What happened
On a scheduled night mail flight between Rouyn and Val-d'Or, Quebec, a Piper PA31-350, registration C-GNIE, crashed approximately two miles southeast of the end of runway 36. The flight, operated by Aéropro under contract for Dicom, was initially filed as an instrument flight rules (IFR) flight due to poor weather. However, as the aircraft approached Val-d'Or, the pilot received updated reports indicating visual flight rules (VFR) conditions were possible.
Upon receiving these updates, the pilot cancelled the IFR flight plan and transitioned to a visual approach on runway 3/6. During the approach, the pilot reported losing sight of the runway for a brief moment and intended to restart the approach. Shortly thereafter, the aircraft's emergency locator transmitter (ELT) began transmitting, and the aircraft was found heavily damaged. The pilot sustained serious injuries.
The investigation
The TSB examined the aircraft's mechanical condition, the pilot's qualifications, and the environmental factors present at the time of the accident. The investigation confirmed that the Piper PA31-350 was properly maintained and that all engines and instruments were functioning normally prior to impact. The engines were found to be producing power at the time of the crash, and the impact marks suggested the pilot was attempting a pull-up maneuver.
Investigators also reviewed the operator's training protocols. It was discovered that while the pilot was certified, he had not completed a required Pilot Proficiency Check (PPC) for this specific aircraft type. Furthermore, the company's interpretation of regulations regarding whether the flight fell under aerial work or air taxi operations led to the pilot operating without the necessary oversight.
Findings
- The primary cause of the accident was the pilot's loss of control due to spatial disorientation during the visual approach.
- Environmental conditions, including low visibility and the loss of ground references, were highly conducive to disorientation.
- The pilot's lack of recent instrument flight experience made him more susceptible to the false-climb illusion, where an acceleration sensation causes a pilot to push the nose down into the terrain.
- The operator failed to ensure the pilot completed the mandatory Pilot Proficiency Check (PPC) and lacked adequate supervision for a night IFR operation.
- The pilot's decision to transition to VFR without a proper plan to execute a missed approach if visual contact was lost contributed to the accident.