LAT Rejects Benefits Claim Involving Spilled Beverage

When does an injury suffered in a motor vehicle not count as a motor vehicle accident? That was the question at the centre of M.P. vs. Allstate Insurance Company of Canada, a recently resolved accident benefits dispute. The case provides additional context for car accident lawyers involved in non-traditional accident benefits claims.

The Facts of the Case

According to a June report from Law Times, the applicant in the case purchased a cup of hot tea at a fast food drive through window. She left the restaurant, stopped at a red light, and noticed that the lid wasn’t secured. She picked up the tea from its tray on the passenger’s seat, attempted to secure the lid, and then spilled the tea as she attempted to place it in the automobile’s cup holder. She filed for benefits under Ontario’s Statutory Accident Benefits Schedule (SABS).

The plaintiff’s insurance provider, Allstate Insurance Company of Canada, argued that the plaintiff was not eligible for accident benefits as her injuries were unrelated to the normal use of an automobile. Instead, Allstate suggested the fast food employee who handed the plaintiff the tea may have been negligent. The plaintiff herself may also have contributed to her injuries.

Background: What are Statutory Accident Benefits?

Most auto insurance policies in Ontario guarantee benefits for injuries in motor vehicle accidents, regardless of who is at fault. The amount of benefits depends on the severity of the injuries and are applied based on the province’s SABS.

Some of the benefits available under the SABS include income replacement benefits, non-earner benefits, benefits to cover the costs of attendant care, medical care, and rehabilitation, death and funeral benefits, and more.

When an insurance policy holder and an insurance provider do not agree on the amount of benefits being provided, they may seek a resolution from Ontario’s Licence Appeals Tribunal.

Background: What is the Licence Appeals Tribunal?

According to its website, the Licence Appeals Tribunal (LAT) is “an independent, quasi-judicial agency and is one of five tribunals in the Safety, Licensing Appeals and Standards Tribunals Ontario (SLASTO) cluster.”

The LAT contains two divisions: General Service and Automobile Accident Benefits Service (AABS). The latter’s mandate is to “resolve disputes about an insured person’s entitlement to, or amount of, statutory motor vehicle accident benefits.”

What Did the LAT Decide?

The LAT agreed with Allstate’s assertion that the plaintiff’s injuries were unrelated to the normal operation of a motor vehicle, and decided that the plaintiff was not entitled to accident benefits.

“Nothing about the vehicle caused her to spill the tea,” wrote tribunal adjudicator Therese Reilly. “The fact that she was in a vehicle was simply incidental.”

In coming to this decision, the LAT examined Dittmann v Aviva Insurance Company of Canada, a 2016 case that also involved a spilled beverage and a drive through window. In that case, the plaintiff was injured when a hot coffee was spilled as it was passed from the window into the automobile. The LAT decided in the plaintiff’s favour, reasoning that she would not have been at the drive through window if she had not been in an automobile, and she would not have been injured if she were not wearing a seatbelt. Importantly, no intervening events took place between accepting the drink and the injury.

The LAT also applied two tests to determine the automobile’s involvement in M.P.’s injuries. The first was the ‘purpose test,’ which asks whether the injury resulted from the ordinary use of the vehicle. The second, the ‘direct causation test,’ asked whether use or operation of the vehicle caused the injuries.

While the LAT’s decision was not in favour of the plaintiff in M.P. vs. Allstate Insurance Company of Canada, it also helps to clarify the ruling in Dittmann v Aviva Insurance Company of Canada and provide added context for car accident lawyers interested in pursuing similar cases.

Contact Will Davidson LLP to discuss your claim

If you’ve been injured in an automobile accident, contact Will Davidson LLP’s car accident lawyers to schedule a free, no-obligation consultation. Our experienced team can help you access the fair and reasonable compensation you deserve.

Will Davidson LLP’s car accident lawyers work on a contingency basis, meaning we will not charge hourly or up-front legal fees for our services. Instead, our team will accept a percentage of the final settlement as payment. This approach allows us to offer access to justice to every Ontarian in need, regardless of their financial circumstances.

With decades of experience in every manner of personal injury claim, Will Davidson LLP is a strong, reputable ally for injured Ontarians. Contact us today to learn more about how our experienced team can help.

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Licence Appeal Tribunal mired in controversy

Ontario’s Licence Appeal Tribunal (LAT), the body in charge of resolving accident benefits disputes between injury victims and insurance companies, was consumed by controversy last month when a top-ranking official was revealed to have meddled in an insurance claim. The event seized the attention of other provincial adjudicating bodies and prompted concern from Ontario personal injury lawyers.

The Case

In 2012, Mary Shuttleworth suffered a traumatic brain injury and tissue damage in a two-car collision near Dundalk, Ontario. Her injuries left her with persistent nausea, vertigo, and stress. She is unable to work.

Despite her impairment, her insurance company, Peel Mutual, informed her that her injuries were not considered “catastrophic,” a designation that would have entitled her to up to $2-million in benefits. Her “non-catastrophic” injuries made her eligible to receive less than $90,000.

Shuttleworth appealed the insurer’s decision to the Licence Appeal Tribunal. It was the first dispute relating to catastrophic injury designation that the newly formed body was asked to resolve.

The LAT adjudicator for the case, Susan Sapin, eventually sided with the insurer and denied Shuttleworth’s claim for additional benefits.

The Controversy

In the months after Shuttleworth’s claim was denied, her legal team team received an anonymous letter accusing Linda Lamoureaux, head of the Safety, Licensing Appeals and Standards Tribunal, of interfering with Sapin’s decision.

“I have heard from reliable source that Sapin’s initial decision was that this was a catastrophic impairment. Linda Lamoureaux changed the decision to make the applicant not catastrophically impaired,” the letter read, per the CBC. “Thought you should know that the decision was not made by an independent decision maker who heard the evidence.”

Shuttleworth’s team filed a Freedom of Information and Protection of Privacy Act application for documents that would back up the letter’s allegations. The request produced an email chain showing that Lamoureaux’s unsolicited review of Sapin’s decision led to the ruling being changed.

Ruling Overturned

After review by a three-judge Divisional Court panel, the LAT’s ruling on Shuttleworth’s claim was overturned.

“Justice must not only be done; it must be seen to be done,” wrote Justice Julie Thorburn. “An informed, cautious observer would have a reasonable basis to believe that the decision did not reflect the independent decision of the adjudicator.”

Fallout

While Justice Thorburn stressed that the court found no evidence of “any actual impropriety having occurred,” the episode has shaken the trust of Ontario personal injury lawyers and their clients in the fairness of the system. Many injury victims already believe that the system is stacked against them, and this event will only worsen the relationship.

If you or someone you love has been injured in a car accident, contact the Ontario personal injury lawyers at Will Davidson LLP to learn how we can help.

 

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