The claimant’s husband was allegedly struck by a vehicle insured by the insurer on December 8, 2020. The claimant and her husband were not insured. The claimant sought accident benefits for psychological injuries resulting from the incident. The insurer denied her claim, stating she is not an “insured person” under section 3(1) of the SABS and raised a preliminary issue of whether the claimant was an insured person involved in the “accident” as per the SABS. The insurer argued that accident benefits only extend to named insureds, specified drivers, spouses, or dependents of the named insured under s. 3(1), and since the claimant did not fall into any of these categories, she was not covered. The claimant contended that she should qualify based on her husband’s catastrophic impairment and that excluding spouses of insured individuals from coverage would be discriminatory. The LAT ruled that the definition of an “insured person” under section 3(1) is clear and applies only to those explicitly named on the policy. In answer to the question of whether the claimant was involved in an accident involving the insured vehicle, the LAT concluded that the claimant was neither involved in nor witnessed the accident and that her impairments were causally connected to caring for her injured husband, rather than the accident itself. As such, the claimant was found ineligible for accident benefits, and her application was dismissed.
