Accident benefits claim dismissed as applicant failed to prove injuries resulted from a motor vehicle accident.
The applicant claimed statutory accident benefits after allegedly being struck by a vehicle and hitting his head on a concrete planter.
The insurer stopped paying benefits and later raised the preliminary issue that the incident did not meet the definition of an 'accident' under the Schedule, while also seeking repayment of benefits already paid.
The arbitrator held that the insurer was not estopped from raising the 'no accident' defence.
On the merits, the arbitrator found the applicant failed to prove on a balance of probabilities that his injuries were caused by the use or operation of a motor vehicle, citing significant inconsistencies in witness testimony and timing.
However, the insurer's claim for repayment was dismissed as it failed to prove the applicant made wilful misrepresentations.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesMar 13, 2015
