Fall outside home did not constitute an 'accident' under the Statutory Accident Benefits Schedule.
The applicant sought statutory accident benefits after suffering a catastrophic impairment from a fall.
The insurer denied the claim, arguing the fall did not involve the use or operation of an automobile.
At a preliminary issue hearing, the applicant claimed he fell while exiting his vehicle when the passenger door blew back in the wind.
The arbitrator reviewed conflicting documentary evidence, including ambulance and hospital records, and a 911 call, none of which mentioned a vehicle.
The arbitrator rejected the applicant's version of events, finding the fall did not involve an automobile, and concluded the applicant was not injured in an 'accident' under section 3(1) of the Statutory Accident Benefits Schedule.
OFSCDRSOntario Financial Services Commission - Dispute Resolution ServicesOct 28, 2015
