I said what I meant and I meant what I said: where an insurance policy expressly outlines specific instances where there will be coverage for additional expenses beyond the limits

Ontario Superior Court finds that where additional coverage is expressly outlined in certain circumstances in a policy, it ought to be concluded that additional coverage is limited to those circumstances, not applicable to the policy generally.

Insurance law – Business interruption insurance – Extra expense – Calculation of losses – Professional fees – Practice – Summary judgments

Jewish Theological Society of Canada (c.o.b. Camp Ramah in Canada) v. Arch Insurance Canada Ltd., [2025] O.J. No. 192, Ontario Superior Court of Justice, January 17, 2025, R. Frank Associate J.

The plaintiffs were two private overnight camps in Ontario – Camp Ramah in Muskoka and Camp Manitou in Parry Sound (the “Insureds”). The Insureds had purchased policies from the defendants, Arch Insurance Canada Ltd. and the Sovereign General Insurance Company (the “Insurers”). 

The Insureds were shut down by government order during the summer of 2020 as a result of the COVID-19 pandemic. In 2021, the Insureds were subject to continued restrictions and requirements due to COVID-19. They suffered business losses as a result.

The Insureds’ policies included extensions for infectious diseases. The Insureds made claims for their business losses under those extensions. The Insurers approved those claims and paid the limits of that coverage.

The Insureds then made claims for additional coverage, for professional fees they had incurred to substantiate their claims for business losses. The Insureds had worked with accountants to assist with quantifying their losses, as well as legal counsel. The Insureds argued that they were entitled to those fees as Professional Fees under their policies. For example, the policies expressly provided for additional coverage for Professional Fees incurred in substantiating claims for property losses.

The Insurers argued that professional fees incurred in substantiating losses under the Infectious Disease Extension fell within the scope of that extension, the limits of which had already been paid.

The Court considered the entirety of the policies. The policies provided specific instances where coverage for professional fees existed in addition to listed coverage limits. In those instances, coverage was clearly stated to extend beyond the limit otherwise provided. The Court rejected the plaintiffs’ argument that those instances created a “general principle” that all references in the policies to professional fees were instances of coverage for such fees beyond the stated limits. Rather, those instances demonstrated that if professional fees were intended to be insured in addition to what was available under the Infectious Diseases Extension sublimit, the policies would have expressly indicated that.

The Court found the Insureds’ coverage for business losses was restricted to the limits outlined in the Infectious Diseases Extension and ordered the Insureds to pay the Insurers’ costs of the motion.

This case was digested by Mollie Clark and edited by Steven W. Abramson of Harper Grey LLP and first published in the LexisNexis® Harper Grey Insurance Law Netletter and the Harper Grey Insurance Law Newsletter.  If you would like to discuss this case further, please feel free to contact them directly at [email protected] or [email protected].