SABS Update – Car Accident Causes Fall Down Stairs
For the week of July 14 to July 18, 2014
Amjid Ali Shah v. Primmum Insurance Company
On July 22, 2009, 6-year-old Omar was struck by a car in front of his family home. Omar’s 11-year-old brother witnessed the accident and ran to tell their father, Mr. Shah, who was sleeping in the upstairs bedroom. Awoken by news of the accident, Mr. Shah rushed to find Omar but in the process fell down the stairs and suffered injuries.
Mr. Shah applied for statutory accident benefits from Primmum Insurance Company (“Primmum”). He claimed benefits for physical and psychological injuries sustained as a result of his fall and psychological and mental impairments related to Omar’s injuries. Primmum conceded that Mr. Shah was eligible to receive benefits for psychological and mental impairments related to Omar’s injuries but denied that he was entitled to benefits for injuries related to his fall.
Section 2(1) of the Statutory Accident Benefits Schedule (the “Schedule”) defines “accident” as an incident in which the use or operation of an automobile directly causes an impairment. The Schedule requires Mr. Shah to prove, on the balance of probabilities, that he was involved in an “accident” to be eligible to receive benefits for injuries related to his fall.
To be involved in an accident means to be involved in an accident in which a motor vehicle “directly causes an impairment.” The arbitrator identified two tests, each of which need to be satisfied independently, to determine whether Mr. Shah had been involved in an accident:
(a) The Purpose Test – Does the first link in the chain of events involve the operation of a motor vehicle in an ordinary and well-known activity for a motor vehicle?
(b) The Causation Test – Was the response natural, appropriate, and directly caused by the accident?
In this case, the use of the motor vehicle set in motion a chain of events beginning with the striking of Omar, followed by the witnessing of the accident by the eldest son, leading to his run to his father’s bedroom, leading to Mr. Shah’s immediate panicked response, leading to Mr. Shah’s fall on the stairs. The arbitrator found that the purpose test was satisfied as the sequence of events was initiated by the operation of a motor vehicle on a residential street which is an ordinary and well-known activity for a motor vehicle. The arbitrator also found that the causation test was satisfied as there was an unbroken chain of events between Omar being struck by the car and Mr. Shah falling down the stairs. Mr. Shah’s response in rushing to the aid of his injured child was both natural and appropriate. Accordingly, the arbitrator found that Mr. Shah was eligible for benefits related to his fall.
Previous decisions have focused on whether a motor vehicle accident was a direct or dominant cause of the injuries, which was a rigid interpretation of the Schedule. Conversely, this decision focuses on whether the response to the motor vehicle accident was natural and appropriate, which is a more flexible interpretation that serves to expand the field of eligible claimants.
It will be important for parties injured in connection with motor vehicle accidents to consider carefully whether they are eligible for benefits under the Schedule as they may be eligible for benefits that on first blush appear too remote.
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