The claimant was a long haul truck driver taking a load from Brampton to Edmonton. The claimant testified that while driving, a fire started due to overheating of electrical wiring, and he was forced to jump out of the moving truck to prevent personal injuries. The insurer took the position that claimant deliberately set the trailer on file, and raised a preliminary issue, arguing that the setting of the fire was an intervening act that resulted in the injuries. Adjudicator Watt accepted the insurer’s position and dismissed the application on the basis that the operation of the truck did not cause the fire, and the fire was an intervening act which caused the damages. In doing so, he emphasized the lack of clarity and consistent evidence from the claimant on certain key issues, including how the fire started and why he was unable to bring the truck to a stop.
Category: Accident Definition
The issue before the LAT was whether the claimant was involved in an accident. Adjudicator Farlam dismissed the claimant’s application finding that the claimant was not involved in an accident as defined by the SABS. The claimant submitted that he sustained physical and psychological injuries when he had to move out of the way of a driver’s vehicle. According to the claimant, the driver of the vehicle was swerving while backing down a ramp and the claimant thought the driver was attempting to hit him. The claimant jumped out of the way of the vehicle, and alleged that he hurt his right knee and back suffered an exacerbation of his pre-existing psychological issues. Adjudicator Farlam agreed with Wawanesa that this incident did not constitute an accident. With respect to the purpose test, Adjudicator Farlam noted that the claimant’s EUO evidence was inconsistent with his evidence before the LAT. At his EUO, the claimant testified that he was aware the driver was planning to reverse down the ramp and he made a quick motion to get out of the way. There was no evidence that the claimant fell or was struck by any part of the vehicle. Adjudicator Farlam also found that the there was no credible objective evidence that the driver attempted to hit the claimant. As Adjudicator Farlam found that the accident did not met the purpose test, she noted that she did not need to address the causation test.
The insurer raised a preliminary issue, arguing that the claimant’s injuries did not arise out of the use or operation of an automobile and therefore did not meet the definition of an “accident” as defined by section 3(1) the SABS. The claimant drove to pick her brother up from a party, where she was verbally assaulted by partygoers and her vehicle was damaged. She then drove away from the initial incident, where the assault continued until the police arrived. The claimant alleged that she sustained significant psychological impairment as a result of the incident. The insurer argued that the two part test (the purpose test and the direct cause test) had not been met, because her psychological impairments were not caused through the use or operation of her automobile, and the verbal assaults and fear of physical assault were intervening acts that broke the chain of causation. Adjudicator Grant agreed with the insurer, and dismissed the application.
The claimant suffered injuries which rendered him paraplegic while attempting to load a GMC Sierra truck onto a trailer in order to move it to another location to be repaired. The trailer was attached to a Dodge truck driven by one of the claimant’s friends. The insurer sought a determination of whether the incident met the definition of an “accident” as defined under section 3(1) of the SABS. Adjudicator Farlam found that the purpose test was not met, because the claimant’s injuries were not the direct result of the ordinary use or operation of the insured vehicle. The vehicle was missing many parts, was not roadworthy, and not drivable under its own power. As such, Adjudicator Farlam determined that the vehicle had ceased to be a motor vehicle that could be motored in and became an object that used to be a motor vehicle. As she found that the purpose test had not been met, Adjudicator Farlam did not conduct an analysis concerning the direct cause test.
The claimant was smoking a cigarette on her driveway as she was walking towards her house and tripped and fell forward striking her face against the rear bumper of her SUV before falling on the ground. The insurer argued that the claimant was not involved in an “accident”. Adjudicator Boyce dismissed the insurer’s motion found that the claimant was involved in an accident. Adjudicator Boyce held that the claimant met both the purpose and causation tests. With respect to the purpose test, there is no requirement that the vehicle in question be in active use. A parked vehicle falls within the ordinary scope of use and operation. Adjudicator Boyce also agreed that the accident met the causation test: but for the vehicle being parked in the driveway, the claimant would not have struck her face against the bumper and fallen to the ground. The dominant feature of the incident was the claimant striking her face against the bumper. The insurer argued that the condition of the driveway caused the claimant’s fall. Adjudicator Boyce held that this was speculative and noted that at her examination under oath, the claimant denied tripping on a protruding water pipe and found her evidence regarding the facts of loss to be credible.
The claimant was on the roof of his trailer checking the roof in preparation for a road trip when he fell off the roof and suffered significant injuries. The insurer brought a motion arguing that the claimant was not involved in an accident. Adjudicator Grant agreed with the insurer. Adjudicator Grant accepted that the incident arose out of the ordinary and well-known activities of the trailer, being a pre-travel inspection. However, Adjudicator Grant found that the incident did not meet the causation test. Adjudicator Grant agreed with the insurer that the claimant suffered injuries because he fell off the roof of his trailer. The incident did not involve the use or operation of the trailer and there was an intervening cause, being that the claimant lost his footing while standing on the roof of the trailer.
The claimants made a claim for accident benefits following an incident in which they witnessed a vehicle strike a close family member (spouse and father-in-law, respectively). The incident was only a few feet in front of the claimant. The claimants heard the collision and witnessed the aftermath. The claimant alleged that they suffered psychological injuries. Because neither claimant had their own automobile insurance, they made a claim to the policy of the driver who struck the relative. Adjudicator Norris concluded that neither of the claimants were an “insured person” because they were not “a person who is involved in the accident involving the insured automobile”. The “insured person” definition in the SABS suggested that claims for nervous shock were limited to family members who qualified under section 3(1)(a)(ii).
The claimant sought entitlement to accident benefits after an incident in which she experienced intense neurological pain in her back and loss of sensation in her right leg and foot while pressing her foot onto the accelerator. Prior to starting the vehicle, the claimant had lifted her 30 pound son into his car seat. Vice Chair Boyce held that the incident qualified as an accident. Regarding the purpose test, the claimant lifting her son into his car seat and pressing on the accelerator were ordinary and well-known activities for which automobiles were used. Regarding the causation test, there was limited evidence about any intervening or distinct activity that was not part of the ordinary course of things. The claimant likely suffered reinjury to an earlier disc injury due to her use of her car.
The insurer appealed the Tribunal’s decision that the claimant was involved in an accident. The claimant slipped and fell on ice while making her way to a Lyft vehicle in her driveway. The Court granted the appeal and concluded that the facts of loss did not qualify as an accident. The Tribunal erred by conflating the “but for” test with the direct causation test. Entitlement to accident benefits required that the use or operation of the vehicle be a direct cause of the injuries. In this case, the car was at best ancillary to the incident. More was required than establishing that the location of the vehicle led to the incident occurring. Ice and snow was the direct cause of the injuries, which was insufficient to establish direct causation for accident benefits entitlement.
The claimant applied to Certas for accident benefits. Certas brought an application to the LAT arguing that the claimant was not involved in an “accident” and sought repayment of accident benefits because the claimant wilfully misrepresented facts in relation to her application for benefits. Adjudicator Maleki-Yazdi agreed that the claimant was not involved in an accident. Adjudicator Maleki-Yazdi considered the claimant’s EUO evidence as well as the evidence of Certas’ investigator. Adjudicator Maleki-Yazdi found there were several inconsistencies with the claimant’s reporting and that the claimant could not describe basic facts regarding the collision at both her EUO and at the hearing. Because Adjudicator Maleki-Yazdi found there was no accident, Adjudicator Maleki-Yazdi also found that the claimant had wilfully misrepresented material facts about her claim for benefits and that the claimant had to repay Certas accident benefits pursuant to section 53.