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

  • May 14, 2019

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.

Full decision here

TGP Analysis

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  • FILED UNDER LAT Rules, Accident Definition
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