One of the reasons we have automobile insurance is that, if we become injured in a motor vehicle accident, we can make a claim against our automobile insurance company to cover our losses. The same applies to any passengers, pedestrians, cyclists and others involved in the accident – anyone injured in a car accident can claim for statutory accident benefits (SABs) against the insurer of the driver/owner of the vehicle in which they were an occupant or the insurer of another driver involved in the accident.
What might be surprising to many people is that we may also be eligible for accident benefits when we’re injured while ‘using a vehicle’ but no 'accident' occurred. This circumstance was the subject of a 2018 car accident claim involving a taxi driver who developed serious back problems after he sat in a collapsed driver’s seat. The man subsequently filed a claim for accident benefits against the insurer of his personal vehicle, State Farm Mutual Automobile Insurance Company. His claim was accepted and then State Farm commenced a priority dispute to recover the amount paid from the taxi insurer, Economical Mutual Insurance Company. Economical rejected the claim on the basis that the driver’s injuries were not caused by an ‘accident’ and he was therefore not eligible for SABs.
The arbitrator for this case decided that the driver’s claim did, in fact, arise from an accident. Further, because Economical was the priority insurer and the owner of the vehicle that caused the claimant’s injuries, Economical was obligated to pay the amount being claimed. And, on appeal, in State Farm Mutual Insurance Company v. Economical, the Court agreed with the arbitrator’s decision.
Background and Analysis
The claimant, Mr. Newman was 66-years of age, with 40 years experience as a taxi driver, and was employed as a cab driver in Oshawa, at the time of the incident in question. One day, at the start of his shift, Mr. Newman noticed that one side of the driver’s seat in the taxi had collapsed, and he reported this fact to the manager. No action was taken in repairing the seat, so Mr. Newman continued to drive the taxi for 6 shifts over a 10-day period. The odd angle of the collapsed seat forced Mr. Newman to sit in an awkward position and after 3 shifts, he began to suffer back pain. At this point, he visited his family physician and she noted that the claimant’s back pain had increased. Mr. Newman drove 3 more shifts which caused his back pain to worsen to the extent that he was forced to request some time off work to seek treatment and recover from his injury. Unfortunately, the claimant was never able to return to work.
After Mr. Newman stopped working, he again saw his doctor and she gave the opinion that his back pain was triggered by the awkward car seat. X-ray imaging showed that the claimant had a narrowing of his disc space in two locations on his lower back as well as ‘grade 3’ spondylolisthesis (slipped vertebrae). The claimant was referred to a physical and rehabilitation physician who noted that Mr. Newman’s spondylolisthesis occurred before the collapsed seat incident, but this pre-existing condition likely became symptomatic due to the unusual stressor of the seat. Mr. Newman was later examined by two orthopedic surgeons, one of whom believed the back injury resulted from the claimant’s pre-existing injury, rather than the car seat. The second orthopaedic surgeon, Dr. Fern, was of the opinion that the defective seat was the cause of Mr. Newman’s injury.
In making their decision, the arbitrator rejected Economical’s assertion that the claimant’s back injury resulted from the long-term effects of driving. Instead, the arbitrator concluded that, although Mr. Newman clearly had a pre-existing back condition, his back injury was caused by the defective seat in the taxi. The arbitrator based this decision on the fact that the claimant’s severe back pain began immediately after driving in the collapsed seat, as well as evidence from the radiology reports, his family physician’s notes, and opinion evidence given by the orthopedic surgeon, Dr. Fern.
Under the Insurance Act, SABs regulation section 3(1), an accident is defined 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.” Although the Act does not define what is meant by ‘an incident’, it does define an impairment as “a loss of abnormality of a psychological, physiological or anatomical structure of function”. The arbitrator dismissed Economical’s argument that it was necessary to pinpoint the exact moment when the claimant’s accident occurred and instead, found that the circumstances of Mr. Newman’s injury fell under the definition of ‘an accident’ for the purposes of the Insurance Act. And, as the arbitrator ruled that Economical was the priority insurer, they are liable for the claim.