Licence Appeal Tribunal says incident can be considered an accident
In a matter involving an incident where a pick-up truck crashed into a house, the Licence Appeal Tribunal found that the homeowner was an insured person involved in an accident under s. 3(1) of the Statutory Accident Benefits Schedule.
On June 29, 2023, the applicant in Poisson v. Intact Insurance Company, 2026 CanLII 56639 (ON LAT), and his partner were sleeping in their bedroom on the second floor of their house. At 4:30 a.m., they woke up when a pick-up truck crashed into the first floor.
The impact set off smoke detectors, flashing strobe lights, and a voice command shouting, “fire, fire, fire.” The applicant walked downstairs and saw the pick-up truck embedded in his home and a person lying on the driveway, whom he assumed was dead. He called 911.
Until at least July 5, 2024, the applicant could not use his house, which sustained extensive damage. He had to switch accommodations multiple times.
Under his personal motor vehicle policy, the applicant applied for accident benefits and requested funding for psychological treatment.
The applicant alleged that he experienced fear and panic immediately after the pick-up truck’s impact with his home, which directly caused his post-traumatic stress disorder (PTSD) and other diagnosed psychological injuries.
The respondent insurance company denied coverage for accident benefits upon finding that the applicant was not an “insured person” involved in an “accident” under s. 3(1) of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016).
Before the Ontario Licence Appeal Tribunal’s Automobile Accident Benefits Service, the applicant applied for a resolution of the dispute.
After a preliminary issue hearing, an adjudicator of the tribunal determined that the applicant was an insured person involved in an accident under s. 3(1) of the Schedule. The adjudicator ordered the application to proceed to a hearing on the substantive issues.
In finding that the incident was an “accident” as defined in s. 3(1) of the Schedule, the adjudicator first addressed the purpose test, or whether the incident arose from the use or operation of an automobile.
The adjudicator decided that the case met the purpose test because the incident occurred when a third-party driver drove – an ordinary and well-known activity for automobiles – his pick-up truck into the applicant’s home.
Based on the evidence, the adjudicator found that the applicant’s psychological impairments resulted from the pick-up truck’s impact on his house, which woke him up, made him see the strobe lights and hear smoke detectors and the warnings, and caused him panic.
The adjudicator rejected the respondent insurer’s argument that the applicant’s psychological injuries arose because he witnessed the aftermath of the incident.
Next, the adjudicator tackled the causation test, or whether the use or operation of an automobile directly caused the impairment.
First, the adjudicator determined that the applicant’s psychological impairments would not have occurred “but for” the use or operation of the vehicle.
The adjudicator explained that the applicant’s psychological injuries would not have arisen if not for the pick-up truck crashing against his home, waking him up suddenly and jolting him out of bed, and setting off the smoke detector, strobe lights, and warnings.
Second, the adjudicator ruled that the pick-up truck’s impact on the applicant’s house directly caused his psychological impairments, without an intervening cause severing the chain of causation.
The adjudicator discerned a series of uninterrupted events resulting from the use or operation of the vehicle.
Third, the adjudicator held that the pick-up truck’s crash against the applicant’s house was the dominant feature of the incident, which directly caused his psychological injuries.
The adjudicator found it reasonable that a traumatic experience of the incident would cause an ordinary person a psychological impairment.
On a balance of probabilities, the adjudicator determined that the applicant was “involved” in the accident under s. 3(1)(a)(i) of the Schedule and was thus an “insured person” under s. 3(1).
The adjudicator reiterated that the applicant’s injuries arose directly from the use or operation of the vehicle, not from the aftermath of the accident.
