**Please note: this article discusses abuse**
When a car accident happens leading to an insurance benefits dispute between a claimant and their insurance provider, the claimant must prove that the accident caused their injuries to succeed. Without establishing causation, a claimant will not be entitled to payment of benefits. Thus, causation is a crucial step in determining whether a claimant is entitled to payment of statutory accident benefits.
This key point was the focus of the recent case Buma v TD Insurance Meloche Monnex, 2024 ONLAT, where the Ontario Licence Appeal Tribunal’s failure to adequately address the issue of causation was placed under strict scrutiny, ultimately resulting in an order for a rehearing of the case.
The facts are simple. The applicant, Ms. Buma, was involved in a car accident and consequently sought payment of accident benefits from her insurer pursuant to the Statutory Accident Benefits Schedule (SABS). A bystander to the accident provided dashcam footage capturing the crash. Upon viewing this footage, Ms. Buma recognized a house in the background at the scene of the accident in which she previously resided and was the victim of abuse. Ms. Buma argued that her viewing of this video triggered a resurfacing of psychological trauma that exacerbated her pre-existing psychological issues. Ms. Buma further submitted that but for the accident, she would not have experienced the trauma and therefore, the accident is the cause of her current impairments. In other words, Ms. Buma argued that the car accident caused her psychological injury and therefore, the insurance policy should cover this injury.
In the original decision, the Tribunal held that Ms. Buma’s viewing of the dashcam footage and noticing the house in which she once resided was not an “accident” as defined under s.3(1) of the SABS because it was not related to the operation or use of an automobile. Thus, Ms. Buma was not entitled to benefits beyond the Minor Injury Guideline, or MIG, because her psychological injuries sustained were not due to an “accident”.
However, upon reconsideration, Vice-Chair Louise Logan of the Tribunal held that this decision was in error. As the Tribunal explained, the issue was not whether there was an “accident” as defined under SABS. Instead, the question before the Tribunal that needed to be addressed was whether there was a sufficient causal connection between the car accident captured by the dashcam footage and Ms. Buma’s psychological injuries. By failing to identify and properly address the correct legal issue, it was held that the Tribunal committed an error of law. Whether there was an “accident” was not in dispute between the parties. In fact, it was agreed that there was an accident involving a motor vehicle as defined by s.3(1) of the SABS. Thus, by misidentifying the issue and focusing on whether there was an accident, the Tribunal erred in applying the Ontario Court of Appeal’s two-part test for what constitutes an “accident” from Greenhalgh. The Tribunal should have instead applied the test for causation to determine whether the car accident, the occurrence of which was undisputed, caused the psychological injuries claimed by Ms. Buma.
Applying the test for reconsideration under Rule 18.2 of the Licence Appeal Tribunal Rules, 2023, the Tribunal held that the outcome of the decision would likely have been different had the correct issue been identified. In the original decision, the Tribunal held that Ms. Buma was subject to the MIG and not entitled to payment of treatment plans, an income replacement benefit, interest, or an award. However, this was based on a finding that there was no accident for which benefits could be paid out. This error of law was sufficient to support the remedy of a rehearing of the issues in dispute by a new adjudicator.
To be clear, the tribunal did not provide a legal determination as to whether the car accident caused Ms. Buma’s psychological injury and, as of now, this question has still not been answered. However, this case reminds us of the importance of identifying the right issues and applying the correct legal tests to resolve a dispute. Otherwise, clients and lawyers alike might accumulate unnecessary expenses where they could have been avoided.
Daniel Hinds is a summer student at ZTGH and the author of this blog. If you have any questions about this blog, please contact Daniel by email at [email protected].
