Category: Accident Definition

The claimant slipped and fell in a grocery parking lot as he was disembarking his vehicle. There was black ice on the ground. The claimant slipped before he had shut his door. The insurer argued that the incident was not an accident for the purposes of the SABS. Adjudicator McGee held that the incident qualified as an accident under the purpose test and causation test. She accepted that the claimant was still holding the interior handle of the door when he fell on the ice. The claimant’s disembarking was an ordinary and well-known use to which automobiles are put. The slipping and falling was not an intervening act capable of breaking the chain of causation between the use and operation of the vehicle and the impairment. Further, losing one’s footing on the pavement while exiting a vehicle is a reasonably foreseeable risk of operating an automobile.

The self-employed claimant was injured when a garage door fell on his head during the delivery of a parcel. He applied for accident benefits, which the insurer denied. Adjudicator Norris held that the incident was not an accident for SABS purposes. The parties agreed that the purpose test was met, as the delivery of a parcel was one of the ordinary uses to which a van may be put. The causation test was not met. The claimant’s use of his van ended once he left it to deliver the parcel to the recipient’s door. The garage door falling on the claimant’s head was also an intervening act, independent of his use or operation of the van.

The claimant slipped and fell in the process of getting into his vehicle at a gas station. The insurer argued that the incident did not qualify as an accident. Adjudicator Makhamra concluded that the incident qualified as an accident. The claimant was just next to his driver’s door and was reaching out with his left hand when he slipped on ice. The adjudicator held that the act of entering a vehicle was an ordinary use of a vehicle, and therefore met the purpose test. She also considered the but-for principle, intervening act, and dominant feature principle and held that the vehicle was the direct cause of the injuries. The claimant would not have been injured but for being in the process of re-entering his vehicle; the incident was one continuous chain of events with no intervening acts; and the dominant cause of the injuries was the claimant’s attempt to get into his vehicle.

This is a preliminary decision over the definition of “accident” in the SABS. The claimant was swapping his winter tires to his summer tires when he injured his back. The claimant took the position that this was an “accident” because seasonally changing tires constituted the normal use and operation of a motor vehicle. Adjudicator Flude concluded that changing tires was not an “accident” and the claimant was not entitled to accident benefits. The parties submitted extensive case law from various jurisdictions dating back to 1975. Adjudicator Flude focused on Ontario jurisprudence and the definition of “accident” as per the 1996 amendments to the SABS. Adjudicator Flude held that as the claimant had disabled the vehicle to change the tires so that it was no longer operative (its wheels were off), and that this action did not meet the purpose or causation test to meet the definition of accident. Adjudicator Flude held that the claimant’s position that he had an “expectation of having insurance coverage while performing maintenance” was not reasonable.

A vehicle struck the claimant’s back patio, which caused it to detach from the house. The claimant heard the crash and opened her back door and stepped onto the patio, not knowing that it had detached. She fell through a gap to the ground. The insurer argued that the claimant was not injured in an “accident”. Adjudicator Hans concluded that the incident was an “accident” under the SABS, as it met both the purpose and causation test. The vehicle that struck the patio was being operated in a typical (though negligent) manner, and that the gap through which the claimant fell was directly caused by the use of the vehicle.

The claimant was involved in an incident when she was shovelling her parking spot, which led to physical injuries. She applied to the insurer for accident benefits. The insurer denied payment of benefits on the basis that the incident did not fall under the definition of “accident” in the SABS. The incident was described as follows: the claimant moved her vehicle from her parking spot to the throughway in order to shovel her parking spot; halfway through shovelling, she decided to throw salt onto the parking spot; the salt was stored in the trunk of her car, which was parked with the engine off; while walking toward the trunk of her car, she fell and injured her back; the claimant did not make contact with her vehicle when falling. Adjudicator Manigat applied the “purpose and causation” test, and found that the claimant was not entitled to accident benefits as the injuries she sustained were not from an “accident” as defined in the SABS.

The claimant was injured while walking down the driveway to get into a Lyft, which was waiting to take her to a medical appointment. She applied for accident benefits. The insurer denied the claim, stating that the incident was not an accident. Adjudicator Mather concluded that the incident was an accident under the SABS. She concluded that the purpose test was met because the use and operation of the vehicle began when the Lyft driver accepted the ride request, and included the claimant’s attempt to enter the car. Her only purpose in walking down the ice-covered driveway was to get into the car. The adjudicator also held that the ice was not an intervening act. While it was one of the direct causes of the accident, so was the use and operation of the Lyft that stopped less than halfway up the driveway. Further, it was the use or operation of the Lyft that was the dominant feature of the accident, because the slip and fall on ice was only ancillary to the fact that the Lyft driver stopped half-way up the driveway.

The claimant applied for accident benefits; the insurer argued that the incident was not an accident. The claimant was burned by hot tea while at a red light. The tea had been passed to her through a drive-through window minutes prior and the lid was not securely placed on the cup. Adjudicator Reilly held that the incident was not an accident. The facts of loss did not satisfy the direct causation test. Nothing about the vehicle caused the impairment, and the claimant’s presence in her vehicle was incidental to her injuries. Rather, it was the negligence of the fast-food server in failing to secure the lid that caused the impairments.