Falling into the Realm of “Accidents”: Madore v Intact, 2023 ONSC 11
By: Bogdan Miscevic (Partner) and Celine Tuncertan (Summer Law Student)
In a recent case, Madore v Intact, the court granted an appeal and set aside previous decisions, determining that the incident in question qualified as an “accident” under the Statutory Accident Benefits Schedule (“SABS”). This case sheds light on the interpretation of the term “accident” and the ordinary use or operation of a vehicle in the context of insurance claims and emphasizes a broad and inclusive approach. This article provides an analysis of the case, highlighting the key facts, analysis, decision, and the legal principle derived from the judgment.
Clayton Madore (“Madore”) appealed the decisions of the Licence Appeal Tribunal (the “LAT”), which denied his claim for accident benefits under the SABS. Madore suffered serious injuries after falling from the roof of his camper trailer while inspecting and cleaning it. His application for accident benefits was initially denied by the insurer, and the LAT Adjudicator agreed with this denial. The Adjudicator concluded that the incident did not meet the definition of an “accident” under the SABS, as there was no direct causation between the use or operation of the trailer and Madore’s injuries. Madore appealed the decisions, arguing that the Adjudicator erred in applying the causation test.
The main issue in this appeal was whether the Adjudicator erred in determining that the incident did not qualify as an “accident” under the Ontario legislative scheme for compensation for automobile accidents. The analysis focused on the interpretation of the term “accident” and its application to the facts of the case.
The court noted that the Adjudicator’s requirement for evidence of tripping on the trailer was inconsistent with the definition of “accident” and the established test from previous cases. The court emphasized that Madore only needed to show a link between the use and operation of the trailer and his impairment, without proving a direct physical connection between the cause of the injury and the trailer. Several precedents were cited, including the case of Fehr v Intact Insurance Co., which recognized that direct contact with the vehicle is not always necessary to establish causation under an insurance policy.
The court granted the appeal, setting aside the previous decisions and determining that the incident involving Madore qualified as an “accident” under the SABS, seeing as the causal link between the ordinary use and operation of the vehicle and the injury was not broken.
Madore v Intact highlights the importance of a broad interpretation of the term “accident” in insurance claims. The court’s decision emphasizes that an “accident” should be understood as an unexpected and unintended event, encompassing a range of incidents that may not necessarily involve a specific cause or identifiable fault, but that can still be included within the ordinary use and operation of a vehicle. This case reinforces the principle of providing insurance coverage and benefits to individuals who suffer harm where the causal link has not been broken. Insurance companies and claimants alike should take note of this inclusive approach when assessing the applicability of the term “accident” in insurance claims.