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What qualifies as an “accident” under the Statutory Accident Benefits Schedule?

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:

  1. the injuries sustained must have been caused by the use or operation of a vehicle, and
  2. 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.

Person on the ground after a car accident

In 2017, the case was appealed. The Ontario Court of Appeal confirmed the approach used to determine whether an attorney for personal injury 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 had to determine the occurrence of an accident under the SABS (Statutory Accident Benefits Schedule) in the case of Madore v Intact Insurance Company. Mr. Madore was in the process of inspecting and cleaning the roof of his fifth-wheel camper trailer to ensure its safety for a family highway trip. The trailer was hitched to his pickup truck during this procedure, both of which were insured under policies with Intact. Unfortunately, while conducting the inspection and cleaning, Mr. Madore fell from the trailer’s roof, resulting in severe injuries including a fractured skull with a frontal hematoma and contusion, along with a broken left ankle and double wrist fractures.

Intact contested Mr. Madore’s application for accident benefits, arguing that the incident did not meet the SABS definition of an “accident”. They asserted that there was no evidence indicating that Mr. Madore’s fall was a result of contact with either the trailer or the automobile. Additionally, they pointed out that there were no witnesses to the fall, and Mr. Madore lost consciousness for several days after the incident, leaving him with no memory of how he fell.

However, the Divisional Court disagreed with Intact’s decision. They affirmed that contact with an automobile was not a prerequisite for defining an accident under the SABS. The crucial question was whether the use or operation of the trailer led to the impairment, not whether Mr. Madore could prove that he tripped on the trailer. The pivotal connection to establish was between the use and operation of the vehicle and the resulting impairment.

Emergency auto mechanic repairing woman vehicle on the street

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 personal injury attorney toronto who knows the insurance and medical systems and is looking out for you.