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Compliance May 15, 2007
Canadian Plasterer Wins Insurance Benefits Appeal
May 15, 2007 (PLANSPONSOR.com) - A Canadian
plasterer who was rendered a paraplegic after contracting the
West Nile virus is entitled to benefits from his workplace
group accident insurance policy, according to an Ontario
appellate court.
Reported by Fred Schneyer
The Ontario Court of Appeal overturned a lower court ruling by Justice Harriet E. Sachs of the Superior Court of Justice, which dismissed the original lawsuit by plaintiff Ryszard Kolbuc seeking the insurance coverage for his resulting medical expenses. Kolbuc sued Ace INA Insurance, challenging the original benefits denial.
The insurer had argued that since Kolbuc’s disability was caused by a disease rather than an accident, he was not entitled to coverage.
However, according to the three-member appellate panel, Kolbuc’s case met the requirements for the triggering event to be legally considered an accident and, therefore, was coverable under his union’s group policy.
“It was an unforeseen, unexpected event that was caused by an external source – a mosquito – and falls within the ordinary definition of an accident,” wrote the appellate judges. “The cause of the illness was an accidental event. The plasterer had no reasonable expectation that he would get West Nile virus from the activity in which he was engaged.”
The judges continued: “(Kolbuc) was engaged in work, without intending to cause himself harm, and the harm that did result could not reasonably have been foreseen or expected. “
The appellate ruling in the case is here .