Category: Accident Definition

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.

The claimant alleged that an accident occurred as he was walking towards a transit bus. As the bus began to pull away from the bus stop, the claimant reported that he knocked on the side of the bus as it drove away. He claimed to have made momentary eye contact with the driver before losing his balance and slipping off the curb. The claimant’s right foot was allegedly run over by one of the rear bus tires. The claimant got onto the next bus and the driver asked if he required an ambulance. The insurer questioned whether or not this incident met the definition of an “accident” under the Schedule, given the claimant’s inconsistencies in his recollection of the accident details and the lack of any objective evidence. Vice Chair Maedel was not satisfied that the claimant’s injuries were caused by the use or operation of the transit bus. Vice Chair Maedal reviewed the totality of the evidence and was unable to determine that there was a nexus between the operation of the bus and the injuries sustained by the applicant. There was no witness evidence to corroborate the incident. There was no photographic evidence of the claimant’s injuries, and no incident reports or calls logged to the City of Hamilton, Hamilton Police, or ambulance records. Lastly, no medical evidence was produced that demonstrated the injuries the claimant sustained are consistent with the type of impact alleged.

The claimant alleged that he was involved in an accident and injured while using and operating his vehicle to drive to an outdoor space to meditate. The claimant has a long history of mental health issues and addiction, and had previously expressed suicidal ideations. The insurer denied the claimant’s accident benefits claim, and argued that the claimant was using his automobile in a deliberate manner to end his own life, a suicide attempt, and therefore, the incident was not an “accident”. The insurer argued that the use of an automobile in a suicide attempt is an aberrant use of the automobile, and not within the “ordinary course of things”. The insurer argued that the dominant cause of the claimant’s injuries was his suicide attempt, not the use of operation of the vehicle. Medical records and police records implied and concluded that this accident was a suicide attempt. However, none of the individuals who created the records testified at the hearing. Vice Chair Farlam found that the dominant factor that caused the applicant’s injuries was the unintended loss of control of the claimant’s motor vehicle while he was driving it. Vice Chair Farlam also found that the claimant was not using his automobile in a suicide attempt on the date of loss, as the claimant’s pre-incident activities (spending time with his son), actions during the incident, and actions immediately after the incident (seeking help) were inconsistent with an attempt at suicide by vehicle. As such, Vice Chair Farlam found that the incident met the definition of an “accident” in the Schedule.

The claimant slipped and fell on black ice in a parking lot as she was trying to open the driver’s side door. The claimant applied for accident benefits, which was denied as her insurer took the position that the claimant was not involved in an accident. Adjudicator Kaur held that the incident did not meet the definition of an “accident”. Adjudicator Kaur found that the claimant’s injuries were not a consequence directly caused by the use of operation of the automobile. Instead, her injuries were caused by an intervening cause, which was the ice on the ground. Adjudicator Kaur found that the ice that initiated the slip and fall led to the claimant’s injuries, not the use of operation of her automobile, and while the vehicle was physically near the ice, it did not cause the slip and fall.