In the recent case of David v. Aviva General Insurance Co., the Ontario Superior Court of Justice determined that a slip-and-fall accident constituted an “accident” for the purposes of the Statutory Accident Benefits Schedule.
This blog post will summarize the court’s decision and will explain what this case means for personal injury claimants.
What are Statutory Accident Benefits?
Under Ontario’s Insurance Act, individuals injured in motor vehicle accidents who need medical or rehabilitative treatment are entitled to receive benefits while their dispute is being resolved. This ensures that you can access the benefits you deserve without waiting for your case to settle or go to court.
Medical benefits will cover all “reasonable and necessary” expenses for the injured person. This includes common treatments like chiropractic care, psychological services, occupational therapy, physiotherapy, and transportation to and from treatment sessions. The Statutory Accident Benefits Schedule offers a detailed list of covered treatments. Moreover, if a person is eligible for income replacement benefits, their insurer will pay them “for the period in which the insured person suffers a substantial inability to perform the essential tasks of his or her employment or self-employment.”
Under the Statutory Accident Benefits Schedule, “accident” is defined in section 3 as an incident in which the use or operation of an automobile directly causes impairment or causes damage to any prescription eyewear, denture, hearing aid, prosthesis, or other medical or dental device.
Plaintiff Injured While Unlocking Her Car
In David v. Aviva General Insurance Co., the plaintiff was walking towards her parked car in November 2017 when she slipped and fell on black ice. The plaintiff had been “one step” away from her car and was in the process of unlocking the vehicle with an intelligent access key.
As a result of the slip and fall, the plaintiff suffered an injury to her left shoulder (resulting in surgery), along with headaches, blurred vision, pain in various parts of her body and emotional and psychological distress.
Plaintiff Brings Application for Denied Accident Benefits
The plaintiff’s first-party insurer, Aviva, accepted her claim for accident benefits while denying others. As a result, the plaintiff applied to the Licence Appeal Tribunal to challenge her insurer’s decision regarding benefits.
During the application process, Aviva brought a motion for a determination regarding whether the plaintiff had been injured in an “accident” such that she would qualify for accident benefits under s. 3(1) of the Statutory Accident Benefits Schedule.
Licence Appeal Tribunal Determined Plaintiff’s Fall Was Not an “Accident”
The Licence Appeal Tribunal considered Aviva’s motion and determined that the plaintiff had not demonstrated that her fall constituted an “accident” as defined in s. 3(1) of the Statutory Accident Benefits Schedule. As a result, the plaintiff’s application was dismissed.
Following the dismissal, the plaintiff requested a reconsideration of the Tribunal’s decision. This request was also denied. The plaintiff appealed the decision to the Superior Court of Justice.
Parties’ Positions Regarding the “Accident”
The plaintiff advanced two arguments at trial. The first related to procedural fairness, which was dismissed by the Court. The second argument related to the decision not to classify her fall as an accident that would fall within the definition outlined in the Statutory Accident Benefits Schedule. Notably, the plaintiff argued that the Licence Appeal Tribunal committed an error of law by finding that there was no causation between her injury and the use or operation of her motor vehicle.
Aviva took the opposite position, arguing that the plaintiff had not been injured in an accident under the Statutory Accident Benefits Schedule.
Court Concludes that the Fall Constituted an Accident
The Court began by noting that the Statutory Accident Benefits Schedule should be considered consumer legislation and read with that goal in mind. Therefore, the Statutory Accident Benefits Schedule must be interpreted generously and with the objective of supporting victims of motor vehicle accidents. With this framework in mind, the Court determined that the plaintiff’s injury qualified as an “accident” under s. 3(1) of the Statutory Accident Benefits Schedule and the Licence Appeal Tribunal had erred in its determination.
The court reasoned that in the course of using her intelligent key to unlock and enter her vehicle, the plaintiff’s actions constituted a direct and ordinary use of the car. The Court referenced a similar case, Seung v. Cooperators General Insurance Co., wherein an individual was also found to have been injured in an “accident” despite the fact that they had not been actively operating their vehicle.
Slipping on Black Ice is Not an Intervening Accident
The Court further found that the black ice the plaintiff slipped on was not an intervening cause. Rather, the black ice was a fortuitous element of the action. Ultimately, the use of the plaintiff’s car was directly connected to her injuries and, as a result, the Court found that she had sustained her injuries during an “accident” as defined by the Statutory Accident Benefits Schedule.
The Court reinstated the plaintiff’s application for accident benefits, and the application was referred back to the Licence Appeal Tribunal to consider Aviva’s denial of certain accident benefits. Aviva was also ordered to pay $17,500 towards the plaintiff’s legal costs.
What Does This Case Mean For Personal Injury Claimants?
This case is an important reminder not to take denial of benefits at face value. As noted by the Court, the purpose of the Statutory Accident Benefits Schedule is to support injured parties. As a result, cases where a victim may believe that they are not entitled to accident benefits—or where they are denied by their insurer—may nonetheless result in approval of benefits.
Furthermore, this case demonstrates that the courts take a generous approach in their definition of a motor vehicle “accident”. While a slip and fall might not look like a motor vehicle accident on its face, it may attract accident benefits depending on the circumstances in which the fall took place (in this case, unlocking your vehicle).
Contact Campbell Litigation in Waterloo for Assistance With Your Personal Injury Claim
The experienced personal injury law team at Campbell Litigation regularly helps individuals who have been denied specific accident benefits or have had their benefits terminated after an accident. We provide each client with an assessment of their circumstances and advise them on their rights and options moving forward. To speak with an experienced personal injury lawyer, call us at 519.886.1204 or contact us online today.
