Category: Accident Definition

Motor Vehicle Accident Claims Fund v. Z.M.H. (18-011392)

The Fund sought repayment of accident benefits on the basis that the claimant was not involved in an accident, and that she had misrepresented the facts of loss. The claimant alleged that she was part-way in her son’s vehicle when he started driving, causing her to fall out of the vehicle onto her knees. The Fund alleged that the claimant suffered a slip and fall incident while walking in an underground parking lot, a few yards away from her son’s vehicle. Adjudicator Hines accepted the claimant’s version of events that she fell while getting into the vehicle as a result of her son starting to move the vehicle. Both the purpose and causation test were satisfied, and the incident fell within the definition of “accident” for the purpose of the SABS. The claim for repayment was dismissed.

I.W. v. Coachman Insurance Company (18-010935)

The claimant sought reconsideration of the Tribunal’s decision that he was not involved in an accident. Adjudicator Grant rejected the reconsideration, holding that there was no error law regarding the purpose or causation test. The claimant had been the victim of an assault, which was an intervening act and the dominant cause of his injuries.

I.W. v. Coachman Insurance Company (18-010935)

The claimant sought reconsideration of the Tribunal’s decision that he was not involved in an accident. Adjudicator Grant rejected the reconsideration, holding that there was no error law regarding the purpose or causation test. The claimant had been the victim of an assault, which was an intervening act and the dominant cause of his injuries.

P.F. v. Economical Mutual Insurance Company (18-010791)

The claimant was the operator of a vac-truck that responded to a fatal tractor-trailer collision. The claimant alleged that, as a result of cleaning up the spilled substances resulting from the accident and seeing the deceased bodies, he suffered from both physical and psychological injuries. The Tribunal denied the claim on the grounds that it did not meet the definition of an “accident”. The claimant filed for Reconsideration. In her decision, Adjudicator Lester noted that the environmental spill would be considered an intervening act, and not part of the “ordinary course of things” in relation to the use or operation of a motor vehicle. Furthermore, the tractor trailer itself did not directly cause the claimant’s injuries. It collided with another vehicle causing a chemical spill and fatality, which ultimately led to the claimant’s injuries as the claimant’s job was to clean up chemical spills outside of his vehicle. The chemical spill and deceased body were not as a result of the use or operation of a vehicle, but as a result of a collision. Adjudicator Lester denied the Reconsideration request.

Z.J. vs. Wawanesa Mutual Insurance Company (18-008967)

The claimant was involved in an accident on June 14, 2018 when he was struck by a BMW driven by a third-party who was making a left-hand turn. the insurer argued that the accident was staged, and that the claimant was not entitled to claim accident benefits as a staged accident did not meet the definition of an accident. Adjudicator Maleki-Yazdi accepted that the accident was staged. The insurer submitted ample evidence, including an expert accident reconstructionist who testified that there was more than one collision to the claimant’s vehicle, rather than the single impact alleged, as well as investigative materials including a store surveillance video showing two tow trucks already on the scene approximately 90 seconds after the alleged accident occurred, compared to 20 minutes after as stated by the claimant. The claimant’s car could also not be seen in the video. Coupled with the claimant’s excessively contradictory evidence at his EUO, specifically in relation to the timeline of events, the claim for accident benefits was dismissed.

A.G. v. Allstate Canada (18-004980)

The claimant filed a request for reconsideration following a decision in which the Tribunal concluded that the claimant’s death was not caused by the subject accident. The claimant argued that the Tribunal failed to properly analyze the evidence and over-exaggerated his pre-accident medical history. Adjudicator Watt dismissed the reconsideration request, finding that there was no misinterpretation or disregard of medical evidence relating to the claimant’s death.

M.L. v. Intact Insurance Company (19-000607)

A preliminary issues hearing was held to determine whether the incident the claimant was involved in met the definition of “accident” as defined by s. 3(1) the SABS. The claimant testified that at 1:30 a.m. on the night of the incident he arranged for an Uber driver to pick him up after a staff Christmas party. The Uber ride was cancelled by the driver at 1:57 a.m. The claimant was found laying in a parking lot by two city workers and was taken to the hospital by ambulance at 2:30 a.m. He was in a coma for two days and discharged from the hospital a month later. No bystanders witnessed the mechanism of the injury. Hospital records referred to a slip and fall. Adjudicator Grant found that the claimant was not involved in an “accident” as defined by the SABS as the claimant could not prove that his impairment arose from the use and operation of an automobile.

G.R. v. Economical Mutual Insurance Company (18-010779)

The claimant fell and sustained injuries while clearing snow off of his parked vehicle. The insurer raised a preliminary issue regarding whether the incident met the definition of an “accident” as defined under section 3(1) of the SABS. Adjudicator Grant concluded that the claimant was involved in an “accident” as defined by the SABS, and as such, was entitled to claim accident benefits. Adjudicator Grant found that the incident arose out of the use or operation of a vehicle, and that the use or operation of the vehicle directly caused the impairment. In doing so, he noted that cleaning snow off a vehicle met the definition of “normal and ordinary use” and that the fall did not constitute an intervening act.

E.C. v. Aviva Insurance Company (18-003072)

The insurer argued that the claimant was not involved in an accident. The claimant had driven to work and was removing items from the trunk of the vehicle. At some point either during the closing of the trunk or shortly thereafter, the claimant slipped and fell, and injured himself. Adjudicator Norris concluded that the claimant was not involved in an accident. He found that the fall occurred after the claimant had stepped away from the vehicle. That evidence came from a statement shortly after the fall, whereas the story about falling while closing the trunk was first given in an EUO a few months later. Adjudicator Norris preferred the more contemporaneous evidence, and concluded that the purpose test was not met.

C.S. v. Certas Home and Auto Insurance (18-003463)

The claimant was injured in an icy parking lot. She was a few feet from her vehicle when she slipped and fell. She applied for accident benefits. The insurer denied coverage on the basis that the incident was not an “accident” under the SABS. Adjudicator Ferguson concluded that the facts of loss were not an “accident.” He reasoned that neither the vehicle nor any action associated with use of the vehicle was a factor in the claimant’s injuries. The chain of causation was broken. Adjudicator Ferguson also held that the insurer was not estopped from arguing that an accident had occurred, despite initially paying the claimant benefits for three years.