Category: Accident Definition

Travis v. Aviva Insurance Company (2024 ONSC 1683)

The claimant appealed the Tribunal’s decision that his injuries were not the result of an accident. The claimant was a firefighter who responded to the 2018 van attacks in Toronto where 10 people were killed. The claimant arrived at the scene after the incident, and was confronted with the bodies of the deceased and injured victims. He suffered psychological trauma as a result. He initially applied to WSIB, but was eventually denied after he was found capable of returning to work. He then applied for accident benefits. The Court dismissed the appeal, holding that the Tribunal correctly concluded that the claimant’s injuries were not a direct result of the use and operation of a vehicle. The firetruck that brought the claimant to the scene of the accident did not cause the claimant’s injuries, and the rental van was not in use by the time the claimant arrived at the scene.

Jiang v. The Co-operators General Insurance Company (2024 ONSC 1225)

The claimant appealed the Tribunal’s decision that she was not involved in an accident. The claimant sustained injuries when she was driving and her husband physically assaulted her. She subsequently lost control of her vehicle and hit the curb. The Tribunal held that the assault was an intervening event that broke the chain of events, and that the dominant feature of her alleged injuries was the assault, while the use or operation of the vehicle was ancillary. The Court partially reversed the Tribunal, holding that the claimant’s alleged injuries after losing control of her vehicle may have been directly caused by the use or operation of an automobile and therefore might be considered an “accident”. The issues of whether and to what extent the claimant’s injuries were sustained as a result of her loss of control of the vehicle were remitted to the Tribunal to be determined at a hearing.

Pinera v. Motor Vehicle Accident Claims Fund (2023 ONSC 3155)

The claimant appealed the Tribunal’s decision that he was not involved in an accident. The Court dismissed the appeal, holding that the Tribunal’s reasons had no error of law, and that the claimant’s appeal was largely an attempt to relitigate the factual issues that were before the adjudicator.

Pec v Certas Direct Insurance (21-009610)

The claimant claimed accident benefits in relation to injuries sustained in a confrontation after an alleged road rage incident. The insurer argued that this did not constitute an “accident” under the SABS. The adjudicator, applying a two-part test, found that while the incident arose from the use of the vehicle, the injuries were not directly caused by it. Instead, they resulted from an intervening act, the physical altercation, which was not an ordinary risk associated with vehicle use. The adjudicator concluded that the use of the vehicle was ancillary to the altercation and not the dominant feature causing the injuries, ultimately denying the applicant’s claim for accident benefits. The appeal was dismissed.

Gray v. Intact Insurance (21-008634)

This is a preliminary issue decision. The claimant applied for accident benefits following an incident in August 2019. The applicant was in her home when a vehicle struck a house a few doors down. A large natural gas explosion occurred at the impacted house. The claimant alleged she sustained psychological impairments as a result of the incident. The insurer denied the claim on the basis that the claimant was not involved in an accident as defined by the SABS. Adjudicator Kaur held that the jurisprudence has established that a person who sees or hears an accident is not a person who is involved in an accident. Adjudicator Kaur found that the claimant was not involved in an accident and dismissed the application.

Howes v, CAA Insurance Company (21-012279)

This is a preliminary issue decision. The claimant applied for accident benefits following an incident in February 2019. She was asleep at home when a truck drove into her house, destroying her dining room and kitchen. She alleged that she was injured when a large mirror fell down on her as a result of the incident. The insurer denied the claim on the basis that the claimant was not involved in an accident as defined by the SABS. Adjudicator Kaur found that the truck was no longer in use and operation by the time the impairments were established and held that an insurer should not be responsible for any impairments that arise out of the aftermath of an accident that has already occurred. Adjudicator Kaur found that the claimant was not involved in an accident and dismissed the application.

Madore v. Intact Insurance Company (2023 ONSC 11)

The claimant appealed the Tribunal’s decision that he was not involved in an “accident” as defined in the SABS. The claimant had been inspecting and cleaning the roof of his camper trailer, which was hitched to his pickup truck. In the course of cleaning the trailer, the claimant fell to the ground, suffering serious injuries to his head. The Tribunal had found that the “causation” test was not met because there was no direct evidence that the trailer caused the claimant’s fall, and that there was an intervening act, namely the loss of footing, which was not part of the ordinary course of things. The Court reversed the Tribunal’s decision, holding that the Tribunal erred in requiring the claimant to show that the incident was caused by tripping on the trailer or that the injuries were directly caused by the trailer to establish direct causation of the injuries. The fact that the claimant was injured in the course of cleaning and inspecting the roof of the trailer was sufficient to prove that the use and operation of an automobile caused the claimant’s impairments; there was no need to prove a direct physical connection between the cause of the injury and an automobile.

Degazio v. Bertie and Clinton Mutual Insurance Company (21-008359)

The claimant applied for accident benefits arising out of an incident. While the claimant was sleeping in his living room, another vehicle collided with the claimant’s vehicle and struck a corner of the claimant’s home. He did not see the accident occur. The claimant alleged that he sustained psychological and emotional injuries as a result of the incident. The insurer refused to accept that the claimant was involved in an accident. Adjudicator Kaur found that the applicant was not involved in an accident, as he did not witness the accident and was not injured in the process. He only observed the aftermath. The claimant was not related to the anyone involved in the accident, and was not able to claim that the accident caused him nervous shock.

Sorouri v. Intact Insurance Company (20-003723)

The claimant applied for accident benefits after he was assaulted while working an Uber driver on March 24, 2019. After he had picked up four passengers, multiple assailants surrounded his vehicle and attempted to remove a female passenger from the rear passenger seats. One assailant allegedly punched the claimant’s face and pulled and twisted his left hand in an attempt to remove him from the vehicle. At least six other assailants surrounded the claimant’s vehicle and broke the driver’s door and window, the rear driver’s window, the back windshield, the side mirrors, and the rear camera. The claimant argued that he had been involved in an “accident” as defined by the SABS and was entitled to benefits for physical and psychological therapy. Adjudicator Kepman held that the claimant had not been involved in an “accident”. She accepted that the incident involved the use or operation of a vehicle, as the claimant was picking up passengers as part of his role as an Uber driver. Adjudicator Kepman agreed that the claimant would not have had his arm twisted and injured “but for” the use of his vehicle as a seated and belted driver. Finally, she acknowledged that the assault did not constitute an intervening act that broke the chain of causation because the assault had occurred simultaneously while the claimant continued to operate his vehicle. However, Adjudicator Kepman found that the claimant had not demonstrated that the use or operation of his vehicle was the dominant feature of the incident. Rather, she found that his injuries had been caused by the assault and dismissed his application.

Bustin v. Economical Insurance Company (20-007017)

The claimant sought entitlement to accident benefits after witnessing a fatal collision on October 13, 2019. He claimed that he had been involved in the accident and was an “insured person” as defined in the SABS. The claimant had been sitting on the porch of his aunt’s home when two vehicles struck one another in a head-on collision, killing two occupants in one of the vehicles. He claimed that he had witnessed the deceased pair being extracted from their vehicle and covered with white cloth. He argued that he had been involved in the accident because he had developed psychological injuries as a result of witnessing the accident. Adjudicator Norris found that the claimant was not involved in the accident and was therefore not an “insured person” under the SABS. He noted that witnessing the accident and its aftermath did not constitute being involved in an accident. In addition, Adjudicator Norris found that the claimant was not entitled to claim for “nervous shock” under the SABS because he had not been related to anyone involved in the accident. The claimant’s application for benefits was dismissed.