A pedestrian says he got hit by a car. Why the tribunal said he wasn’t involved in an ‘accident’

A pedestrian who claimed to be injured as a result of a vehicle backing into him and his pregnant fiancée didn’t produce or appear in any documentation showing he was involved in an “accident,” an Ontario tribunal found.

The man’s name did not appear in the police report of the accident, nor in the adjuster’s field notes, both of which noted three people were involved in the incident, including an unnamed “pedestrian,” a “driver,” and the vehicle “owner.”

“I find that the [claimant’s] name [Devante Ashman] is not mentioned anywhere in the reports and there is also no mention that there was more than one pedestrian involved in the accident,” the Ontario Licence Appeals Tribunal (LAT) ruled in a decision released May 13.

“The pedestrian, who is the [claimant’s] fiancé according to his reply submissions, provided a statement to the police at the scene which is contained in these notes. I find there is no mention in this statement that she was accompanied by the [claimant] or that he was involved in the accident….

“While I accept that there can be errors made in police reports as suggested by the [claimant], I give significant weight to the fact that there is no mention of [his] involvement in either of the police reports or the statement of his own fiancé.”

Ashman insisted that he was injured in the July 9, 2022 accident and claimed more than $4,000 in accident benefits. His auto insurer, CAA Insurance, denied the claim on the basis he could not prove he was involved in the accident.

Aside from citing the police reports and adjuster’s field notes, Ashman referenced other instances of documentation that he said proved his involvement in the accident. Among them:

• medical record evidence, namely the clinical notes and records of Dr. Maria Bagovich and Dr. Rahim Jessa, which he said, “identify his accident-related injuries consistent with the described mechanism of his injury,” as the tribunal paraphrased.
• sworn testimony at an examination under oath on Sept. 26, 2022.

LAT found the medical records of Dr. Bagovich did not support Ashman’s claim.

Also in the news: Is insurance facing its Napster moment?

“Upon review of the medical documentation submitted by [Ashman], specifically the CNRs of Dr. Bagovich and the report dated Dec. 11, 2024, there is no mention of his involvement in an accident on July 9, 2022.

“Dr. Bagovich notes in her report her previous diagnosis of the [claimant] with axial spondyloarthritis in February 2017 and notes the [claimant’s] complaints of a flare up in his back because he missed his regular injection of Simponi in December.”

Ashman did not submit Dr. Jessa’s clinical notes for review, the tribunal noted. Likewise, he did not provide a transcript of his examination under oath.    

Inside Intact’s growing Global Specialty Lines business Image

Insights Paid Content

Inside Intact’s growing Global Specialty Lines business

How Intact is combining global scale, specialized expertise, and ambitious growth plans to support brokers placing increasingly complex risks.

By 

Sponsor Image

In the absence of documentary evidence supporting his claim, Ashman said the insurer acted as though he had been involved in the accident when it adjusted his claim.

The tribunal did not agree.

“I…do not accept the [claimant’s] submission that the [insurer’s] conduct demonstrates that it treated this as an accident throughout its investigation and led him to believe that his claim was accepted,” LAT Adjudicator Melanie Malach wrote in the decision.

“I find that the correspondence of the [insurer], specifically the letters dated Sept. 16, 2022, Oct. 3, 2022, June 29, 2023, and Sept. 1, 2023, consistently advises [Ashman] that his involvement in the accident is under investigation and that [his] claim was being handled on a without prejudice basis.”

David Gambrill

David has twice served as Canadian Underwriter’s senior editor, both from 2005 to 2012, and again from 2017 to the present.