaccurate
information supplied by an insured, the agent does so as agent
of the insured.
In
the case at bar the incorrect information originated with
the agent who had binding authority from Allstate.
That being the case, the insured
had a cause of action against the plaintiff [Allstate]. The
plaintiff [Allstate] was correct in its decision to pay the
claim of its insured Martlew and it is entitled to recover
the amount so paid from the defendant [insurance agent]."
17
Mr. Justice Brenner
in effect held that because the error in the insurance application
originated with the agent, the agent was deemed in law to be
the agent of the insurer. Accordingly, the insurer could not
rely upon the defence of misrepresentation to void the policy,
but rather had to cover the assured's loss, and sue the agent
for indemnity, which it did successfully.
In the 1943 Ontario
Court of Appeal decision of Sleigh v. Stevenson,18
it was held that where an assured signs an application form,
by the very act of signing, he authenticates the statements
contained in the form. It must be appreciated however, that
Sleigh did not deal with a situation in which an assured
signs a blank application form and the insurance agent unilaterally
decides to provide answers which amount to material misrepresentations
thereon.
In Levesque v.
Federation Cie d'Assurance du Canada,19 the ratio
of the Van Schilt case was applied. It was held that
as the assured did not purposefully attempt to deceive the insurer,
the policy remained valid, despite the fact the agent had misrepresented
material facts on the application, and despite the fact that
the assured had signed the application thereafter, without having
read it.
One can distinguish
Levesque from the British Columbia Court of Appeal case
of Kehoe, on the basis that the assured in Kehoe did
not tell his agent the truth but rather a "half-truth,"
which the agent misinterpreted fully, and which therefore led
to a completely false answer being transcribed onto the application
form. Where an assured misrepresents material facts to the agent,
and these misrepresentations result in the application being
completed falsely, it would appear the courts will take one
of two positions. A court might hold the agent to be the agent
of the assured for the purpose of completing the application,
regardless of the form the misrepresentation takes in the application.
Alternatively, a court might apply the reasoning, as found in
Biggar v. Rook Life Assurance Company,20
which is simply that the assured will be found responsible
for the information contained in an application he signs.
In the Ontario Supreme
Court case of North American Life Assurance Co. v. Caputo,21
the insurer sued its assured to recover disability benefits
already paid, alleging material misrepresentation by the assured.
On the application there was a question which read:
"Have you consulted
any physician or other person about your health or for examination?",
which was answered: "No". The assured had in reality
seen many doctors about a stomach ailment. He later underwent
stomach surgery and was unable to work for a long period of
time.
The jury found the
assured had satisfied the onus on him to show that the question
which was falsely answered in the application form was not put
to him and that the agent had unilaterally decided to write
in the answer before the document was signed by the assured.
However, Mr. Justice Saunders held that the assured was under
a duty to consider the document before he signed it. Following
the Court of Appeal decision in Sleigh, he held that
in most situations an assured is responsible for the contents
of the application form he signs.
Mr. Justice Saunders
then provided a brief history of the case law spelling out the
situations in which an assured is not responsible for misrepresentations
and fraudulent omissions in an application which he signs. He
stated that in the Supreme Court of Canada case of Blanchette
v. C.LS. Ltd.,22 it was held that the
agent was the agent of the insurer in filling in blank sections
of an application falsely, where the assured had signed the
application prior to the agent filling in the blank sections.
Mr. Justice Pigeon in Blanchette stated:
"When the insured
signs after the answers have been entered by the agent,
he has the opportunity of reading them. On the assumption
that he is under a duty to verify before signing that the
agent has properly filled in the form, I can understand how
he can be said to be negligent if he does not do so.
However, in the
present case, the signed form was already in the hands of
the agent when he told the appellant that the additional coverage
could be obtained by his making the necessary additions on
the basis of the information given him by telephone. When
Blanchette agreed not to insist on Raiche returning to his
home for the purpose of adding the tractor coverage on the
insurance application, he had no means of verifying the correctness
of the form as completed. In my view, it is unfair to hold
that he should suffer the consequences of Raiche's failure
to complete the form properly . . . The [insurance] company
is therefore precluded from relying on an erroneous answer
written by its agent." 23 (underlining ours)
Consequently, the assured was able
to collect under the policy in Blanchette.
Mr. Justice Saunders
in Caputo cited the cases of Bird v. New York Life
Insurance Co.,24 and Bawden v. London, Edinburgh
& Glasgow Assurance Co.,25 as standing for
the proposition that an assured will not be bound by answers
in an application where the application is knowingly completed
by the agent falsely, and subsequently signed by the assured,
where the assured did not read same prior to signing but was
not attempting to defraud the insurer.
Mr. Justice Saunders
also cited the cases of Stone v. Reliance Mutual Insurance
Society Ltd.,26 and Ayrey v. British Legal
and United Provident Assurance Co.,27 as
standing for the proposition that an assured will not be bound
by answers in an application completed by the agent and subsequently
signed by him, if in fact the insurer knew, or had information
concerning the facts materially misrepresented in the application.
Mr. Justice Saunders
distinguished the facts in Caputo from those in Bird
and Bawden on the basis that the assured in Caputo
did not communicate to the agent all the necessary information
to enable the agent to correctly complete the application form.
The assured was therefore found responsible for the material
misrepresentations therein by having signed it, despite the
fact he did not read it prior to signing.
It must be appreciated
from Mr. Justice Saunders' survey of the case law on the subject,
that each case turns very much on its own facts. It is therefore
vital when confronted with a suspected misrepresentation or
omission in the application, that statements from the agent,
the assured, and any witnesses be obtained which incorporate
answers to the following questions:
1. Who filled
in which parts of the application form, and on what date(s)?
2. Who signed
the application form, and on what date(s)?
3. If the
agent filled in any parts of the application form, on what
dates did the
agent receive information from the
assured to do so, what information was
provided and how was this information
conveyed?
4. Exactly
what information did the assured communicate to the agent,
even if
same was not used to complete the
application, and how and on what
date(s) was it communicated?
5. What relevant
information did the agent have, or at least have in his/her
files, with respect to the assured,
apart from the information communicated
by the assured for the purpose of
filling in the subject application?
6. If the
assured signed the application form, was it completed before
signing,
did he/she read it prior to signing,
and if so, on what date(s), and where was
this done, e.g. at the assured's
home, place of business, at the agent's
office, etc.?
7. Were any
additions or alterations made to the application following
the
signing of same, and if so by whom,
and on what date(s)?
8. Were there
any witnesses to the filling in and/or signing of the application?
Answers to such questions
will obviously not provide all the information required in every
case. Each situation will require that special consideration
be given to the particular set of circumstances involved. However,
the above list can serve as a rough guideline or checklist when
approaching the task of securing statements during the investigation
process.
Depending on the kind
of case, it may also be advisable to obtain as much information
as possible regarding the relative sophistication of the assured.
Mr. Justice Saunders in the Caputo case found it relevant
that the assured was both well educated and an experienced businessman,
meaning he was entirely capable of reading the application form
and understanding it completely, prior to signing.
Important from the
standpoint of fraudulent omissions made in contravention of
Statutory Condition 1 are two very recent cases decided by the
Supreme Court of Canada in the criminal context, which delineate
the actual elements of fraud, as well as the tests needed to
establish it.
In R. v.
Theroux,28 Madam Justice McLachlin, speaking
for the majority of the Court, stated with respect to the actus
reus of fraud:
"Speaking of
the actus reus of this offence, Dickson J. (as he then
was) set out the following principles in [R. v. Olan,
[1978] 2 S.C.R.1175]:
(i) the offence
has two elements: dishonest act and deprivation;
(ii) the dishonest
act is established by proof of deceit, falsehood or `other
fraudulent means';
(iii) the element
of deprivation is established by proof of detriment, prejudice,
or risk of prejudice to the economic interests of the
victim, caused by the dishonest act.
Olan marked
a broadening of the law of fraud in two respects. First, it
overruled previous authority which suggested that deceit was
an essential element of the offence. Instead, it posited the
general concept of dishonesty, which might manifest itself in
deceit, falsehood or some other form of dishonesty. Just as
what constitutes a lie or a deceitful act for the purpose of
the actus reus is judged on the objective facts, so the
`other fraudulent means' in the third category is determined
objectively, by reference to what a reasonable person would
consider to be a dishonest act. Second, Olan made it
clear that economic loss was not essential to the offence; the
imperiling of an economic interest is sufficient even though
no actual loss has been suffered. By adopting an expansive interpretation
of the offence, the Court established fraud as an offence of
general scope capable of encompassing a wide range of dishonest
commercial dealings." 29
In situations which
involve a breach of Statutory Condition 1, the act which is
prohibited is merely the misrepresentation or omission itself.
The deprivation caused by the prohibited act, under such circumstances,
is the placing of the insurer's pecuniary interests at risk,
given that when misleading or insufficient information is provided
to the insurer, its ability to properly assess the risk is impaired.
As only omissions
need be fraudulent in the context of Statutory Condition 1,
the mens rea of criminal fraud, by analogy, need only
be addressed in the case of omissions. This is not necessary
in the case of misrepresentations since they can result in the
insurance contract being voided ab initio, even where
they are completely innocent.
In Theroux, Madam
Justice McLachlin stated that the mens rea of fraud is
established by proof of:
"1. subjective
knowledge of the prohibited act; and
2. subjective
knowledge that the prohibited act could have as a consequence
the deprivation of another (which
deprivation may consist of knowledge that
the victim's pecuniary interests
are put at risk).
Where the conduct
and knowledge required by these definitions are established,
the accused is guilty whether he actually intended the prohibited
consequence or was reckless as to whether it would occur.
The inclusion of
risk of deprivation in the concept of deprivation in Olan
requires specific comment. The accused must have subjective
awareness, at the very least, that his or her conduct will
put the property or economic expectations of others at risk.
As noted above, this does not mean that the Crown must provide
the trier of fact with a mental snapshot proving exactly what
was in the accused's mind at the moment the dishonest act
was committed. In certain cases, the inference of subjective
knowledge of the risk may be drawn from the facts as the accused
believed them to be." 30
In R. v. Zlatic
31 Madam Justice McLachlin, again speaking for the
majority of the Court, said the following about the mens
rea of fraud:
"The findings
of the trial Judge established that the appellant, when he
received the goods, did not care whether or not he paid for
them, and then proceeded to sell them and divert the money
received from their sale to gambling. As is pointed out in
Theroux, released concurrently, fraud by `other fraudulent
means' does not require that the accused subjectively appreciate
the dishonesty of his or her acts. The accused must knowingly,
i.e., subjectively, undertake the conduct which constitutes
the dishonest act, and must subjectively appreciate that the
consequences of such conduct could be deprivation in the sense
of causing another to lose his or her pecuniary interest in
certain property or in placing that interest at risk."
32
It can therefore be
seen clearly the mens rea of fraud does not require the
defrauder to be subjectively aware of the fact that he is committing
fraud. Rather, all the defrauder need do is commit an act which
a reasonable person would consider dishonest, be fully aware
he has undertaken this act, and be fully aware that deprivation
to his victim as caused by his act will, or could reasonably
occur. On this basis, an omission as contemplated under Statutory
Condition 1 is fraudulent if:
1. The assured had
subjective knowledge that he/she did not inform the insurer
of certain facts; and
2. The assured had
subjective knowledge that his/her non-disclosure of these
certain facts could place the insurer's
pecuniary interest at risk.
Theroux and Zlatic
stand for the proposition that to prove fraud, one need no longer
demonstrate the existence of a "heinous state of mind"
or "wicked mind," as was previously long held.33
Now, to be guilty of a fraudulent omission, the assured need
only omit material facts, know that he/she is omitting material
facts and understand that the insurer might need the full facts
in order to assess the risk. The reasons for the assured's nondisclosure,
on this formulation of fraud, are wholly irrelevant.
The Supreme Court
of Canada decision in Coronation Insurance Company et al.
v. Taku Air Transport Ltd. et al.,34 presents
an interesting facet to be considered in insurance fraud cases.
In this case, Taku was a small commercial air carrier. Coronation
Insurance was Taku's first insurer. As Taku had three accidents
in its first year of business, Coronation refused to renew the
policy. Taku consequently obtained coverage from the British
Aviation Insurance Company. This insurance was terminated seven
years later, as a result of further accidents. Taku then applied
to Coronation again. Unfortunately, Coronation did not check
its own files. Rather, it asked Taku to disclose its records.
Taku did not do this, but instead reported just one accident
which it falsely stated occurred when it was insured by British
Aviation. Coronation calculated the risk based on the false
information provided by Taku. Coronation neither consulted its
own records nor investigated Taku in any significant manner.
Coronation at the
time of assessing the risk for the second time also requested
that Taku declare how many seats it wished to insure for each
of its aircraft. Taku requested coverage for only four seats
on its Beaver Aircraft, the subject vehicle in the current case,
when in fact Taku regularly carried five passengers on this
type of aircraft.
Mr. Justice Cory,
speaking for the majority of the Supreme Court of Canada, stated
that in situations where insurance is really for the benefit
of the public at large, as is the case in the air passenger
industry, the duty is on the insurer to investigate the risk
it assumes. Consequently, the material misrepresentations of
the assured will not void the policy unless the subject matter
of the misrepresentation constitutes information which only
the assured could possibly know.
Fortunately in this case, as only
Taku would have known how many passengers it would carry at
a time in its Beaver Aircraft, which in reality was five not
four, as was told to Coronation, the policy of insurance was
found void ab initio.
Mr. Justice Cory,
fortunately, also stated that where insurance is for the benefit
of the assured alone, a material misrepresentation of any fact
of which the insurer was unaware, is sufficient to void the
policy, for the simple reason that in such cases it is generally
presumed that the material facts necessary to assess the risk
are only within the knowledge of the assured.
Cases in which the
initial concern is a suspected misrepresentation or omission
in the application, are not the only cases which warrant careful
consideration of the information contained in the application.
Often in cases of suspicious fire, burglary and theft claims
in particular, assureds who would present a fraudulent claim
are equally capable of misrepresentation or omission when applying
for insurance coverage. A thorough investigation by the adjuster
of any suspicious claim should therefore automatically include
examination of the information provided in the application to
determine whether there is any evidence to establish that there
has been a misrepresentation or omission which would warrant
voiding the policy ab initio.
Footnotes
1. R.S.O.1990, Chap. 1.8.
2. (1986) 57 O.R. (2d)159 (H.C.J.), rev'd. 1989), 66 O.R. (2d)
799 (C.A.).
3. Freesman v. Royal Insurance Company
of Canada (1986), 29
D.L.R. (4th) 621 at 628 (H.C.J.), aff'd (1988),
63 O.R. (2d) 224
(C.A.).
4. Dressew Supply Ltd. v. Laurentian
Pacific Insurance Co. et al.,
Mindell v. Canadian Northern Shield Insurance
Co. (1991), 77
D.L.R. (4th) 317 (B.C.C.A.).
5. supra.
6. Maryland Casualty Co. v. Blue Sparrow Industries Ltd., [1980]
I.L.R.1-1299
(Ont.H.C.).
7. See Chenier v.
Madill, 2 O.R. (2d) 361, 43 D.L.R. (3d) 28, [1974] I.L.R.
1-585 (H.C.J.); Goldshlager
v. Royal Insurance Company Ltd. (1977),19
O.R. (2d)166 (Ont. S.C.).
8. [1990] I.L.R. 1-2617 (B.C.S.C.).
9. Kruska v. Manufacturers Life Insurance
Company (1984), 54 B.C.L.R. 343
at 350 (B.C.S.C.), aff'd (1985),11 C.C.L.I.197
(B.C.C.A.), as cited in
McLean, supra, at 10,216.
10. [1993] B.C.J. No. 1172
(B.C.C.A.).
11. [1967] S.C.R. 720; (1967),64
D.L.R. 715.
12. supra, 720-22 (D.L.R.).
13. Kehoe, supra, at
para. 32.
14. (1988), 23 B.C.L.R. (2d)
201 at 207; (1988), 29 C.C.L.I. 181 at 186-7
(B.C.C.A.), as cited in Kehoe,
supra, at para. 35.
15. Van Schilt, supra, at
188 (C.C.L.I.).
16. (1993), 15 C.C.L.I. (2d)
36 (B.C.S.C.).
17. supra, at 42.
18. (1943) 10 I.L.R. 287 (Ont.
C.A.).
19. (1990), 21 A.C.WS. (3d)
881 (Que. C.A.).
20. [1902] 1 K.B. 516.
21. (1989), 41 C.C.L.I. 104
(H.C.J.).
22. [1973] S.C.R. 833, [1973]
36 D.L.R. (3d) 561, [19731 I.L.R. 1-532.
23. supra, at 577-8
(D.L.R.).
24.(1920), 47 O.L.R. 510 (H.C.).
25. [1892] 2 Q.B. 534 (C.A.).
26. [1972] 1 Lloyd's Rep. 469
(C.A.).
27. [1918] 11 K.B. 136.
28. [1993] 2 S.C.R. 5.
29. supra, at 15-6.
30. supra at 20.1.
31. [1993] 2 S.C.R. 29.
32. supra, at 49.
33. See, for example: Chenier
v. Madill, supra, note 6.
34. (1991), 85 D.L.R. (4th)
609 (S.C.C.).
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