Ontario's Licence Appeal Tribunal denied a driver accident benefits, ruling her gas-station head injury was not an "accident" and her claim came too late.
The decision released June 22, 2026, turned on two questions - whether an incident qualifies as an "accident," and whether a late claimant has a reasonable explanation for delay.
On November 24, 2023, the claimant parked beside a gas pump, stepped out, and struck her head on a metal fixture overhanging the pump structure. She sought statutory accident benefits. Co-operators denied the claim, arguing the event was not an automobile accident and that she gave notice too late.
Under the two-part test from Economical Mutual Insurance Company v. Caughy, both sides agreed the incident met the purpose test. The dispute was causation. The adjudicator accepted that "but for" parking at the pump the injury would not have happened, but noted this alone does not establish legal causation.
Reviewing video surveillance, the adjudicator found the claimant moved away from the vehicle while looking at her phone and struck her head as she stepped up onto a median. That step, she held, was an intervening act that broke the chain of causation - not a normal risk of using a car, but "a flaw in the layout of this particular gas pump median with overhang fixture."
The adjudicator distinguished Davis v. Aviva General Insurance Co., where black ice was fortuitous rather than an intervening cause, noting the median and overhang were a fixed, visible object. She also set apart Miceli v. TD Insurance, a coffee-spill case, because there the injured person was inside the vehicle and unable to avoid the harm. The dominant feature here, she found, was striking the head on the fixture. The incident was not an "accident" under the Schedule.
The Tribunal then addressed notice. The claimant filed her application for benefits in November 2024, roughly a year after the incident. She argued genuine uncertainty about whether the event was an "accident" until a related court decision was released on May 31, 2024, plus time needed to obtain insurance details for a vehicle she did not own, and a significant mental health history.
The adjudicator was unpersuaded. Ignorance of the law, she noted, is not on its own a reasonable explanation. Despite retaining counsel on July 1, 2024, the claimant did not file for nearly five more months, and her submissions on that gap were vague and unsupported by evidence. Because the explanation was not credible, there was no need to weigh its reasonableness.
The application was dismissed. The claimant was barred from proceeding under section 55(1) of the Schedule.
