The Ontario Court of Appeal overturned the finding of the motions judge on a Rule 21 procedure and ruled that the death of an insured during childbirth from an amniotic fluid embolism did not result from an "accident". For this reason, and because amniotic fluid embolism was found to be a physical illness which constituted an exclusion, coverage under the terms of the accidental death benefit rider was denied.

The first issue was whether the motions judge erred in her interpretation of the case law on what constitutes "an accident". The Court of Appeal found that the motions judge was correct in her conclusion that the ratio in Smith v. British Life Insurance Co., [1965] S.C.R. 434, had been overturned by the Supreme Court of Canada in Martin v. American International Assurance Life Co., [2003] 1 S.C.R. 158; however, she erred in concluding that the Supreme Court of Canada expressly rejected the distinction between an accidental death and a death from natural causes upon which Metlife relied in this case. The Court of Appeal held that the expectation test is not appropriate in a case where death results from a natural cause. Such a death is not one "in which death appears to be accidental."

The second issue was whether Mrs. Lin’s death as a result of amniotic fluid embolism was an "accident" according to the terms of the policy. The Court of Appeal concluded that an ordinary person would not describe what happened to Mrs. Lin as an "accident" and that therefore her death was determined not to be the result of an accident.

The third issue was whether the motions judge erred in restricting her analysis on whether the death resulted from a physical illness to the question of whether pregnancy was an illness. The Court of Appeal held that the motions judge’s analysis on this issue was flawed because pregnancy was not a cause of death. The proper question was therefore whether amniotic fluid embolism is an illness. This led to the fourth issue.

The fourth issue was whether, based on the totality of the evidence, the death was caused or contributed to by a physical illness within the exclusion contained in the policy. The Court of Appeal held that the expert evidence indicated that amniotic fluid embolism is one of the most common causes of maternal death and is recognized as a physical illness. An ordinary person would characterize this condition as a physical illness. It is an event created by a process within our body and therefore cannot be considered an accident. In conclusion, amniotic fluid embolism is a physical illness and since it "caused or contributed to" Mrs. Lin’s death, the occurrence falls within the scope of the exclusion.

The majority of the Court of Appeal allowed the appeal and set aside the motions judge’s order substituting an order in accordance with these reasons.

How Can You Insure Your Future?

Long ago, people realized that there is strength in numbers. For hundreds of years, we have been joining forces against all kinds of calamities — including financial troubles.

The concept of insurance is simply that if enough of us can pool our money to form a large enough fund, then together we can handle practically any financial disaster. Our motivation for contributing to this fund is our own eligibility to draw from it in the event of a disaster. One for all and all for one, so to speak.

Purchasing individual or family insurance coverage is probably one of the most important financial decisions you will make. A great deal of study and advice is needed to choose wisely. A few basic guidelines can safely be applied to most consumers. Beyond these, each individual’s needs are unique and should be carefully assessed by an expert.

1. How much insurance do you need?

A good rule of thumb is: Don’t insure yourself against misfortunes you can pay for yourself. Insurance is there to protect you in case of an event with overwhelming expenses. If anything short of a calamity does occur, it will usually cost you less in actual costs than the insurance premiums you would have paid.

2. What kind of policy is best?

Broader is better. Purchase insurance that will cover as many misfortunes as possible with a single policy; for example, homeowners insurance that covers not only damage to the house itself but also to its contents. Carefully examine policies that exclude coverage in certain areas, the “policy exclusions.”

3. From whom should I buy?

Always buy from a financially strong company. Take the time to shop around for the best prices with the most coverage for your specific situation. You may be able to save money by buying multiple policies from the same agent.

If you have further query feel free to contact Canada Insurance Plan