The LAT has issued an accident benefits coverage decision, finding a claimant who was assaulted in his vehicle was not involved in an “accident” under the Statutory Accident Benefits Schedule.
Overview of assault and claim
In Addison v Intact, the claimant had just gotten into his car and started the ignition, when he noticed a person was approaching toward his car. He exited the vehicle to see what they wanted, when the person hit him on the head with a baseball bat. The claimant got back into his car, but the assault continued. At some point during the attack, the claimant managed to get away and went inside his house.
As a result of the incident, the claimant applied for accident benefits, claiming he was involved in an “accident”, defined in the policy as “an incident in which the use or operation of an automobile directly causes an impairment”.
The insurer denied the claim, stating the claimant wasn’t in an “accident”.
Adjudicator finds assault is not an “accident”
The claimant disputed the denial and applied to the Licence Appeal Tribunal. The LAT adjudicator agreed with the insurer. Although the claimant satisfied the purpose and causation test, he failed the direct causation test. The adjudicator held that the assault was an intervening act that cannot be said to have happened in the ordinary course of things:
[I]t cannot be said that the applicant’s impairments from the assault were directly caused by the vehicle or that they resulted from the ordinary and well-known use of it just because he was in his vehicle. I find that this assault was not a foreseeable risk related to the operation of the automobile. The use or operation of the motor vehicle – sitting in his parked car — was not the direct cause of the impairment, but rather was caused by an intervening act: an assault by a third party. The use or operation of the vehicle was ancillary to the assault.
…
The use or operation of vehicle was not the dominant feature of this incident, it was the assault. There is no evidence that the use or operation of the vehicle directly caused any injuries whatsoever. The evidence indicates that the applicant’s injuries were caused by an assailant who attacked him with a baseball bat.
Accordingly, the claimant’s claim was dismissed.
Takeaways
Accident benefits coverage cases are usually very fact specific. In this case, there was no evidence that the claimant suffered any injuries arising from the ordinary use or operation of the automobile. Like most assault cases, a claimant will usually face an uphill battle trying to prove coverage if their physical injuries were caused by a fist or weapon.
Are you handling an accident benefits claim caused by an assault? Give me a shout.
See Addison v. Intact Insurance Company, 2025 CanLII 3770 (ON LAT)
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