Category: Accident Definition

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.

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.

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.

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.

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.

The insurer brought a preliminary motion to address whether or not the claimant was involved in an accident as defined in the Schedule. The claimant had started her car and brushed off the snow, and planned on throwing out the garbage in a nearby communal garbage bin before starting her day that morning. As she finished brushing off the snow, the claimant proceeded to throw out her garbage and slipped and fell after taking two steps from her vehicle. The claimant broke her wrist. Vice Chair Flude held that this incident was not an accident as defined in the Schedule, as it failed to meet both the purpose and causation test. Vice Chair Flude concluded that proximity is not use or operation, and that falling next to a car does not necessarily implicate the use of operation of the car in the fall. Further, he also concluded that the claimant’s intention of throwing out garbage was an intervening act which broke the chain of causation, and that the dominant feature was the slippery surface that caused her slip and fall.

The claimant exited an Uber vehicle, and was attempting to cross Bay Street to take a GO Bus at Toronto’s Union Station when she slipped and fell on Bay Street. She fractured her hip. The claimant applied for accident benefits, which were denied by the insurer on the basis that this incident did not qualify as an “accident” under the Schedule. The claimant argued that this incident qualified as an accident, because but for the actions of the driver in refusing to conduct a U-turn and drop her off in front of Union Station, she would not have sustained her injuries. Vice Chair Maedal held that the incident was not an accident under the Schedule. While Vice Chair Maedal found that the incident arose out of the use or operation of an automobile, he concluded that use of the motor vehicle was not the dominant feature of the incident. Rather, he found that the dominant feature of this incident was the applicant’s slip and fall on Bay Street, and the operation of the uber vehicle was ancillary to her injuries.