Definition of an Accident

"accident" means an incident in which the use or operation of an automobile directly causes an impairment or directly causes damage to any prescription eyewear, denture, hearing aid, prosthesis or other medical or dental device; (SABS as of 2007-06-14)

Many situations that might seem at first glance to not meet the definition of accident actually do. If you have any doubt you should contact your insurer or a lawyer to discuss your particular circumstances. The definition of accident uses the descriptor of directly causing the impairment but, if the accident sets into motion a chain of events leading to injury without any intervening act, it may well meet the definition of an accident. Therefore, the definition of accident incorporates the concept of causation.

Causation

The insured, the insurer and the treatment team need to examine what injuries and limitations were caused by the accident. Then, in accordance with the guiding principals noted above, attempt to mitigate those losses. Insurers will examine a case closely to determine what injuries, and limitations were caused by the accident and focus interventions on those issues. An insurer is not responsible for bettering an individual's circumstance.

Some injuries and limitations are directly caused by the accident, others indirectly. The accident benefit insurer is responsible to deal with both direct and indirect injuries and limitations and the consequences of those issues.

"When one thinks of direct causation one thinks of something knocking over the first in a row of blocks, after which the rest falls down without the assistance of any other act." (Chisholm v. Liberty Mutual Group)

Direct Causation

An example of direct causation might be an individual who was studying to be a carpenter prior to the accident. His injuries are such that he will never be able to pursue a career as a carpenter. It was therefore the accident that caused that person to become unable to pursue a career as a carpenter. In that circumstance the auto insurer should examine what alternate career he could enter without further education and if there is no viable alternative, explore an alternate educational program.

Direct Causation that Appears Indirect

Often individuals develop a chronic pain or a psychological reaction over time. Even though the accident did not initially cause the chronic pain syndrome or other reaction, it set into motion a set of circumstances that did. In such circumstances, the insurer would be responsible to address and mitigate those issues. They are a direct result of the accident unless some other event intervened.

The cases of Correia and TTC Insurance Co. (FSCO P00-00061, July 16, 2001) and Papp v. LeClerc provide examples of indirect causation. Arbitrator Makepeace (FSCO A00-000045, October 27, 2000), that:

New injuries clearly may be related to an impairment sustained in the accident. The arbitrator gave examples of cases in which someone fell down the stairs due to dizziness related to, or a knee weakened from, the effects of an accident and sustained new injuries. Those new injuries can be viewed as a direct consequence of the accident and a result of it. Likewise, if someone undergoes surgery for accident-related problems and, through no one's fault, suffers new impairment in the course of the operation, such consequences are directly traceable to the accident.

Papp v. LeClerc

Every tortfeasor causing injury to a person placing him in the position of seeking medical or hospital help, must assume the inherent risks of complications, bona fide medical error or misadventure, and they are reasonable and not too remote. . . . It is for the defendant to prove that some new act rendering another person liable has broken the chain of causation.


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