O.M. v. Aviva Insurance Company of Canada (18-001929)

The claimant applied for accident benefits after suffering injury on a city bus. The insurer denied that he was entitled to accident benefits because there was no collision; rather, the claimant fell when the bus driver accelerated. The claimant suffered from various disabilities prior to the accident and sought a seat in the priority seating area. However, the bus was not a bus specially designed for persons with disabilities. Adjudicators Norris and Letourneau dismissed the claim and held that the claimant was not entitled to receive accident benefits. They held that the fact that the claimant wished to use priority seating on the city bus did not make the bus “special transportation for persons with disabilities.” Furthermore, the availability of priority seating was not a special service provided for persons with disabilities.

Intact Insurance Company v. Lanziner-Brackett (2018 ONSC 6546)

The insurer sought judicial review of the Tribunal’s decision that the claimant was involved in an accident, and also sought judicial review of the Case Conference adjudicator’s framing of the dispute. The claimant had been struck by the door of a vehicle twice, and then physically assaulted by the driver of the vehicle. The insurer had accepted that the door-related injuries qualified as an “accident,” but that the punches to the face did not. The adjudicator concluded that the whole incident was an “accident.” The Court concluded that the Tribunal’s decision was unreasonable and sent the matter back to the Tribunal for a new hearing. The Court explained that the Case Conference adjudicator’s reframing of the issue in dispute denied the insurer procedural fairness. The Court did not address whether the facts of loss qualified as an “accident.”

Charbonneau v. Intact Insurance Company (2018 ONSC 5660)

The insurer sought judicial review of the Tribunal’s decision that the claimant was involved in an accident. The claimant had been “car surfing,” and was injured after falling from a moving vehicle when it made a sharp turn. The insurer argued that although the causation test was met, the purpose test was not. The Court rejected the insurer’s application. It agreed that “car surfing,” while reckless and foolish, was still using a vehicle for its normal purpose of transportation. The Tribunal’s decision was reasonable and within the consumer protection purposes of the SABS.

B.A. v. Gore Mutual Insurance Company (18-000290)

The claimant sought coverage for accident benefits following an assault at an auto mechanic. The insurer denied that the facts of loss constituted an accident. Adjudicator Mazerolle agreed with the insurer. He conceded that attending an auto mechanic was part of the ordinary and well-known activities to which an automobile is put. He also conceded that the assault in this case was closer to an “accident” than other assault cases, because the assault arose in the process of having an automobile serviced. However, he concluded that there was an intervening act – the argument between the claimant and the auto mechanic, and the assault ordered by the auto shop owner – which resulted in the injuries not arising from the “ordinary course of things.”

Applicant v. Liberty Insurance (17-006380)

The claimant was struck on the head by an unidentified cyclist travelling on the sidewalk while she was taking something out of her work vehicle. She sought accident benefits. The insurer argued that the facts of loss did not qualify as an accident. Adjudicator Hans concluded that the incident was an accident for the purposes of the SABS. Both parties agreed that the purpose test was satisfied. Regarding the causation test, Adjudicator Hans concluded that the incident satisfied each of the “but for,” “intervening act,” and “dominant cause” considerations.

N.M. v. Western Assurance Company (17-009102)

The insurer denied entitlement to accident benefits based on the facts of loss. The claimant had parked her vehicle at a mechanic’s garage in order to have a emissions test performed. She pulled into the service bay, turned offer her engine, left the keys in the vehicle and exited her vehicle. She then spoke with an attendant beside her vehicle and was handed a clipboard. While walking around her vehicle to the waiting area she tripped on netting and fell, fracturing her foot. Adjudicator Boyce concluded that the claimant was not involved in an accident because the use of her vehicle was not the direct cause of the claimant’s injuries and the netting on which she tripped was an intervening cause.

N.P. v. Motor Vehicle Accident Claims Fund (17-005135)

The claimant was roller blading along a sidewalk when a van allegedly cut in front of him, causing the claimant to fall to the ground. The claimant did not impact the van. The insurer argued that the incident did not occur as reported, and that if it did, it did not qualify as an accident. Adjudicator Grant held that the incident qualified as an “accident.” He favoured the evidence of the claimant over that of the insurer, which had relied upon a police officer testifying two years after the incident without notes of the incident. The facts as reported by the claimant met both the purpose and causation test because a van was involved and there were no intervening acts.

S.G. v. Intact Insurance Company (17-002640)

The claimant was a pedestrian who was struck by an egg thrown at him from the occupant of a moving vehicle. He applied for accident benefits. The insurer argued that the incident was not an “accident” as defined in the SABS. Adjudicator Ferguson dismissed the application and held that the claimant had not been involved in an accident. He accepted that the purpose test had been met, but that the causation test had not. The egg throwing was an intervening act. The claimant’s injuries arose from an assault rather than due to an automobile.

D.M. v. Certas Direct Insurance Company (17-000180)

The insurer requested a preliminary issue hearing as to whether the incident in question was an automobile accident. The claimant had sustained injuries after she slipped and fell next to the passenger door of her parked vehicle. The claimant had sought benefits under the SABS, which the insurer denied as the incident did not qualify as an “accident.”  Adjudicator Anwar held that the incident was not an accident for the purposes of the SABS as the dominant feature causing the claimant’s injuries was the slip and fall itself, and the vehicle was not closely involved in the incident.

S.J.L.V. v. Certas Direct Insurance Company (17-000796)

The claimant was the driver of a vehicle when she and her boyfriend were subject to a gun attack. The claimant’s boyfriend was hit by bullets and the claimant fled the scene in the vehicle and tried to find a hospital for her boyfriend. Her boyfriend eventually died of his injuries. The claimant argued that she was in an “accident” because she suffered psychological impairments as a result of not being able to find a hospital, which directly arose out of the use and operation of a vehicle. Adjudicator Flude rejected the claimant’s arguments. He held that the incident met neither the purpose test nor the causation test; the vehicle was simply the venue of the incident and its use and operation did not directly cause the claimant’s psychological impairments.