If you fall down the stairs at home, could this be considered a car accident?
Published on October 3, 2016
People who are injured in motor vehicle accidents in Ontario are entitled to no-fault accident benefits. Judges and arbitrators have broadly interpreted what is considered a motor vehicle accident. Coverage has even been extended to people who were not even involved in a motor vehicle collision.
In the arbitration decision Shah v. Primmum (FSCO A13-000511), Mr. Shah had applied for automobile accident benefits after falling down the stairs in his home. Mr. Shah had been awoken by his eldest son, who had just seen his brother struck by a car in front of the family home, and had alerted his sleeping father. Mr. Shah got out of bed and ran to his injured son. In doing so he fell down the stairs and was injured.
Mr. Shah applied for no-fault automobile accident benefits. The insurer, Primmum Insurance Company, denied the claim. Primmum took the position that Mr. Shah was not injured in an automobile accident. Mr. Shah sued Primmum to claim benefits, by bringing an arbitration to the Financial Services Commission of Ontario.
The arbitrator considered a similar case, Grewal v. Dominion (FSCO A03–000750). In that case, Mr. Grewal felt his house being struck by a car. While rushing to see whether his children were injured, he fell and was injured himself. The arbitrator concluded that Mr. Grewal was injured in an automobile accident and was entitled to benefits.
In the Shah v. Primmum case, the arbitrator believed that the facts were very similar to the Grewal case. He therefore concluded that Mr. Shah’s incident was an accident and he was entitled to no-fault accident benefits.
The insurance company appealed the decision and it was reversed. The Director’s Delegate hearing the appeal concluded that the Shah case was different from the Grewal case. Unlike Mr. Grewal, Mr. Shah had not seen the accident, nor felt the force of the impact. He knew nothing of the accident until he heard about it from his son. Therefore, it was concluded that the connection to the car crash was indirect. If the connection is not direct, the injury is not considered to result from the use or operation of an automobile.
As you can see, there is a fine line drawn between what is considered an accident and what is not. If you fall down the stairs while running in your house after hearing a car crash, you are probably entitled to no-fault accident benefits. If someone tells you a crash has just happened then you fall down the stairs, your accident benefits claim will probably be denied.
Examples of other situations which can result in a dispute regarding accident benefit coverage include someone slipping and falling on a driveway before or after driving car; someone injured while removing snow from a car; or while repairing their car.
If you have been injured and an automobile may have been involved in the accident, it is recommended that you discuss your case with a personal injury lawyer. You may be entitled to no-fault benefits even when you did not expect it.