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2nd Session, 42nd Legislature

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Bill 17

THE MANITOBA PUBLIC INSURANCE CORPORATION AMENDMENT ACT (CLAIM DISPUTE TRIBUNAL)


  Bilingual version (PDF) Explanatory Note

(Assented to                                         )

HER MAJESTY, by and with the advice and consent of the Legislative Assembly of Manitoba, enacts as follows:

C.C.S.M. c. P215 amended

1           The Manitoba Public Insurance Corporation Act is amended by this Act.

2           Subsection 1(1) is amended by adding the following definition:

"claim dispute tribunal" means the claim dispute tribunal established under section 67.1; (« tribunal de règlement des différends »)

3           Subsection 33(1) is amended by adding the following after clause (n):

(n.1) respecting the claim dispute tribunal, including

(i) prescribing the qualifications of adjudicators appointed to the tribunal,

(ii) governing the remuneration and expenses to be paid to an adjudicator,

(iii) establishing a claim resolution process for the purpose of subsection 67.2(1),

(iv) prescribing the grounds for denial of coverage for the purpose of clause 67.3(1)(b),

(v) prescribing the fee payable for an application for review to the tribunal, and

(vi) respecting assistance that may be provided to persons applying to the tribunal;

4           The following is added after section 67:

Claim dispute tribunal established

67.1(1)     The claim dispute tribunal is hereby established to hear reviews under sections 67.2 and 67.3.

Membership

67.1(2)     The tribunal consists of a chief adjudicator and one or more other adjudicators appointed by the Lieutenant Governor in Council.

Qualifications of adjudicators

67.1(3)     An adjudicator must have the qualifications prescribed by regulation and must not be an employee of the corporation.

Term

67.1(4)     An adjudicator must be appointed for a term of not more than three years and continues to hold office until re-appointed or replaced.

Termination only for cause

67.1(5)     The appointment of an adjudicator must not be terminated except for cause.

Remuneration and expenses

67.1(6)     An adjudicator is to receive the remuneration, and be reimbursed for expenses incurred, in accordance with the regulations.

Disputes concerning insured vehicles

67.2(1)     An insured and the corporation must follow the claim resolution process prescribed by regulation in respect of the corporation making a decision about a claim concerning

(a) the nature and extent of repairs required to an insured vehicle;

(b) the adequacy of the repairs performed or replacement parts used on an insured vehicle; or

(c) the amount of insurance moneys payable in respect of any loss or damage to an insured vehicle.

Insured may apply to tribunal for review

67.2(2)     An insured who disagrees with the decision of the corporation respecting a claim set out in subsection (1) may apply to the claim dispute tribunal for a review of the decision.

Exclusive jurisdiction of tribunal

67.2(3)     The tribunal has exclusive jurisdiction to decide disputes between an insured and the corporation concerning claims set out in subsection (1), and the decision of the tribunal is final and binding on the insured and the corporation and is not subject to appeal or review by a court.

Disputes concerning liability and denial of coverage

67.3(1)     An insured who disagrees with the decision made by the corporation concerning the following may apply to the claim dispute tribunal for a review of the decision or commence a court proceeding in respect of the decision:

(a) the assessment of liability for an accident that occurs in Manitoba involving one or more vehicles insured by the corporation;

(b) the denial of coverage for a loss, unless the denial is based on a ground prescribed by regulation.

Consequence of tribunal application

67.3(2)     If an insured applies to the tribunal concerning a decision of the corporation set out in subsection (1), the tribunal has exclusive jurisdiction to decide the dispute and the decision of the tribunal is final and binding on the insured and the corporation and is not subject to appeal or review by a court.

Consequence of court proceeding

67.3(3)     If, before applying to the tribunal, an insured commences a court proceeding in respect of a decision set out in subsection (1), the tribunal ceases to have any jurisdiction in respect of the dispute.

Exception: decision of court is binding

67.3(4)     If a party to an accident involving multiple vehicles commences a court proceeding seeking an assessment of liability for the accident, the decision of the court respecting liability is binding on all parties involved in the accident and on the corporation.

Conflict with tribunal decision

67.3(5)     Despite subsection (2), a decision of the court concerning liability for an accident prevails over a decision of the tribunal concerning liability for the accident.

Notice of right to apply for review

67.4(1)     When the corporation informs the insured of its decision under section 67.2 or 67.3, it must also inform the insured of their right to apply to the claim dispute tribunal for a review of the decision.

Deadline to apply for review

67.4(2)     An insured may apply to the tribunal for a review within 45 days after being advised of their right to apply to the tribunal for a review under subsection (1).

Chief adjudicator may extend time

67.4(3)     The chief adjudicator may extend the time to apply if satisfied that the insured has a reasonable excuse for failing to apply within the 45-day time period.

Application requirements

67.5(1)     An application for review must

(a) be made in a form approved by the claim dispute tribunal;

(b) include a written statement that sets out the insured's position in relation to the corporation's decision;

(c) include any other information or material that the insured wishes the tribunal to consider; and

(d) be accompanied by the prescribed application fee.

Application forwarded to the corporation

67.5(2)     The tribunal must forward a copy of an application to the corporation immediately after receiving it.

Submission by corporation

67.5(3)     Within 30 days after receiving an application, the corporation must submit to the tribunal and the insured

(a) a written statement that sets out the corporation's position in relation to the application; and

(b) any other information or material that the corporation wishes the tribunal to consider.

Submissions by insured

67.5(4)     The insured may provide the tribunal with a written response to the corporation's submission within 14 days after receiving it, and the response may include any additional information or material that the insured wishes the tribunal to consider.

Review by single adjudicator

67.6(1)     A review by the claim dispute tribunal must be conducted by the chief adjudicator or a single adjudicator designated by the chief adjudicator.

Adjudicator has authority of tribunal

67.6(2)     The adjudicator conducting the review has the power and authority of the tribunal and their decision is deemed to be a decision of the tribunal.

Decision on basis of written submissions

67.7(1)     The claim dispute tribunal must make its decision on an application for review solely on the basis of the written statements and other information or material submitted by the insured and the corporation.

Tribunal not bound by rules of evidence

67.7(2)     The tribunal is not bound by the rules of evidence that apply to judicial proceedings.

Decision on application for review

67.8(1)     The claim dispute tribunal may confirm, vary or set aside the decision of the corporation, but the tribunal must not make a decision that requires the corporation

(a) to provide coverage that is not otherwise provided by the insured's policy; or

(b) pay any amount that exceeds the limits of the insured's policy.

Tribunal to give written reasons

67.8(2)     The tribunal must give the insured and the corporation written reasons for its decision.

Time limit for decisions

67.8(3)     Subject to subsection (4), the tribunal must give its written reasons within 45 days after the expiry of the 14-day period under subsection 67.5(4).

Chief adjudicator may extend time

67.8(4)     The chief adjudicator may extend the time for the tribunal to make a decision.

Decision independent of all other questions

67.8(5)     A decision of the tribunal concerning a matter set out in subsection 67.2(1) is independent of all other questions between an insured and the corporation, including whether or not coverage is admitted by the corporation.

Tribunal costs to be paid out of Consolidated Fund

67.9(1)     The remuneration, expenses and other costs relating to the operation of the claim dispute tribunal must be paid out of the Consolidated Fund.

Corporation to pay costs into Consolidated Fund

67.9(2)     At the beginning of each quarter of a fiscal year, the tribunal must present the corporation with a statement of account that sets out the remuneration, expenses and other costs of its operations in the quarter just ended. The corporation must pay the total amount set out on the statement into the Consolidated Fund.

Corporation may provide administrative support

67.10       The corporation may provide administrative and clerical support to the claim dispute tribunal.

Minister not to be the same

67.11       The minister responsible for the claim dispute tribunal must not be the same minister that the corporation reports to under subsection 2(13).

Tribunal to report annually to the minister

67.12(1)    The claim dispute tribunal must report annually to the responsible minister about affairs and activities of the tribunal.

Summary in department's annual report

67.12(2)    The minister must include a summary of the affairs and activities of the tribunal in the annual report of the minister's department.

Coming into force

5           This Act comes into force on a day to be fixed by proclamation.

Explanatory Note

This Bill amends The Manitoba Public Insurance Corporation Act to establish the claim dispute tribunal.

The tribunal is an independent body that has exclusive jurisdiction to resolve a dispute between an insured person and MPI concerning vehicle repairs or the amount payable when a vehicle is damaged.

In addition, the tribunal may resolve a dispute about MPI's determination of liability for an accident or a decision to deny coverage, unless the insured person elects to have those matters determined by the court instead.