What auto insurers need to deny coverage based on alleged suicide attempt

If an insurer needs to deny auto coverage to an injured driver on the premise of an alleged suicide attempt, the insurer’s claims investigation will need to transcend the police or medical stories alleging suicide, the Ontario Licence Appeals Tribunal (LAT) has dominated.

Most significantly, the insurer will need the authors of the paperwork — on this case, the police or medical professionals — to testify to corroborate the premise of their allegations.

In R.S. v. Optimum Insurance coverage Firm, a person recognized as ‘R.S’ in tribunal paperwork utilized for accident advantages after he was injured in his 2000 Volkswagen Jetta on Could 1, 2016. He was driving on a secluded, forested two-lane street on or close to the grounds of an area faculty in a small metropolis in northern Ontario, the place he swerved off the street and struck a rock face.

“[R.S.] submits that regardless of his lengthy historical past of psychological well being points and dependancy, and even contemplating that he has mentioned earlier than that he would finish his life, he has by no means acted on these suicidal ideas and didn’t act on them on Could 1, 2016,” in accordance to a abstract of his place by the LAT.

R.S. testified his actions earlier than and after the crash have been inconsistent with these of a suicide attempt.

Amongst different issues, he testified that, earlier than the crash, he’d requested his son to be a part of him on a drive to a meditation spot close to the crash scene. The son declined. Secondly, when he crashed on his approach to a documented AA assembly, he instantly sought medical consideration. Additionally, he was driving the pace restrict on the time, or at a pace so low that his automotive’s air baggage didn’t deploy.

Nonetheless, Unica denied advantages, alleging R.S. was trying to use his automobile to commit suicide. The authorized definition of an accident is when accidents occur in the course of the ‘abnormal course’ of working a automobile; intentionally crashing the automotive in a suicide attempt isn’t a standard danger of utilizing or working a automotive.

Unica relied on police information of the scene investigation, in addition to a report from one of many hospital’s medical professionals who noticed R.S. shortly after the crash.

“The conclusion that [R.S.] was trying suicide along with his automobile seems to have began with the law enforcement officials on the scene,” LAT vice chair Avril A. Farlan wrote in a ruling issued Thursday.

“Whereas the police constable’s handwritten notes dated Could 1, 2016, point out the applicant mentioned, ‘he had been feeling down recently — points along with his spouse,’ this seems to be in response to a query from the officer about ‘…stress in his life,’” Farlan wrote. “The motorcar accident report goes additional and information that the applicant ‘…failed to negotiate slight bend within the street (purposely/suicide attempt)…’ and signifies ‘code 33. Suicide attempt.’”

The premise for this conclusion isn’t clear from the law enforcement officials’ notes, nor the motorcar accident report, Farlan wrote. “From their notes, the law enforcement officials don’t seem to have requested the applicant if he had tried suicide along with his automobile in the course of the incident and the applicant doesn’t seem to have mentioned this to them. Neither police officer testified on the listening to.”

The emergency room physician additionally recommended the crash may have been the results of a suicide attempt. However Farlan downplayed the emergency physician’s credentials to make such a declare.

As an alternative, the LAT vice chair most well-liked the evaluation of the hospital psychiatrist, who launched R.S. from hospital the day after the crash.

“I discover this medical evaluation [by the hospital psychiatrist] is extra seemingly than not inconsistent with an attempt at suicide by automobile,” Farlan wrote. “I give this proof higher weight than the notes and report of the law enforcement officials, the ambulance attendants and the emergency room doctor as a result of, it was carried out by a medical specialist inside a comparatively quick time post-incident.”

And, as Farlan repeatedly famous, not one of the police or medical professionals who alleged suicide testified to clarify the premise of their conclusions.

“[Unica] depends on the police, ambulance and hospital information from Could 1, 2016 and the pre- and post-incident information, which the [insurer] submits set up that the applicant deliberately drove his automobile off the street on Could 1, 2016 in a suicide attempt. Not one of the makers of those notes testified at this listening to. With out some other rationalization, I’m ready to settle for [R.S.’s] testimony that he didn’t say he had tried to commit suicide along with his automobile that day, and if he did, it was in circumstances the place he had injured his head.”

Characteristic photograph courtesy of iStock.com/welcomia