Chronic Pain: Subjective vs. Objective Disability (Long Term Disability Claims)

May 21, 2014,

How does an insurer, judge or jury assess one's pain level? If their pain is not showing up on any x-ray, scan, or test result, then how does a Court truly know that the claimant is in pain; and in fact telling the truth?

What's stopping somebody from simply making a claim that they're disabled, and lying to their doctor and to the Court alike?

How do we know that somebody is telling the truth about their subjective pain, fatigue or other cognitive difficulties (loss of memory, sadness, fatigue, loss of concentration etc.)?

These are all very good questions. Believe it or not, our the way that personal injury claims and long term disability claims work in Ontario make it pretty clear who's faking, and who's not.

First, we have to draw a distinction between an objective injury vs a subjective injury. An objective injury is one that will show up on an xray, scan or test. A factured ankle. A broken femur. A cranial facture. A hematoma on the brain. All of these are injuries which will show up on a test, which any doctor, or non-medical person can likely see. It's pretty hard for an insurer to refute an ankle fracture injury when the x-ray clearly shows that the ankle is fractured.

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The most commonly asked questions of a personal injury lawyer

May 15, 2014,

Hey Brian! As a lawyer, you must hear some crazy stories. (TRUE).

You probably have lots of strangers calling you every day, wanting to discuss their legal problems (TRUE).

What are some of the most commonly asked questions of you (GOOD QUESTION).

As an injury lawyer, we hear of, and see lots of crazy things; lots of sad things; and lots of things that you just can't make up. Some of these stories, I'm not at liberty to share with the general public.

Regardless of the severity of the injury, one thing that ties most clients together are their questions and concerns for their respective cases. From Toronto to London to Peterborough, client questions are generally the same. Just shows you that geography, race, culture, creed; it doesn't really matter. People are people, and they share many commonalities regardless of your background, upbringing, or the mechanism and nature of the injury.

So, without further a due, here are some of the most commonly asked questions we here from inquiries to Goldfinger Personal Injury Law.

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What does Incurred Expense for claiming Attendant Care Benefits mean?

May 7, 2014,

The laws continue to get tougher and tougher on accident victims in Ontario for no apparent reason.


It's not like the victim of a drunk driving accident did anything wrong. So why is it then that innocent accident victims are being treated like criminals at every turn when dealing with large insurance companies? Is this the new reality?

It seems this way because it really is this way.

When No Fault Accident Benefits were introduced in Ontario circa the 1980's, it was introduced as "consumer protection legislation" intended at helping accident victims recover from their injuires. In plain English, the laws were created and intended to PROTECT and ASSIST the CONSUMER (that's you), in your time of need.

There was a contract in place between insured and insurer. The driver would pay premiums to the insurer. In return, should the driver need the insurer's assistance, the insurer would step in and provide benefits to their insured so they could get back on their feet to business as usual.

So where did things go wrong?

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Assessing Damages in Catastrophic Injury Claims (Ontario)

May 1, 2014,

Catastrophic Injury claims, by their very nature, are the most serious car accident claims which a personal injury lawyer will face during their legal career.

The term "catastrophic" has a special meaning at law for car accident claims in Ontario. At law, we were refer to "castastrophic" as a term of art. This means that it has a special legal significance, and means something very specific which is defined in the Insurance Act.

If you meet the definition of "catastrophic", you will be eligible for a greater amount of accident benefits. In particular,, you will be eligible for:

$1,000,000 in medical and rehabilitative benefits, instead of just $50,000 or $3,500 under the Minor Injury Guideline

Up to $1,000,000 in attendant care benefits, instead of just $36,000 for non-catastrophic car accidents

Up to $100/week in housekeeping and home maintenance, instead of ZERO for non-catastrophic claims

Up tp $250/week for a caregiver claim, plus $50 for each dependant, instead of ZERO for non-catastrophic injuries

These differences are signficant, and dramatically increase the amount of value to any car accident claim. But, how do one's injuries meet the definition of "catastrophic" in the first place? Read on and I'll fill you in.

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Bike Safety & Injury a "hot button" issue when the weather heats up

April 23, 2014,

Bike safety is becoming a "sexy" and "on trend" topic for municipal and provincial politicians for a variety of reasons. Governments can't afford to ignore cyclists. They can't afford to ignore motorists either.

Ontario has pledged $25 million dollars for bike infrastructure over the next 3 years. Where's that money going to come from? I don't know. Do you think that the Liberals will get enough support to pass that through a budget? Another excellent question.

That cycling money is for the entire province. That means that every municipality will be fighting for a piece of that provincial money. Toronto will of course want the lion's share of that money so that they can accommodate the hundreds of thousands of cyclists who take to the roads every day. London, Brampton, Mississauga, Peterborough, Lindsay, Sudbury, Richmond Hill, Vaughan. You name the Ontario Municipality. They will want a piece of that provincial bike lane money.

Will $25 million of provincial money adequately finance Ontario's cycling needs? Will $25 million in provincial money keep cyclists and motorists safe from accident?

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New Trends in Car Accident Law (Ontario)

April 16, 2014,

Personal Injury Law and insurance claims handling practices have trends.

Just like we see trends for runway fashion, or trends on a celebrity packed red carpet; we see trends for accident law. What's hip, sexy, or cool for one insurer, or for one judge on a case, will likely apply to the next insurer or judge. It's a copy cat industry.

Now law isn't as trivial or fickle as the world of fashion. It takes judges to rule on the law. It takes politicians to create law. It takes people to elect those politicians who make the law. All it takes is one fashion designer to create the next "big hit".

Other lawyers who don't practice personal injury law want to know what's new, and what's changed with Ontario's car accident law. Let me assure that you LOTS has changed in the last few months alone. Leave it up to our law firm to keep you up to date with those "hottest trends".

Did you ever think that personal injury law could be so cool and hip? Me neither.

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Top Questions for Critical Illness, Life, and Disability Insurance Policies We See at our Law Firm

April 10, 2014,

This week's entry comes straight from the Toronto Injury Lawyer Blog reader mailbag.

Question: Goldfinger: Love the Blog. Hate the new head shots. But seriously, my wife and I are looking at getting insurance. You know. We were curious about life, disability, critical illness etc. You see it all. What should we be looking out for when buying our insurance. Best Regards JJ + PJ

Well JJ and PJ, thanks for your question. Always nice to hear from our readers.

NOTE: Lawyers don't sell insurance. We sue insurers after they've denied your claim.

For starters, buying insurance is not an easy decision. For starters, I could count of a million things more exciting than insurance to spend your hard earned dollars on. On top of that, insurance can be expensive.

Secondly, have you ever read an insurance policy? They're long, boring, and very difficult to understand. You really need to be a lawyer to truly understand what they're trying to say. And even then, some clauses and and definitions contained in those policies are subject to one's interpretation. Any ambiguity contained in a policy will be interpreted in your favour: BUT: do you really want to have to retain a lawyer and fight in Court for years and years over benefits, when you could have just saved the trouble and hassle and received them now? That's just a big pain in the you know what; not to mention all of the unnecessary stress and anxiety which might come with involved in being in litigation with a large deep pocketed insurance company. Hey: sometimes it's necessary. That's what we're here for.

Here are a few tips I've learned from litigating life insurance, disability insurance and critical illness insurance policies throughout the years.

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What to do for money after an accident if you're so injured that you can't work? (Ontario)

April 2, 2014,

Many of our clients cannot return to work after serious accidents.

The form of accident is irrelevant. It doesn't matter if your accident was caused by bike, car, pedestrian knock down, boat, fall or otherwise.

It doesn't matter if your injury is catastrophic, is a brain injury, spinal cord injury, ankle fracture, chronic pain, psychological injury or any of the above.

The purpose of this Toronto Injury Lawyer Blog Post is to discuss and examine what you can do for money when you cannot return to work on account of your accident related impairments.

Firstly, it's important to better understand how the Courts and how insurers quantify income loss claims. Many clients tell me that they're high income earners, like having high, CEO style six figure salaries with benefits packages. Then, when we request their tax returns, they show little to no income. Go figure.

Courts require evidence of your income loss claim. The best evidence to prove income loss is what's reported on your tax returns. In some cases, this is the only evidence that matters. In fact, if you should know that whatever you don't report, you cannot claim. That means if you work at a cash business, and you deliberately conceal earned cash income on your tax returns without reporting it to revenue Canada, the Courts will not re-reimburse you for that income loss (save in exceptional circumstances).ankle.jpg

Basically, you cannot have the tax benefit and NOT report income in a cash business, and later seek to claim that money from an insurer as reportable income later on as your case develops. It doesn't work that way. The law doesn't let you suck and blow at the same time. In fact, the laws of physics don't allow you to suck and blow at the same time. Go ahead. Try it.

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Do I have to attend the "Independent" Medical Examination arranged by the Insurance Company? Steps in a car accident or Long Term Disability Case (Ontario)

March 26, 2014,

You've been involved in a car accident, or you're involved in a dispute against your Long Term Disability Insurer. The adjuster for the insurance company tells you over the phone, or in an incomprehensible letter that they want you to attend a medical examination with a doctor you've never heard of.

You don't know who this doctor is.

You don't know where their office is located.

You don't know how you'll ever get there because transportation has been difficult for you since your accident or disability.

You don't know why you have to attend the examination.

You don't know what the examination is for, how long it will last, what tests will be administered.

You have about a million and one other questions about the examination, and you have nobody to turn to.

Enter a Personal Injury Lawyer.

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How Ontario is cracking down on distracted driving & preventing bike accidents (dooring)

March 19, 2014,

A psychiatrist friend of mine innocently teased me for a Toronto Injury Lawyer Blog Post back in October 2013 on "dooring" epidemic that was facing cyclists in many of Canada's largest cities (and the smaller ones too!).

Here is a link to that Toronto Injury Lawyer Blog Post, along with a video to Peter Mansbridge explaining on The National exactly what dooring is, and how it's putting cyclists at risk of injury.

If you've never heard of "dooring", basically, it's when a car door opens directly in to the path of a passing cyclist, thereby causing the cyclist to hit the door or swerve out of control and result in serious injury.

I guess I was ahead of the curve. Recently, the Ontario government introduced the "Keeping Ontarios' Roads Safe Act" (what a name!). One of the significant provisions of the Act was to increase fines for dooring from $60-$500, up to a range of $300-$1,000. It would also see demerit points raise from 2 to 3 points.

Imagine that, getting hit with a $1,000 fine and 3 demerit points for just trying to get out of your car and accidentally dooring a passing cyclist. You weren't even driving! Your car was likely off, with keys in hand for such an offense. It's not just motorists who drive that cause accidents. They're caused in all sorts of ways.

In any event, to my psychiatrist friend who teased me over a year ago for writing about dooring and advocating for increased cyclists' rights, I say eat my words (in a friendly tone of course). Always a trailblazer on these issues.

But, there's much more to the Keeping Ontario's Roads Safe Act which you should know about. In particular, when it comes to fines for distracted driving.

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Why insurance companies don't like fibromyalgia clamaints (LTD & Car Accidents)

March 12, 2014,

It's an unscientific fact that insurance companies don't like fibromyalgia claimants. It makes no difference of the context of that fibromyalgia claim. It could be for your short term disability claim, long term disability claim, slip and fall or car accident.

Don't take it personally. It's not YOU they don't like. It's your symptoms, injuries, and what they stand for.

Here's the harsh reality about fibromyalgia. It won't show up on an x-ray, CT scan, MRI or any other fancy objective scan. There are trigger points but those don't show up on computer tests. Insurance companies LIKE those sort of tests. It puts your injuries in to a black and white context. If it's there on the scan and visible to the naked eye on a computer screen, then you have it and you're likely suffering from it. If your injury doesn't show up on the scan, then it doesn't exist. It's probably a figment of your imagination, or a way for you to lie in your attempt to deceive the insurance company.

It makes it much easier for an insurance company to lump your claim in to a simple formula that an unskilled, and untrained adjuster can follow. If the claimant has an ankle fracture, then he/she is entitled to "X" amount of dollars. If the claimant has a broken femur then he/she is entitled to "Y" amount of dollars...And so forth. I hope you get the picture.

The moment that your injuries cannot be put in to a simple mathematical and easy to understand equation is the moment that the insurance company needs to think and take a better look at your claim. When the insurance company has to slow down its operations for your claim, it hampers their productivity and profits. This is NOT good for their business.

The problem is that fibromyagia cannot be put into a simple mathematical equation and cannot be looked at from a "black and white" perspective. There's a lot of grey area when dealing with these types of claims.

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Ontario government to introduce drastic changes to how car insurance claims work yet again and YOU weren't consulted

March 6, 2014,

Our office's Toronto Injury Lawyer Blog has been a huge success at educating the general public about how car insurance works, how the Courts work with respect to personal injury claims, and all sort of other helpful information for accident victims, disability claimants and their families.

Our law firm prides itself on using easy to understand language to get the message across. We know that not everybody is comfortable reading hard to understand legal terms or "legalese" as we call it.

This has been a big week for car insurance law in Ontario. So much of the law involves politics. Believe it or not, politicians through our government create the laws we live by.

We vote for politicians, who in turn, have the power to make, break, or change laws. We often write about politics in the Toronto Injury Lawyer Blog because decisions made at Queens Park have a major impact on personal injury law.

A few months ago, the Provincial Government introduced some radical changes to the Insurance Act. This is the piece of legislation which deals directly with how car accident law, and accident benefit law works. The changes were brought in very quickly, without any prior notice or debate. They were just passed through without the general public really knowing. You can read our previous blog post here posted on December 18, 2013.

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Fines for Distracted Driving Set to Increase to $280: Just a slap on the wrist

February 27, 2014,

Ontario's Chief Justice, Annemarie Bonkalo recently signed an order approving the fine for distracted driving to increase from $155 to $280 effective March 18, 2014.

Want a copy of the Judicial Order? Here you go. Short, sweet and to the point.

This fine increase for distracted driving in Ontario has made provincial and national headlines. I really don't know why as I think the fine being set so low is an embarrassment and an insult to the families and accident victims of distracted drivers.

Presently, the fine for distracted driving is just $155. That's it. Minimum wage in Ontario just went up to $11/hr. That's under two days of work over a 7.5 hour work day to pay off a distracted driving penalty for almost killing somebody or rendering them a quadriplegic.

So, what's the big deal and why be so hard on distracted drivers? I mean, everybody seems to do it. It's just a phone call, a quick text or a simple email; right? I've seen a Kardashian send out a VINE Video while driving, so it's gotta be cool to do it!

Distracted driving is just as bad as dunk driving. Yes, I made the comparison. Shocked? Bold words, I know. But, our law firm sees the realities of distracted driving every day. To give you evidence of how serious the problem is, the US Government has its own OFFICIAL WEBSITE DEVOTED TO THE DANGERS OF DISTRACTED DRIVING. If you didn't take the problem seriously before, maybe you will now that Barack Obama, the world's most powerful world leader, got his own country to design a website and set up an agency devoted to increasing awareness.

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Hurt in an accident? Don't count of getting the treatment you need says Globe & Mail

February 19, 2014,

While Canada was glued to their TVs watching Latvia play their version of a prevent defence in American Football, or an ultra conservative soccer defence, another story creeped up which caught my eye.

Today's front page of the Globe & Mail had a story about Canadian Doctors being urged by 8 medical societies to reduce medical tests in order to save money.

Here is a copy of that Globe & Mail article.

The gist of this article states that Canadian doctors are wasting their time and money on unnecessary tests. All of these tests are a burden to the Canadian health care system. Imaging for complicated headaches, and lower back pain are seen as some of those unnecessary tests. Treatment for "minor" head injuries is also on the list. Just ask Sidney Crosby. No head injury is minor.

Tell that to some of my car accident and chronic pain clients. It would likely make them sick to their stomachs. Ever wait for an MRI? The wait period is months long (unless you get really lucky), and the time you get is very firm. Miss it, and you're sent back to the bottom of the wait list. Months and months more of waiting around. The best is when they call you in for an MRI at 2AM or some other absurd time.

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The Long Term Disability Appeal: Worthwhile or a waste of your time?

February 11, 2014,

We receive many calls every week from people who have been denied their Long Term Disability Benefits, by private disability insurers such as Great West Life, SunLife, Manulife, Standard Life, Industrial Alliance, SSQ, Co-Operators, Empire Life, RBC Insurance and others.

People want to know what to do after they've been denied.

Denial, or termination letters are often lengthy detailed letters which include the provisions of your LTD policy, the definition of the term "disability" based on the policy, excepts from medical records or medical reports, along with the insurer's reasoning to deny or terminate benefits.

After these long winded reasons are provided, the insurer will also then include ways that you can appeal their decision. Statements like you have 90 days from the date of this letter to appeal this decision through our Appeals/Investigation Committee are common. People call our law firm in an absolute PANIC stating that they're under the gun and that their opportunity to appeal the claim is fast approaching.

What I tell these people is NOT TO WORRY, and NOT TO PANIC. These internal reviews or internal appeals are often a waste of time and energy. Here's why

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