What is “Accident” in Accident Benefits?

Often times, we travel on our local roads and see accidents involving automobiles. We hope for the well being of individuals in these situations. As claimants file their claims with the insurance company, the author reveals he frequently helps clients understand whether their situation is an “accident.”

The usual claims involve slip and fall situations involving automobiles. In fact, the definition of an “accident” is 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.”

The reason for this inquiry is simple because the insurance firm must adhere to the legislation in order to fulfill the claims.

Prior legislation in Bill 164 defines “accident” to include those incidents where an automobile “indirectly” caused impairment. Later legislation in Bill 59 drops “indirectly” from the provision.

However, a particular number of decisions at FSCO over the years did not help the public understand the scope of accident benefits. For example, in reference to the case Whipple v. Economical Mutual Insurance Co., 2011, we find an accident in a 62 year-old man doing a headstand against a stripper pole at the back of a moving limousine bus.

Clearly, the story does not inspire confidence.

However, recent case law (1, 2) suggests a more rigorous analysis in the form of 2 tests:

  1. The purpose test: did the incident arise out of the use or operation of an automobile
    • The injuries were caused by the use or operation of an automobile.
    • Is there a direct chain of causation between the use or operation of an automobile and the injuries?
  2. The causation test: did such use or operation of an automobile directly cause the impairment?

Hopefully, the precedent case law can bring clarity to claimants.

Find example cases in the source link and test yourself with new accident benefits knowledge.

Ho Cheung Chan is a Paralegal student at Centennial College in Toronto studying professional communications with Omar Ha-Redeye.

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