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OPIP - LEI Quick Reference Guide

Legal Expense Insurance
What's Covered - Quick Reference Guide

What does it cover? Example What's Not Covered
Employment disputes Disputes with an insured person's employer relating to employment contracts and severance or a provincial human rights tribunal. Dr. Smith’s spouse has been dismissed from her job. They commence a wrongful dismissal action alleging discrimination based on her hearing disability. The policy will provide legal representation to pursue the action.
  • Claims relating to Disciplinary Hearings or internal grievances
  • Any claim relating solely to death, illness, or bodily injury
  • Any claim where the insured person is the employer
Contract disputes (non-auto, limited to Small Claims Court) Disputes arising from the insured person buying or selling goods or obtaining services. Dr. Chen booked a family vacation and paid additional fees for access to a private pool. However, upon arrival, the room was not as advertised and there was no pool. The policy will provide legal representation to pursue the travel agent who misrepresented the vacation package.
  • Any claim relating to an insured person's profession, trade, occupation, employment or any other business venture.
  • Any claim related to a dispute arising from any loan, mortgage, investment, borrowing, or other financial product.
  • Any claim relating to the terms of a lease or land or building or a licence or tenancy of land or buildings
  • Any claim that arises out of contracts for legal services
  • Any claim that arises within the first 90 days of policy inception
Contract disputes (auto) Disputes relating to the purchase, sale, lease, rental and service of a vehicle. Dr. Jones leases a vehicle and at the end of the term returns the car to the dealership who is now charging her for damage that they claim extends beyond normal wear and tear. Legal costs will be covered to pursue legal action against the dealership.
  • The minimum amount in dispute for a contract claim is $500
  • Any claim that arises within the first 90 days of policy inception.
Fault determination ruling and total loss valuation disputes Disputes against an insured person’s own automobile insurer regarding fault determination and total loss valuation. Dr. Phillips is in an accident and his car was written off. His auto insurer valued the car at a lower amount than anticipated based on recent bodywork completed on the car. Legal costs arising from the dispute with the auto insurer will be covered.
  • Any losses, costs, damages or benefits other than legal costs
  • Any dispute with an automobile insurer before the insurer has provided the insured person with its position in writing on the matter
  • Any dispute between an insured person and any other person (including that other person’s insurer) in respect of that other person’s liability or fault for any injury, death or damage
Obtaining statutory accident benefits from your automobile insurer Presenting and obtaining payment of a claim to the insured person’s own automobile insurer for no-fault accident benefits under the no-fault accident benefits coverage provided to the insured person. Dr. Moore was in a car accident and required physiotherapy. DAS will assist her in completing the necessary documents to obtain the physiotherapy.
  • Any losses, costs, damages or benefits other than legal costs.
  • Any claim against an insurer that issued, outside Canada, a policy of insurance to an insured person.
Property protection Pursuing a claim if a neighbour damages an insured person’s property or interferes with an insured person’s use of their land. A neighbour cuts down a common property hedge. DAS will assist Dr. Roberts in rectifying the situation regarding the shared hedge.
  • The minimum amount in dispute for a physical damage claim is $500
  • The first $500 of any claim for legal nuisance or trespass

Any claim relating to:
  • a contract entered into by the insured person
  • any building or land other than the insured person's principal or recreational home
  • someone legally taking the insured person's physical property from them
  • work done by or on behalf of any governmental, quasi-governmental or public or local authority
  • the first $500 of any claim for legal nuisance or trespass
  • a motor vehicle
  • mining, subsidence, heave or landslide
  • defending an insured person's legal rights other than in defending a counterclaim
Bodily injury (worldwide) Costs to pursue a claim for damages following an accident that causes the insured person injury or death. Dr. Carpenter slipped and fell on an unmarked puddle of water at a grocery store, which resulted in injury. DAS will appoint a lawyer and cover legal costs to take action against the grocery store.
  • a dispute with any provincial worker's compensation board
  • psychological injury or mental illness unless the condition arises from a specific or sudden accident
  • surgical, clinical or medical negligence
  • death, illness or bodily injury arising from the ownership, use or operation of a motor vehicle
  • defending an insured person's legal rights other than in defending a counter-claim.
Tax protection (personal and business) Providing counsel if an insured person has to respond to a tax audit or wants to appeal a Canada Revenue Agency decision with respect to their personal tax returns. Dr. May received a Notice of Assessment, which she felt was inaccurate. DAS will cover the legal costs to appeal this assessment.
  • Any claim arising from tax avoidance, dishonesty, alleged gross negligence or criminal offences
Employee legal defence Defending criminal charges laid against an insured person arising from their work as an employee. Dr. Hwang is charged criminally while carrying out his duties as an employee. A lawyer will be appointed to defend Dr. Hwang against the charges laid.
  • any offence arising from the alleged use of alcohol, drugs, or racing.
  • any offence arising from the insured person's prohibited use of electronic/communication devices while driving
  • any offence arising from parking and obstruction charges
  • any offence arising from automatic traffic enforcement cameras
Automobile legal defence Defending highway traffic violations. Dr. Wallace received a speeding ticket that he would like to challenge in court.
  • Any offences related to the alleged use of alcohol or drugs while using or operating of a motor vehicle, including failure to provide a sample or be tested for the presence of such substances
  • Any offences where the insured allegedly operated a motor vehicle for any type of race or contest, while performing a stunt or on a bet or wager
  • Parking or obstruction offences
  • Any claims or traffic tickets arising from the alleged use of a prohibited electronic device while driving
  • Any automated Traffic Enforcement Camera Offences including but not limited to photo radar and photo red light tickets
Driver’s licence protection Representation at a driver’s licence suspension hearing. Dr. Manning’s driver’s licence is suspended. DAS will assist her in expediting the process of reinstating her driver’s licence.
  • Any offence arising from the alleged use of alcohol, drugs, or racing
  • Any claims or traffic tickets arising from the alleged use of a prohibited electronic device while driving


Major Excl​​usions

  • ​Use of ins​ured automobile for any illegal activity
  • A claim arising from an act which is wilfully committed
  • Any claim reported to us more than 120 days after the date of occurrence


Limit of Indemnity and Deductibles

Limit of indemnity: $100,000 per claim and $500,000 per issued per annual period.

Deductibles: 

  • ​The first $500 of any claim for a legal nuisance or trespass
  • The minimum amount in dispute for a physical damage claim is $500
  • The minimum amount in dispute for a contract claim is $500
  • The maximum amount in dispute for a contract claim is the Small Claims Court limit

Reasonable Prospects

For civil cases, "reasonable prospects" means that it is always more likely than not, that an insured OMA Insurance member will recover losses or damages, obtain legal remedy, or make a successful defence.​

​​*An insured person is you, or your spouse or civil partner or any son or daughter, normally living with you. Anyone claiming under this policy must have your agreement to claim.

*The above scenarios are examples only. Coverage is subject to the terms, conditions, and exclusions of the policy.​