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Insurance - Auto - Notice
MORE CASES
Part 2
. Hussein v. Intact Insurance Company
In Hussein v. Intact Insurance Company (Ont Divisional Ct, 2025) the Divisional Court allowed a LAT SABS appeal, here on statutory interpretation 'consumer' grounds regarding a claim notice issue:[2] The Appellant, (the “Insured”), was involved in a motor vehicle accident, He notified his insurance company, Intact Insurance (the “Insurer”), one day later that he was in an accident in which his vehicle had sustained heavy damage. The Insured did not file his claim for accident benefits until seventeen months later. His explanation for the delay was that he was not aware that he was entitled to accident benefits until he spoke to a paralegal. The Insurer denied his claim on the basis that he did not give the insurance company notice of his claim for accident benefits within seven days as required by the SABS.
[3] The Insured applied to the LAT for a resolution of his dispute with the Insurer. In its decision dated December 22, 2023 (the “Decision”), the LAT denied his application for benefits on the basis that he failed to notify the Insurer of his claim within seven days and that his explanation for the 17-month delay in making his application was not credible. The Insured requested that the LAT reconsider its Decision. On May 21, 2024, that request was dismissed (the “Reconsideration Decision”).
[4] This is an appeal from both the Decision and the Reconsideration Decision. For the reasons that follow, I would allow the appeal, set aside both decisions and find that the Insured’s notification to the Insurer that he had been in an accident was sufficient notice to satisfy the seven-day deadline for notice under the legislation. Fundamental to my decision is the fact that the SABS is consumer protection legislation, which must be interpreted in a manner consistent with its objective - to reduce economic dislocation and hardship for victims of motor vehicle accidents.
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[22] Section 32 of the SABS reads as follows:32 (1) A person who intends to apply for one or more benefits described in the Regulation shall notify the insurer of his or her intention no later than the seventh day after the circumstances arose that give rise to the entitlement to the benefit, or as soon as practicable after that day.
(2) The insurer shall promptly provide the person with,
(a) the appropriate application forms;
(b) a written explanation of the benefits available;
(c) information to assist the person in applying for benefits; and
(d) information on the election relating to income replacement, non-earner and caregiver benefits, if applicable. [23] According to the decisions under appeal, the seven-day notice requirement in s. 32(1) required the Insured to notify the Insurer that he intended to apply for accident benefits. It was not sufficient to notify the Insurer that he had been in an accident. However, the Insured submits that the notice requirement under s. 32(1) was satisfied when he notified the Insurer that he had been in an accident.
[24] In Tomec v. Economical Mutual Insurance Co., 2019 ONCA 882, 148 O.R. (3d) 438, the Court of Appeal set out the overriding principles to be applied in interpreting the SABS. In doing so the Court adopted the articulation of those principles set out in Arts (Litigation Guardian of) v. State Farm Insurance Co. (2008), 2008 CanLII 25055 (ON SC), 91 O.R. (3d) 394 (S.C.J.), at para. 16, where the Court states:The SABS are remedial and constitute consumer protection legislation. As such, it is to be read in its entire context and in their ordinary sense harmoniously with the scheme of the Act, the object of the Act, and the intention of the legislature. The goal of the legislation is to reduce the economic dislocation and hardship of motor vehicle accident victims and, as such, assumes an importance which is both pressing and substantial. [25] Tomec also states that faced with a choice between an interpretation of the statute “that furthers the public policy objectives underlying the SABS and one that undermines it, the only reasonable decision is to side with the former”: para. 45.
[26] The Insured submitted three LAT cases in support of his position as to the correct interpretation of s. 32(1).
[27] In Ilangeswaran v. Sonnet Insurance Company, 2021 CanLII 55200 (Ont. LAT), the insured made a call to the insurer to report her accident within the seven-day period, but the call was disconnected before the insured reported any injuries. The LAT found that the insured had notified the insurer of her claim for accident benefits. If the insurer wanted to clarify with the insured as to whether she had been injured, it should have called her back.
[28] In M.O. v. Jevco Insurance Company, 2020 CanLII 63561 (Ont. LAT), the LAT found that when the insurer received notice of the insured’s tort claim, this was sufficient to constitute notice under the SABS of an accident benefits claim. The Tribunal found that at that point the insurer would have been alive to the potential of an accident benefits claim and should have reached out to the insured’s guardians to advise them of their rights to make a claim. The Tribunal found at para. 12 that “considering the Schedule is consumer-protection legislation, Jevco’s actions are alarming.”
[29] In K.H. v. Northbridge General Insurance Company, 2019 CanLII 101613 (Ont. LAT), the Tribunal articulates the insured’s obligation to give notice under s. 32(1) in the following manner, at para. 7:Section 32(1) of the Schedule requires an insured person to inform an insurer of an accident within seven days, at which point the insurer will provide the insured with the application forms for accident benefits. (emphasis added). [30] The Insurer referred us to two cases that it alleged took a different position than the cases cited by the Insured.
[31] In Abbany v. Pafco Insurance Company, 2012 ONFSCDRS 144, an insured reported a collision to his insurer on the date of the accident, but two days later advised the insurer that he was not injured. The insurer closed its claim. Approximately one year later, the insured advised the insurer that he would be making an accident benefits claim. The Financial Services Commission found that the insurer failed to comply with the notice timeline set out in s. 32 of the SABS and that he did not have a reasonable explanation for the delay.
[32] In Clements v. The Co-operators Group Limited, 2021 CanLII 18911 (Ont. LAT), Mr. Clements was a witness to the aftermath of an accident involving his brother, his partner and his three children. Two years later, Mr. Clements contacted his brother’s insurer to submit a claim for accident benefits. The LAT upheld the insurer’s denial of Mr. Clements’s claim on the basis that he did not file a reasonable explanation for his delay in applying for benefits. It also found:[23] There is no evidence that Jason Clements notified Co-operators at any time that he suffered an injury as a result of the accident, or that he was contemplating making a claim for accident benefits. Consequently, Co-operators is under no obligation to advise Jason Clements of his right to claim benefits. Further, Co-operators is not obligated to provide Jason Clements with forms in order to commence a claim for accident benefits. [33] The LAT essentially found that since the Insured in this case did not advise the Insurer that he suffered injuries in the accident, the Insurer had no obligation to make further inquiries or to advise the Insured of his right to claim accident benefits.
[34] According to the Insurer, the wording of s. 32(1) is clear – the onus is on the Insured to give notice within seven days and that notice requires the Insured to be specific about the fact that the nature of his claim is one for accident benefits.
[35] This interpretation is neither consistent with the Tribunal’s case law, nor consistent with the consumer protection purpose of the SABS. In both Ilangeswaran and M.O v. Jevco, the Tribunal found that once the insurer became aware of an accident, notice had been given of the claim for accident benefits. If the insurer wished to clarify more, it was their obligation to make inquiries. In Abbany, that obligation was not imposed because the insured advised the insurer that he had not suffered any injuries. In Clements, Mr. Clements was making a claim for psychological injuries he incurred because he observed the aftermath of the accident. This is not the type of claim that an insurer would reasonably anticipate once being advised that there had been an accident. Clements was also a case that turned on the issue of reasonable explanation, not on the issue of notice.
[36] In this case, the LAT found (based on the evidentiary record before it) that the Insured told the Insurer that he had been in an accident in which his vehicle has sustained “heavy damage.” The Insurer did not ask if the Insured had been injured in the accident and did not advise him that if he had, he could not only obtain coverage for the damage to his vehicle, but he could also claim accident benefits for his personal injuries. According to the Insurer and the LAT, to read s. 32(1) of the SABS in a way that requires any such action on the part of an insurer would run contrary to the wording of the SABS.
[37] The Insurer also submitted that any consumer protection concerns about the interpretation of s. 32(1) are answered by s. 34 of the SABS, which provides that if an insured has a reasonable explanation for failing to comply with a time limit under the SABS, they will not be disentitled from claiming the benefits provided. The problem with this submission is that, as the Insurer argued and the LAT accepted, the jurisprudence around the interpretation of “reasonable explanation” contains a number of guiding principles, one of which is that the onus is on an insured to establish a reasonable explanation and the other is that “ignorance of the law alone is not a reasonable explanation.” In this case, the Insured’s explanation is that he did not know that he had a legal claim to accident benefits, and he did not know that the law required him to notify his insurance company within seven days of his intention to apply for those accident benefits. Thus, according to the Insurer, even if the LAT had found it credible, the Insured’s explanation could not be a reasonable explanation because ignorance of the law is no excuse.
[38] Consumers who have motor vehicle accidents are in a vulnerable position, particularly in the period immediately following an accident. Seven days is a very short notice period. Insurance contracts are complicated documents that the average consumer is unlikely to read. If they do read the document, they are unlikely to remember its contents if they have an accident, which could be many years later. The entitlement to damages for motor vehicle accidents in Ontario and the role of the SABS in that regime is not something that it is fair to assume the average consumer would be familiar with. Insurance adjusters and agents, on the other hand, can be presumed to know that if one of their insureds has an accident and is injured in that accident, they will want to make a claim for accident benefits. An interpretation of s. 32(1) that recognizes these realities is one that fosters the consumer protection purpose of the SABS. An interpretation that ignores these realities does the opposite.
[39] The interpretation of s. 32(1) in the decisions under appeal ignores these realities. As such, it undermines the consumer protection purpose of the SABS.
[40] In my view the notice requirement under the LAT was met when the Insured advised the Insurer one day after the accident that he had been in an accident. A reasonable insurer would assume that an insured who has been in an accident intends to access all the benefits available to them under their policy. If the insured has been injured in the accident, this will include accident benefits. If the Insurer in this case wished to clarify which specific benefits the Insured intended to access, the Insurer could have asked the Insured whether he sustained any injuries. As the Insurer chose not to ask any more questions, it should have acted on the assumption that the Insured would want to apply for accident benefits. At that point, the Insurer should have complied with its obligations under s. 32(2) of the SABS, which included sending out the necessary application forms and an explanation of the benefits available. This is an interpretation that fosters the consumer protection purpose of the SABS.
[41] I do not accept the Insurer’s submission that this would put an unfair financial burden on insurers and would precipitate an increase in the number of claims, many of which could be illegitimate. First, I do not accept that requiring an insurer to send out paperwork to explain to insureds, who have paid them significant premiums, what benefits they are entitled to claim now that they have had an accident, imposes an unfair financial burden. Furthermore, if the insurer is concerned about the expense of sending out unnecessary forms, its agents or adjusters can simply confirm beforehand that the insured was not, in fact, injured in the accident. Second, I do not accept that if you tell an insured they have the right to claim a benefit this will entice them to make a claim for a benefit they are not entitled to.
[42] The Insurer also relied on a previous version of the notice requirement to support its interpretation of s. 32(1). That version read:32 (1) A person who wants to apply for a benefit under this Regulation shall notify the insurer within 30 days after the circumstances arose that give rise to the entitlement to the benefit, or as soon as practicable thereafter. [43] According to the Insurer, the “Legislature deliberately changed the wording of s. 32(1) in 2003 to place an onus on the claimant to notify the insurer of their specific intention to bring a claim, rather than imply that they must only report that an accident occurred.” I disagree. While the precise words used in s. 32(1) may have changed, the changes make no substantive difference to the meaning of the section, except to reduce the notice period from thirty days to seven days.
[44] The Insurer’s argument is, in effect, that in 2003 the Legislature changed the wording of s. 32(1) not only to facilitate an insurer’s ability to investigate and assess the circumstances of a claim expeditiously by shortening the period of notice, but also to increase the requirements for notice so that it would be harder for an insured to give proper notice. Implied in this argument is that the Legislature wanted to make it easier for insurance companies to deny claims and harder for insureds to make claims. In the absence of any evidence that this was the case or any rationale as to why this would be the case, I am not prepared to find that this was the Legislature’s intention.
[45] The Insured also made a submission that the LAT erred in law in its analysis on the reasonable explanation issue. In view of my finding that the Insured did give the required notice under s. 32(1) there is no need to deal with this issue. . Tracy Adams v. Aviva Insurance Company
In Tracy Adams v. Aviva Insurance Company (Div Court, 2023) the Divisional Court considered what are (IMHO awkward structured) claim 'notice' time extension SABS provisions, here provisions that can extend insurance claim timelines [primarily under SABS s.32(1) 'Notice to insurer and application for benefits', but also s.32(10), 34 and 55]. The case doesn't reflect definitive legal points, but it is helpful to see consider how these time provisions may operate together:[1] This is an appeal by the Appellant, Tracy Adams, of an underlying decision and of a reconsideration decision of the Licence Appeal Tribunal (the “Tribunal”), which held that Adams’ application for statutory accident benefits (“SABS”) was barred because she failed to provide a “reasonable explanation” for her failure to notify the Respondent, Aviva Insurance Company of Canada (“Aviva”) of the circumstances giving rise to her claim for benefits within the prescribed timelines set out in the Statutory Accident Benefits Schedule, O Reg. 34/10 (the “Schedule”).
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Preliminary Decision
[4] In a decision of the Tribunal, dated January 27, 2023 (the “Preliminary Decision”), the Tribunal dismissed the Appellant’s application for insurance benefits.
[5] The Tribunal stated that it was not disputed that the Appellant had submitted her application after the time period described in s. 32(1) of the Schedule. It further noted that s. 34 of the Schedule states that “A person’s failure to comply with a time limit set out in this Part does not disentitle the person to a benefit if the person has a reasonable explanation.” The Adjudicator concluded that the Appellant did not have a “reasonable explanation” for the delay and that the Appellant was barred from applying to the Tribunal because of her failure to adhere to the SABS timelines.
[6] In light of this finding the Tribunal stated that it was unnecessary to consider whether the Appellant failed to submit her application within the time limit prescribed in s.32(5) of the Schedule.
[7] Finally, the Tribunal concluded that the Appellant was precluded pursuant to s.55(1) of the Schedule from applying to the Tribunal due to her breach of the timelines and there was no need for the Tribunal to consider whether it should use its discretion to invoke s. 55(2) of the Schedule to permit the Appellant to continue her application to the Tribunal.
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The Law
[13] A person involved in an automobile accident may seek accident benefits from their insurer. Section 32(1) of the Schedule provides:A person who intends to apply for one or more benefits described in the Regulation shall notify the insurer of his or her intention no later than the 7th day after the circumstances arose that give rise to the entitlement to the benefit, or as soon as practicable after that date. [14] Section 32(10) of the Schedule states:Despite any shorter time limit in this Regulation, if an applicant fails without a reasonable explanation to notify an insurer under subsection (1) within the time required under that subsection, the insurer may delay determining if the applicant is entitled to a benefit and may delay paying the benefit until the later of,
(a) 45 days after the day the insurer receives the completed and signed application; or
(b) 10 business days after the day the applicant complies with any request made by the insurer under subsection 33(1) or (2). [15] Section 34 of the Schedule provides that “[a] person’s failure to comply with a time limit set out in this Part does not disentitle the person to a benefit if the person has a reasonable explanation.”
[16] Finally, section 55 of the Schedule provides:(1) Subject to subsection (2), an insured person shall not apply to the Licence Appeal Tribunal under subsection 280(2) of the Act if any of the following circumstances exist:1. The insured person has not notified the insurer of the circumstances giving rise to a claim for a benefit or has not submitted an application for the benefit within the times prescribed by this Regulation.
2. The insured has provided the insured person with notice in accordance with this Regulation that it requires an examination under section 44, but the insured person has not complied with that section.
3. The issue in dispute relates to the insurer's denial of liability to pay an amount under an invoice on the grounds that,
i. the insurer requested information from a provider under subsection 46.2(1), and
ii. the insurer is unable, acting recently, to determine its liability for the amount payable under the invoice because the provider has not complied with the request in whole or in part. (2) The Licence Appeal Tribunal may permit an insured person to apply despite paragraph 2 or 3 of subsection (1). . Tagoe v. The Personal Insurance Company
In Tagoe v. The Personal Insurance Company (Div Court, 2023) the Divisional Court considers (and allows on other grounds) an Insurance Act (IA) appeal [under s.280] from a LAT decision to deny SABS income replacement benefits on limitation grounds.
In these quotes the court considered the running of the IA s.56 application limitation period on the issue of the date of 'clear and unequivocal' notice of decision:[1] ... The adjudicator dismissed the application on the ground that it had been brought after the two-year limitation period in s. 56 of the SABS.
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[7] In January 2019, the appellant applied for income replacement benefits.
[8] In June 2020, the insurer informed the appellant that his claim was barred by the expiry of the limitation period on May 20, 2018, relying on the Explanation of Benefits dated May 20, 2016.
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Denial of benefits
[12] For the limitation period to run, the denial of benefits must be clear and unequivocal from the point of view of an unsophisticated person: Smith v. Cooperators General Insurance Company, 2002 SCC 30. In dismissing the application, the adjudicator said:[32] On the evidence, I find that the respondent’s EOB [Explanation of Benefits] letter to [the appellant] satisfied the basic requirements of Smith because it stated the reasons for the denial of the IRBs; it clearly indicates the [appellant] is not eligible for IRBs; provides particulars as to why he is not eligible; and it provides, in straightforward language, the dispute process available to [the appellant] should he disagree with the denial. The respondent provided a clear indication of a denial. [13] The adjudicator went on expressly to acknowledge that the reference to income replacement benefits in the discussion of non-earner benefits may have presented as confusing but noted that it must be read within the context of the entire form. The adjudicator concluded that she was persuaded that the respondent’s clear language of “you do not qualify for an IRB benefit”, which appeared under the appropriate IRB section, would extinguish any such uncertainty. The adjudicator did not err by looking through the lens of counsel instead of an unsophisticated person. The adjudicator added that the appellant had counsel who would have made an effort to obtain clarification if needed. The reference to counsel was an added comment, and not a central part of the analysis.
[14] This finding was open to the adjudicator on the evidence. She made no error of law. . Varriano v. Allstate Insurance Company of Canada
In Varriano v. Allstate Insurance Company of Canada (Ont CA, 2023) the Court of Appeal considered the adequacy of a SABS auto insurance discontinuation notice letter, and in the process engaged in statutory interpretation of the notice provision:[3] The Divisional Court overturned the decision of the LAT adjudicator, finding that Mr. Varriano’s application was not time-barred because Allstate’s Benefits Letter did not meet the legislative requirements under s. 37(4) of the SABS. The Divisional Court held that s. 37(4) required Allstate to provide medical reasons in the Benefits Letter for the stoppage of benefits.
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[11] If the insurer determines that it will discontinue paying a benefit because an insured is ineligible on any one or more grounds, the insurer, pursuant to s. 37(4) is required to provide a notice to the insured containing the reasons for their determination:37(4) If the insurer determines that an insured person is not entitled or is no longer entitled to receive a specified benefit on any one or more grounds set out in subsection (2), the insurer shall advise the insured person of its determination and the medical and any other reasons for its determination. [Emphasis added.] ....
[17] The Divisional Court held that Adjudicator Boyce erred in his interpretation of s. 37(4) of the SABS. That court concluded that a plain reading of s. 37(4) supported the interpretation of the word “and” in the phrase “medical and any other reasons” as bearing a conjunctive meaning. ...
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A. The Divisional Court’s Interpretation Does Not Accord with the Modern Principle of Statutory Interpretation
[23] I begin with the observation that the modern approach to statutory interpretation requires that statutes “are to be read in their entire context and in their grammatical and ordinary sense harmoniously with the scheme of the Act, the object of the Act, and the intention of Parliament”: Rizzo & Rizzo Shoes Ltd. (Re), 1998 CanLII 837 (SCC), [1998] 1 S.C.R. 27, at para. 26. A statute must not be interpreted in a manner that would result in absurd consequences. An interpretation will be absurd where it leads to “ridiculous or frivolous consequences, if it is extremely unreasonable or inequitable, if it is illogical or incoherent, or if it is incompatible with other provisions or with the object of the legislative enactment”: Rizzo, at para. 27. The modern principle of interpretation applies with equal force to regulations: Beaudin v. Travelers Insurance Company of Canada, 2022 ONCA 806, at para. 36.
[24] In my view, in giving a conjunctive meaning to the word “and” in the phrase “medical and any other reason” in s. 37(4), the Divisional Court failed to properly apply the modern principle of statutory interpretation. That interpretation failed to acknowledge that the grammatical and ordinary usage of the word “and” can include both the joint sense and the several sense. When the phrase “medical and any other reason” in s. 37(4) is read contextually, it becomes clear that the ordinary meaning of the word “and” was intended in its several sense. Nor does the Divisional Court’s interpretation accord with the purpose of the notice provision.
(1) The grammatical and contextual meaning of “medical and any other reason”
[25] Presuming that the plain meaning of the word “and” is conjunctive reflects an incomplete appreciation of the grammatical use of the word in ordinary language. As Ruth Sullivan points out in The Construction of Statutes, 7th ed. (Markham: LexisNexis Canada Inc., 2022) at § 4.05, “and” is sometimes used in the joint and several sense (A and B jointly or severally) and in other circumstances is used only in the joint sense (A and B jointly, but not severally).
[26] Considering the use of “and” in a statutory provision contextually assists in determining when it should be interpreted in the joint sense as opposed to the joint and several sense: R. v. Yadegari, 2011 ONCA 287, 286 C.C.C. (3d) 320, at para. 62. In my view, the requirement to provide reasons in s. 37(4) is inextricably tied to the grounds for discontinuance of benefits stipulated in s. 37(2). Contextually, when the two provisions are read properly together, it is clear that the word “and” in the phrase “medical and any other reason” was intended in the joint and several sense.
[27] These two sections read together simply require the insurer to determine the basis for disqualifying the insured person under s. 37(2) from receiving specified benefits and to communicate the basis for that determination to the insured. Some of the grounds under s. 37(2) are medical and some are not. For example, ss. 37(2)(a), (d), (f) and (g) provide for non-medical grounds to terminate benefits.
[28] Importantly, s. 37(4) states that the insurer may rely on “any one or more grounds set out in [s. 37(2)]” (emphasis added) in terminating benefits. By explicitly including those words, s. 37(4) recognizes that an insurer may rely on a single non-medical reason for termination of benefits, even though the insured might be otherwise medically entitled to the benefit. In such case, a medical ground is not a “reason” for the insurer’s determination under s. 37(4). Yet, the Divisional Court’s interpretation requires the insurer to state its position on the person’s medical eligibility even if that is not the basis for its determination. Put differently, interpreting “and” in the joint sense conflicts with the joint and several nature of the grounds for termination.
[29] Such an interpretation is not a harmonious reading of the two sections particularly in light of s. 37(2)(g) which specifically contemplates that the disentitlement need not relate to an impairment. This subsection permits termination if the insurer determines that the insured person is not entitled to a specified benefit “for a reason unrelated to whether [the insured] has an impairment that entitles the insured person to receive the benefit” (emphasis added). The Divisional Court’s interpretation would require the insurer to state its position on the insured’s impairment even though it has no bearing on the insurer’s determination.
[30] In support of its interpretation that s. 37(4) requires an insurer to provide its position on an insured’s medical eligibility, the Divisional Court relies upon the fact that the SABS was amended in 2010 to specifically add the language “medical and any other reasons”. However, as the Divisional Court recognizes, prior to that, the SABS did not require insurers to provide any reasons for their determination. In my view, the addition of language of the 2010 amendment does not indicate that the legislature intended to mandate the provision of medical reasons in all cases, as the Divisional Court suggests. It merely codified the requirement to provide a sufficient reason or reasons for the insurer’s decision, by directly tying the reasons to the actual grounds for termination of benefits in s. 37(2).
[31] Accordingly, s. 37(4) requires provision of the insurer’s actual reasons for determination. If the insurer relies on a medical and a non-medical reason to deny benefits, the insurer must advise the insured person of both. However, if the insurer is relying on a non-medical ground under s. 37(2), the provision requires only that the insurer provide notice of the cancellation of the benefits and to provide the insured with the non-medical reason for that determination.
(2) The purpose of the notice provision
[32] This interpretation of the 2010 amendment accords with the purpose underlying the notice provision. In Smith, Gonthier J. concluded that insurance notice provisions serve a consumer protection purpose by requiring insurers to completely and clearly provide insured persons with the information they need in straightforward and understandable language to enable them to challenge a refusal to pay or a reduction of payments: at paras. 11-14. In Turner v. State Farm Mutual Automobile Insurance Co., (2005) 2005 CanLII 2551 (ON CA), 195 O.A.C. 61 (Ont. C.A.), this court also concluded that: “[t]he purpose of the requirement to give reasons is to permit the insured to decide whether or not to challenge the cancellation.” at para. 8.
[33] Accordingly, Smith and Turner support the argument that s. 37(4) should be interpreted with this policy goal in mind. That policy goal requires reasons to be sufficiently explanatory to permit the insured to decide whether to challenge the denial of benefits.
[34] Although these cases were decided before the Legislature’s 2010 amendments to the SABS, those amendments did not alter that underlying purpose. Rather, those amendments enhance and reinforce that purpose by codifying the requirement to provide a sufficient reason or reasons for the insurer’s decision. However, the amendments also acknowledge that the sufficiency of the content of those reasons is determined by the grounds for termination of benefits. Where the insurer relies solely on a single non-medical ground for denying benefits, requiring the addition of a line stating, “there are no medical reasons for this denial”, would not further assist an insured in deciding whether to challenge the denial of benefits.
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