The insurer was granted leave to appeal an arbitrator’s decision which had determined that an incident involving an ATV was an “accident” as defined under the Ontario Statutory Accident Benefits Schedule, O. Reg. 34/10.

[2016] O.J. No. 1855

2016 ONSC 2334

Ontario Superior Court of Justice

April 6, 2016

R.F. Goldstein J.

The insured was involved in an accident while riding an ATV on her boyfriend’s property. Her insurer (“insurer 1”) initially paid her benefits, but later stopped payment on the basis that the incident was not an “accident” as defined under the Ontario Statutory Accident Benefits Schedule, O. Reg. 34/10 (“SABS”). The boyfriend’s insurer (“insurer 2”) denied the claim on the basis that the insured had already commenced an accident benefits claim with insurer 1. The matter was referred to an arbitrator who determined that an ATV met the test for an automobile, which was not defined under SABS, and that the incident met the definition of an “accident”. The question in this decision was whether insurer 1 should be granted leave to appeal the arbitrator’s decision.

The court held that the proposed appeal concerned a question of law because the issue between the insurers was one of statutory interpretation. There were no facts in dispute. Rather, the dispute concerned which insurer was obliged to pay the insured and the answer turned on whether the definition of accident was met. Further, the court noted that this was not a contractual dispute between the insurers. Turning to the specifics of the test, the court was satisfied that leave to appeal should be granted because the appeal was important as there was a great deal of money involved for the insurance industry and the appeal would resolve the question in dispute.