{"id":30970,"date":"2025-11-27T12:40:45","date_gmt":"2025-11-27T17:40:45","guid":{"rendered":"https:\/\/www.rsslex.com\/?p=30970"},"modified":"2025-11-27T12:40:45","modified_gmt":"2025-11-27T17:40:45","slug":"finally-properly-interpreted-the-policy-had-a-heart","status":"publish","type":"post","link":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/","title":{"rendered":"Finally Properly Interpreted, the Policy Had a Heart"},"content":{"rendered":"

In a recent decision, Morissette<\/em> v. BMO Soci\u00e9t\u00e9 d\u2019assurance vie<\/em><\/strong>, the Superior Court reviewed the principles applicable to the interpretation of insurance policies.<\/p>\n

Facts<\/strong><\/h2>\n

In June 2003, the Plaintiff took out a health insurance policy (hereinafter \u201cPolicy\u201d) with BMO Soci\u00e9t\u00e9 d\u2019assurance vie (hereinafter \u201cBMO\u201d). The Policy provides, among other things, that $150,000 will be paid to the beneficiary upon the first diagnosis of one of the critical illnesses set out in the Policy.<\/p>\n

In June 2021, the Plaintiff was diagnosed with severe aortic stenosis, for which he eventually underwent surgery to transplant a new aortic valve. Based on this diagnosis, the Plaintiff submitted a claim to BMO under the Policy. BMO rejected the claim, alleging that the aortic valve transplant did not meet the definition of \u201cmajor organ transplant\u201d under the Policy. BMO argued that the aortic valve is not part of the heart, but rather another organ. BMO also claimed that the primary diagnosis received by the Plaintiff was not included in the list of \u201cCovered Medical Conditions\u201d in the Policy.<\/p>\n

After notifying BMO and being refused again, the Plaintiff filed suit against BMO to obtain payment of the insurance benefit.<\/p>\n

Decision<\/strong><\/h2>\n

To determine whether the Plaintiff was entitled to the indemnity provided for in the Policy, the Court had to first determine whether to interpret the Policy or not. To do so, the Court noted that a policy must be interpreted only when its wording is ambiguous. In such cases, reference must be made to the general rules of contract interpretation. The contra proferentem<\/em> rule should only be used as a last resort if ambiguity remains after applying the general rules.<\/p>\n

After reading the Policy, the Court determined that it contained certain difficulties that prevented it from being \u201csimply\u201d applied. In particular, the Court noted that in the first paragraph of the clause in question, the Policy stated that it covers \u201cthe transplantation of any of the following organs or tissues: heart [\u2026]\u201d. However, in the second paragraph of the same clause, BMO referred instead to the transplantation of \u201corgans or bone marrow.\u201d<\/p>\n

The Court noted that there is a presumption in interpretation that the use of different terms suggests different meanings. While BMO claims that the term \u201ctissues\u201d in the first paragraph refers only to bone marrow, the Court noted that the term \u201ctissues\u201d used in the first paragraph of the clause is in plural, and as such, cannot refer only to bone marrow.<\/p>\n

Based on the text of the clause itself, the Court held that the transplantation of the components of the organs listed in the first paragraph, including the heart, was covered by the Policy. Thus, the transplantation of the Plaintiff\u2019s aortic valve, a component of the heart, would be covered.<\/p>\n

The Court also noted that it \u201cmust give a broad and liberal interpretation to the provisions of an insurance policy offering coverage to the insured and, conversely, must give a restrictive interpretation to clauses excluding coverage.\u201d Based on this principle, the Court determined that the broad and liberal interpretation of the Policy was more consistent with the position that the transplant undergone by the Plaintiff was covered by the Policy.<\/p>\n

Once this ambiguity was resolved, the Court had to rule on whether the Plaintiff could obtain the indemnity provided for in the Policy. The Court established that the Policy sets out three (3) conditions that must be met for indemnity to be paid. After analyzing these conditions, the Court determined that the Plaintiff had met them and was therefore entitled to payment of the indemnity provided for, namely, $150,000.<\/p>\n

Finally, the Plaintiff also claimed a refund of the premiums paid to prevent the Policy from lapsing during the proceedings. In analyzing the Policy, the Court determined that the benefit became payable thirty (30) days after the Plaintiff underwent surgery, and that it was then, in accordance with the wording of the Policy, cancelled. The Court therefore ordered that the premiums paid after the cancellation of the Policy be refunded to the Plaintiff.<\/p>\n

Takeaway<\/strong><\/h2>\n

While the principles of interpretation have remained consistent over time, it is occasionally beneficial to return to the fundamentals in order to discern the underlying intent of the policy.<\/p>\n","protected":false},"excerpt":{"rendered":"

In a recent decision, Morissette v. BMO Soci\u00e9t\u00e9 d\u2019assurance vie, the Superior Court reviewed the principles applicable to the interpretation of insurance policies. Facts In June 2003, the Plaintiff took out a health insurance policy (hereinafter \u201cPolicy\u201d) with BMO Soci\u00e9t\u00e9 d\u2019assurance vie (hereinafter \u201cBMO\u201d). The Policy provides, among other things, that $150,000 will be paid […]<\/p>\n","protected":false},"author":27,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[242],"tags":[],"class_list":["post-30970","post","type-post","status-publish","format-standard","hentry","category-insurance-law-en"],"acf":[],"yoast_head":"\nFinally Properly Interpreted, the Policy Had a Heart - RSS - Robinson Sheppard Shapiro<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Finally Properly Interpreted, the Policy Had a Heart - RSS - Robinson Sheppard Shapiro\" \/>\n<meta property=\"og:description\" content=\"In a recent decision, Morissette v. BMO Soci\u00e9t\u00e9 d\u2019assurance vie, the Superior Court reviewed the principles applicable to the interpretation of insurance policies. Facts In June 2003, the Plaintiff took out a health insurance policy (hereinafter \u201cPolicy\u201d) with BMO Soci\u00e9t\u00e9 d\u2019assurance vie (hereinafter \u201cBMO\u201d). The Policy provides, among other things, that $150,000 will be paid […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/\" \/>\n<meta property=\"og:site_name\" content=\"RSS - Robinson Sheppard Shapiro\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/rsslex\/\" \/>\n<meta property=\"article:published_time\" content=\"2025-11-27T17:40:45+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.rsslex.com\/wp-content\/uploads\/2022\/03\/Placeholder-News.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1000\" \/>\n\t<meta property=\"og:image:height\" content=\"500\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Joycy Altino\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Joycy Altino\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/bulletins-en\\\/insurance-law-en\\\/finally-properly-interpreted-the-policy-had-a-heart\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/bulletins-en\\\/insurance-law-en\\\/finally-properly-interpreted-the-policy-had-a-heart\\\/\"},\"author\":{\"name\":\"Joycy Altino\",\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/#\\\/schema\\\/person\\\/af9d1c5bd2dabdf4ef0d148fe96eccf0\"},\"headline\":\"Finally Properly Interpreted, the Policy Had a Heart\",\"datePublished\":\"2025-11-27T17:40:45+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/bulletins-en\\\/insurance-law-en\\\/finally-properly-interpreted-the-policy-had-a-heart\\\/\"},\"wordCount\":704,\"articleSection\":[\"Insurance Law\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/bulletins-en\\\/insurance-law-en\\\/finally-properly-interpreted-the-policy-had-a-heart\\\/\",\"url\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/bulletins-en\\\/insurance-law-en\\\/finally-properly-interpreted-the-policy-had-a-heart\\\/\",\"name\":\"Finally Properly Interpreted, the Policy Had a Heart - RSS - Robinson Sheppard Shapiro\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/#website\"},\"datePublished\":\"2025-11-27T17:40:45+00:00\",\"author\":{\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/#\\\/schema\\\/person\\\/af9d1c5bd2dabdf4ef0d148fe96eccf0\"},\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/bulletins-en\\\/insurance-law-en\\\/finally-properly-interpreted-the-policy-had-a-heart\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.rsslex.com\\\/en\\\/bulletins-en\\\/insurance-law-en\\\/finally-properly-interpreted-the-policy-had-a-heart\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/bulletins-en\\\/insurance-law-en\\\/finally-properly-interpreted-the-policy-had-a-heart\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"RSS\",\"item\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Finally Properly Interpreted, the Policy Had a Heart\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/#website\",\"url\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/\",\"name\":\"RSS - Robinson Sheppard Shapiro\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/#\\\/schema\\\/person\\\/af9d1c5bd2dabdf4ef0d148fe96eccf0\",\"name\":\"Joycy Altino\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/189388ca8d6e02b8d3d4aedca2cd80670244191464d2598dddd4c5ded3b0b9c0?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/189388ca8d6e02b8d3d4aedca2cd80670244191464d2598dddd4c5ded3b0b9c0?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/189388ca8d6e02b8d3d4aedca2cd80670244191464d2598dddd4c5ded3b0b9c0?s=96&d=mm&r=g\",\"caption\":\"Joycy Altino\"},\"url\":\"https:\\\/\\\/www.rsslex.com\\\/en\\\/author\\\/joycy-altino\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Finally Properly Interpreted, the Policy Had a Heart - RSS - Robinson Sheppard Shapiro","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/","og_locale":"en_US","og_type":"article","og_title":"Finally Properly Interpreted, the Policy Had a Heart - RSS - Robinson Sheppard Shapiro","og_description":"In a recent decision, Morissette v. BMO Soci\u00e9t\u00e9 d\u2019assurance vie, the Superior Court reviewed the principles applicable to the interpretation of insurance policies. Facts In June 2003, the Plaintiff took out a health insurance policy (hereinafter \u201cPolicy\u201d) with BMO Soci\u00e9t\u00e9 d\u2019assurance vie (hereinafter \u201cBMO\u201d). The Policy provides, among other things, that $150,000 will be paid […]","og_url":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/","og_site_name":"RSS - Robinson Sheppard Shapiro","article_publisher":"https:\/\/www.facebook.com\/rsslex\/","article_published_time":"2025-11-27T17:40:45+00:00","og_image":[{"width":1000,"height":500,"url":"https:\/\/www.rsslex.com\/wp-content\/uploads\/2022\/03\/Placeholder-News.png","type":"image\/png"}],"author":"Joycy Altino","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Joycy Altino","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/#article","isPartOf":{"@id":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/"},"author":{"name":"Joycy Altino","@id":"https:\/\/www.rsslex.com\/en\/#\/schema\/person\/af9d1c5bd2dabdf4ef0d148fe96eccf0"},"headline":"Finally Properly Interpreted, the Policy Had a Heart","datePublished":"2025-11-27T17:40:45+00:00","mainEntityOfPage":{"@id":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/"},"wordCount":704,"articleSection":["Insurance Law"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/","url":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/","name":"Finally Properly Interpreted, the Policy Had a Heart - RSS - Robinson Sheppard Shapiro","isPartOf":{"@id":"https:\/\/www.rsslex.com\/en\/#website"},"datePublished":"2025-11-27T17:40:45+00:00","author":{"@id":"https:\/\/www.rsslex.com\/en\/#\/schema\/person\/af9d1c5bd2dabdf4ef0d148fe96eccf0"},"breadcrumb":{"@id":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.rsslex.com\/en\/bulletins-en\/insurance-law-en\/finally-properly-interpreted-the-policy-had-a-heart\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"RSS","item":"https:\/\/www.rsslex.com\/en\/"},{"@type":"ListItem","position":2,"name":"Finally Properly Interpreted, the Policy Had a Heart"}]},{"@type":"WebSite","@id":"https:\/\/www.rsslex.com\/en\/#website","url":"https:\/\/www.rsslex.com\/en\/","name":"RSS - Robinson Sheppard Shapiro","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.rsslex.com\/en\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.rsslex.com\/en\/#\/schema\/person\/af9d1c5bd2dabdf4ef0d148fe96eccf0","name":"Joycy Altino","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/189388ca8d6e02b8d3d4aedca2cd80670244191464d2598dddd4c5ded3b0b9c0?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/189388ca8d6e02b8d3d4aedca2cd80670244191464d2598dddd4c5ded3b0b9c0?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/189388ca8d6e02b8d3d4aedca2cd80670244191464d2598dddd4c5ded3b0b9c0?s=96&d=mm&r=g","caption":"Joycy Altino"},"url":"https:\/\/www.rsslex.com\/en\/author\/joycy-altino\/"}]}},"views":140,"_links":{"self":[{"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/posts\/30970","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/users\/27"}],"replies":[{"embeddable":true,"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/comments?post=30970"}],"version-history":[{"count":2,"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/posts\/30970\/revisions"}],"predecessor-version":[{"id":30972,"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/posts\/30970\/revisions\/30972"}],"wp:attachment":[{"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/media?parent=30970"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/categories?post=30970"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.rsslex.com\/en\/wp-json\/wp\/v2\/tags?post=30970"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}