In Ontario law, being a “spouse” comes with many benefits – including insured benefits. But what happens to spouses in an off-and-on relationship?
In a recent case, the Ontario Superior Court of Justice was called upon to determine whether an insured’s spouse was entitled to benefits despite their “roller-coaster ride” relationship.
The Plaintiff Was Struck by a Vehicle and Severely Injured
The plaintiff – a pedestrian at the time of the accident – was struck by a vehicle and severely injured in 2009. He sued the driver of the vehicle, who was unlicensed and uninsured. The plaintiff also sued his spouse’s insurer, Intact Insurance Company of Canada, claiming that if the defendant was found to be underinsured or uninsured (or if his policy limits were inadequate to meet the claims against him), they should be held liable for the plaintiff’s resulting loss.
As the case progressed, the defendant was noted in default – essentially, he failed to respond to the case against him. The plaintiff brought a claim against Intact, relying on the uninsured provisions of the automobile insurance policy issued by Intact to the insured.
The Spouse’s Insurance Policy
The plaintiff and the insured had a child several years before the accident but never married. The insured carried coverage that would provide coverage for her and her spouse if an underinsured or unidentified driver injured them.
For the purposes of the policy, “spouse” was defined as follows:
- Either of two persons who:
- are married;
- have entered a marriage that is voidable or void; or
- have lived together in a conjugal relationship outside marriage continuously for three years or more or in a relationship of some permanence if they have a child or children together.
Therefore, the plaintiff needed to establish on a balance of probabilities that he was the insured’s spouse at the time of the accident to receive benefits through the insured.
The Parties’ Positions Regarding the Relationship
The parties disagreed on whether the plaintiff was the insured’s spouse at the time of the accident. The plaintiff claimed that he was the insured’s spouse. In contrast, the insurer claimed that the plaintiff had not established that he was living together in a conjugal relationship of some permanence with the insured on the date of the accident.
The Plaintiff’s Relationship with the Insured Party
The plaintiff and the insured had a rocky relationship, breaking up and getting back together regularly. At the time of the accident, however, the plaintiff and insured lived together and shared a sexual and emotional relationship.
The insurer did not dispute that the plaintiff and insured had previously been in a conjugal relationship. However, they relied on statements the plaintiff made to the Guelph Police Service and the Family and Children’s Services of Guelph and Wellington County personnel in 2009, where the plaintiff had referred to the insured as an “ex-girlfriend” to suggest that they were no longer together. The insurer also noted the on-and-off nature of the plaintiff and the insured’s relationship.
The Relevant Factors for a Conjugal Relationship
First, the court considered what constitutes a “conjugal relationship.” Rather than looking at specific factors, determining whether two people are in a “conjugal relationship” requires the court to examine the couple’s actions and routines against accepted principles associated with close relationships and to determine whether those actions and routines rise to the level of spouses. This holistic approach acknowledges that relationships can vary wildly between couples.
Some of the factors the court considered that can suggest evidence of a conjugal relationship included:
- Shared shelter
- Sexual and personal behaviour
- Social activities
- Economic support
- The social perception of the couple (i.e., whether other people believe them to be a couple)
The Court’s Assessment of the Parties’ Relationship
The court determined that, on the accident date, the plaintiff met the definition of “spouse” and was entitled to the insured’s benefits.
As noted above, the court relied on several holistic factors to find that the plaintiff was the insured’s spouse at the time of the accident. While the parties had broken up in the past for short periods, they always got back together. The plaintiff had lived with the insured for at least one month before the accident and shared a bedroom with her. Their relationship remained “sexual and emotional.”
On the evening of the accident, the plaintiff was walking to meet the insured and help her with her truck (which had broken down). The court noted that this “was not the conduct of a person who had formed a settled intention not to continue the relationship.” The court also noted evidence that the insured was upset and worried when she learned about the plaintiff’s accident and injuries, met him at the hospital and accepted responsibility for his care during his recovery.
What This Case Means for Personal Injury Claimants
First, this case is a reminder that spouses are typically entitled to coverage through an insured spouse. In cases where a plaintiff is injured due to the negligence of an uninsured or underinsured driver, insured benefits can help cover damages and expenses for plaintiffs who may not have other methods of recourse against the defendant.
Second, this case exemplifies the holistic approach the courts will take when assessing whether two people are in a conjugal relationship. Recognizing that there is no “one-size-fits-all” approach to relationships, the courts typically offer some flexibility when determining whether two people are in a relationship – whether in a family law case or when determining whether a party is entitled to their spouse’s benefits.
Ultimately, the courts assess whether two people are spouses on a “balance of probabilities” – that is, looking at all of the evidence, is it more likely than not that the parties were in a conjugal relationship? Here, despite their difficulties, it was apparent to the court that the parties were in a conjugal relationship at the time of the accident.
While the courts’ holistic approach to determining relationship statuses is flexible, this flexibility can come with additional confusion. If you have legal questions or concerns about relationship status, speak with a skilled lawyer for clarification.
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At Tierney Stauffer LLP, our skilled personal injury lawyers have many years of experience going up against insurance companies to get full and fair settlements for our clients. We will advise you of the best course of action to obtain the maximum possible settlement so that you can recover financially and move on with your life.