The insurer defended the claim on the basis that the accident was staged and that no accident benefits were payable. Adjudicator Neilson accepted the insurer’s position. She first rejected FSCO case law that held that a staged accident still qualified for accident benefits. She noted that section 118 of the Insurance Act states that a person shall not profit from a person’s intentional or criminal act, and that the term “accident” in the SABS must be interpreted in light of that provision. She held that allowing a person to claim accident benefits for a staged accident would contravene the public policy contained in section 118. Next, the adjudicator concluded that the claimant was involved in the staging of the accident. Her conclusion was based on significant discrepancies in the statements given by the claimant and other individual involved in the incident; a reconstruction report showing that the collision could not have occurred as reported; and the claimant’s failure to call evidence from the other individuals allegedly involved in the accident. Finally, the adjudicator stated that the claimant’s misrepresentation of the facts of loss to the insurer were made wilfully and were material to the claim. She concluded that the claimant was not involved in an “accident” as defined in the SABS, and that the insurer could terminate benefits in accordance with section 53.
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