Statutory Accident Benefits (SABS) provides financial support to individuals involved in accidents that are covered under a car insurance policy. It is essential to have a clear understanding of what constitutes an accident in order to determine one's eligibility for these benefits.
What exactly counts as an accident?
If someone has hot coffee spilled on their lap while making a purchase at a drive-through and suffered serious burns, have they experienced an accident?
What about someone who fell off the roof of a fifth-wheel camper trailer and suffered serious injuries?
Subsection 3(1) of the Statutory Accident Benefits Schedule ("SABS") defines "accident" as "an incident in which the use or operation of an automobile directly causes an impairment or directly causes damage to any prescription eyewear, denture, hearing aid, prosthesis or other medical or dental device."
In 2016, the Ontario Superior Court of Justice stated in Dittmann v Aviva Insurance Company of Canada that to be considered an "accident" under the SABS:
- the incident must have resulted from the ordinary and well-known activities to which automobiles are put,
- the injuries sustained must have been caused by the use or operation of a vehicle, and
- the injuries must have occurred as part of the "ordinary course of things". The injuries cannot have occurred due to an intervening act.
In the Dittmann case, the insured purchased coffee at a McDonald's drive-thru and attempted to transfer it to a cup holder in her vehicle. The lid detached and hot coffee spilled on her thighs. Her vehicle was in gear and running at the time, but it was not in motion, and there was no collision. The insured was seat-belted, so she was unable to take reflexive, evasive action to avoid or lessen the effect of the spill.
Aviva, the insurer in Dittmann, asked the Court to dismiss the insured's claim alleging that the injuries did not arise from an accident pursuant to subsection 3(1) of the Statutory Accident Benefits Schedule. The Court denied Aviva's request and found that the insured was indeed involved in an accident.
In 2017, the case was appealed. The Ontario Court of Appeal confirmed the approach used to determine whether an accident had happened. The Court of Appeal further clarified that the issue was not what was the triggering event of the incident, but rather, what caused the impairment. In this case, the use of a running motor vehicle in gear to access the drive-through and the seatbelt restraint were direct causes and dominant features of the impairment the individual suffered.
This year, the Divisional Court was asked to decide whether an accident under the SABS occurred in Madore v Intact Insurance Company. Madore was inspecting and cleaning the roof of his fifth-wheel camper trailer to ensure its safety for highway travel with his family. Madore's trailer was hitched to his pickup truck while he carried out his inspection and cleaning. Both trailer and truck were covered by policies with Intact. In the course of his inspection and cleaning, Madore fell from the roof of the trailer and sustained serious injuries including a fractured skull with a frontal hematoma and contusion as well as a broken left ankle and double wrist fractures.
Intact denied Madore's application for accident benefits on the basis that the incident did not meet the definition of an "accident" under the SABS. Intact alleged that there was no evidence that Madore's fall was due to contact with the trailer or the automobile. Intact alleged that there were no witnesses to the fall and Madore lost consciousness for days after the fall. He had no recollection of the incident or how he fell.
The Divisional Court disagreed with Intact's decision. The Divisional Court confirmed that contact with an automobile is not a required part of the definition of accident under the SABS. The issue was whether the use or operation of the trailer caused the impairment, not whether Madore proved that he tripped on the trailer. The link to be drawn was between the use and operation of the vehicle and the impairment.
The Divisional Court found that Madore was entitled to accident benefits coverage.
These cases underline the importance of seeking expert legal advice, as the interpretation of what an accident is may not always be straightforward. If you have been injured, always consult with an experienced lawyer who knows the insurance and medical systems and is looking out for you.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
