Understanding your Critical Illness Policy & Litigating Critical Illness Claims

July 1, 2014,

The idea behind Critical Illness Insurance sounds great.

If you suffer from a particular critical illness, then the insurance company will pay you a lump sum.

What sort of critical illnesses are covered are defined by the policy.

It all sounds great, and sounds like a very lucrative proposition. For many, this sort of insurance bets AGAINST your very own health. People think that if they sustain a heart attack, then they'll be entitled to a lump sum under the policy. So, eating that hamburger and skipping that workout might actually pay out in the long term if your critical illness policy works the way you think it works.

Unfortunately, many of these policies don't work they way that you think they work, or the way that the broker who sold you the policy explained it to you.

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A few tips to avoid trouble this Canada Day Long Weekend (Accident Lawyer Toronto)

June 25, 2014,

Yesterday, there was a fatal crash on Highway 401 just outside of Whitby. The accident involved 4 vehicles (a Toyota Corolla, a transport truck, a tour bus, and a Pontiac motor vehicle).

The transport truck hit the Corolla at around 10:30AM, so visibility was likely not an issue around that time of day. Police are still uncertain about how the accident happened, but they suspect that the transport truck rear ended the Corolla.

There were 3 passengers in the Corolla. The driver (47 years old) and front seat passenger (29 years old) was taken by ambulance to the hospital with very serious injuries. The third passenger was seated in the back seat. He passed away at the accident scene. At law, this is what we call a fatality claim. Those claims, contrary to popular belief, do not attract as big as settlement as you would think. The pain and suffering for such claims is limited from the time of the accident, to the time of the death. If the death is instantaneous, the damages for pain and suffering will not be significant.

Where the damages can get significant are where there are Family Law Act Claims, along with claims for loss of income to the family.

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How Insurers use Social Media (Facebook, Twitter, Instagram) against you

June 18, 2014,

You know what's fun?

Posting status updates on Facebook.

Posting pictures on Instagram.

Posting videos on Vine.

Posting your day to day thoughts on Twitter.

Posting your new job on LinkedIn.

Social media is FUN.

But just because something is fun or popular, doesn't mean that it's right for you, particularly when you're in the middle of a litigation battle against a large, deep pocketed insurance company.

The purpose of this Toronto Injury Blog Post is to show you how insurers can and WILL use social media against you to defeat your credibility and to defeat your personal injury case.

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Why does it take so long for personal injury cases to settle or finish?

June 11, 2014,

When will my case settle?

When will I get compensation for my injuries?

When will my case close?

These are just a few of the most common questions that our lawyers are asked at our firm. They are very good questions to say the least. It's entirely understandable when an inncocent, injured accident victim would want to know when their case will close and when they will receive compensation for their injuries. Living with a looming legal case over your head; having to worry about surveillance, medical appointments with insurance doctors; attending at discovery; attending at Court is all very worrying and taxing to one's psyche.

For you and the insurance company, a closed file is a good file. And for innocent accident victims, settling their case helps bring a sense of closure and finality to the case; so that they can close that chapter of their lives; and move on the next. Our lawyers often see a catharsis and sense of relief; light a large weight/burden is being taken off a client's shoulders once a case is closed and settled.

So, if there are so many positive elements to closing or settling one's file; then WHY DOES IT TAKE SO DARN LONG TO DO SO?!?!?!

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Medical Treatment after a Car Accident (Ontario)

June 5, 2014,

So; you've been involved in a serious car accident. You were taken by ambulance to hosptial. They did a few x-rays, scans, gave you some pills, and told you to follow up with your family doctor.

Or, the injuries were more serious, and you were an in-patient at the hospital for a few days or weeks, and discharged home or to a long term health car facility (and then home afterwards).

Many people ask me where is the BEST place to recieve treatment following their respective car accident.

The right answer is that there is no single BEST place for treatment. At the end of the day, it's important that you attend a doctor or rehabiliation facilty that's right for you; and that you're most comfortable with.

Rule of thumb: much like going to the gym to excercise; the closer the rehabiliation facility, the greater the likelihood that you will be diligent with your treatment. The longer the commute, the great chance tha you will miss out on appointments. That's not good for your treatment, and certainly not good for your case.

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How to place a dollar figure on your Long Term Disability Claim: The Mediation Process Explained

May 29, 2014,

Our law firm sees some very seriously injured accident victims and disability claimants. Many of our long term disability clients who have cases against large multi national insurers such as Manulife, SunLife, Great West Life, Standard Life, Desjardins, Industrial Alliance, SSQ, Equitable Life etc; want to know how an insurer can place a dollar figure on their disability and inability to work for the rest of their lives.

For a disability claimant, the answer to this question can be very simple. If I can't work for the rest of my life, then naturally, I should be entitled to MILLIONS of dollars worth of compensation. Afterall, my pain and suffering is immeasurable.

One of the most common misconceptions in long term disability cases is that claimants are entitled to damages to compensate them for their pain and suffering. This is NOT true. At our Law Firm, we refer to LTD cases as "four corner" cases. That means that your damages, or benefits, are limited to what the four corners of the policy provide for. If you have a bad policy, which, based on the wording of the policy will not properly compensate you in disability benefits; then your award will reflect that.

There are some situations where awards in long term disability cases can fall outside of the four corners of the policy.

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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.

Continue reading "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)" »