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This Holiday break, my family didn’t go away on a nice vacation. We stayed in town. Our offices were open, and I worked. The cities I visited (Windsor, London, Leamington, Toronto, Peterborough) were all very quiet.  It seemed like everyone was away somewhere else. The busiest place I saw was Masonville Mall and the Cineplex at Masonville in London, ON. Both were jam packed at really odd hours which I found rather strange; but that’s a topic for a different day.

A few hot shot Bay Street type lawyers I know recommended that I listen to the Pod Cast “Serial“. They knew I did considerable driving to meet with clients and listening to the Serial Podcast would be a great way to make the time pass. I downloaded Season #1 of Serial and binge listened. What a fascinating (but troubling) series of events. If you haven’t yet listened to it, I highly recommend you get in to it. The production quality and research that went in to the Podcast is nothing short of exceptional. The producers are well deserving of all of the accolades they have received. They ought to start practicing law!

Having got hooked on Serial, I proceeded to get hooked on the recent documentary “Making a Murderer” on Netflix. The documentary, filmed over 10 years or so tells the story of Steven Avery and his nephew Bobby Dassey, who were accused and later convicted of murder along with other charges.

The documentary pokes large holes in the case of the prosecution and advances the theory that the police may have framed Mr. Avery and Mr. Dassey in order to secure the conviction.

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Happy New Year to all of the readers of the Toronto Injury Lawyer Blog! We hope that the upcoming new year brings you  health, happiness and prosperity. We also want to thank all of our readers for their excellent comments, likes and shares. 2015 was a banner year for Goldfinger Personal Injury Law and the Toronto Injury Lawyer Blog and we hope to build upon that success in 2016.

What’s new for 2016? Well, Ontario has a set of laws which have just kicked in pursuant to the aptly named “Making Ontario’s Roads Safer Act“. As an aside, Ontario along with other jurisdictions have a tendency of giving grandiose names to acts which make the public think that they are not only AMAZING, but also do what they say they do. The reality is that within these incredibly named acts, there are sometimes provisions which have little or nothing to do with the name of the Act as well. Sometimes, it’s a way for legislature to pass laws under the rug, without the public or media catching on. We often see this with car insurance and the Statutory Accident Benefits Schedule and the Insurance Act.

In any event, the Making Ontario’s Roads Safer Act is a fantastic name for a set of laws. Whether or not it will do what it purports to do is still up in the air.

Here’s what you need to know:

There are increased fines for violations at crosswalks, school crossings, and pedestrian crossings. Those fines are DOUBLED in Community Safety zones. Drivers will be fined $150-$500 along with 3 demerit points for such offences.

Staring January 1, 2016, drivers and CYCLISTS must STOP and yield the entire road to pedestrians at pedestrian crossovers, and at school crossings where  there is a crossing guard displaying a school crossing stop sign. These pedestrian crossovers are identified with specific signs, road markings and lights. The new rules do NOT apply to pedestrian crosswalks at intersections with stop signs or traffic signals, unless a school guard is present.

The Making Ontario’s Roads Safer Act also gives municipalities the power to install new types of pedestrian crossings on low speed, low volume roads in addition to existing crossovers (think more speed bump crossings in a sub-division).

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The Christmas lights have gone up. The festive parties are a plenty. The snow is….um…..non-existent with some of the highest temperatures Ontario has ever seen for December. In any event, it’s HOLIDAY time once again.

Around this time, and in to the New Year, our lawyers get some strange, and some not so strange calls. This means that there are some common injury patterns we see, and other patterns which aren’t so common. Without further a due, here are Goldfinger Personal Injury Law’s top tips on keeping things safe for the Holiday and New Year season.

DON’T DRINK AND DRIVE: Quite simply, alcohol and driving don’t mix. And that statement applies to any amount of alcohol consumed; even if it’s “just a couple of drinks” at a friend’s Holiday Gathering. We can tell you that R.I.D.E will be out in full force across Ontario; from London to Peterborough, to Toronto to Sudbury. Your local police force will be out there making sure people aren’t drinking and driving. If you play your cards right, you may even get a coupon from those friendly officers at R.I.D.E. I would also like to add that the term “driving” applies not only to cars, motorcycles or other vehicles. It also applies to bikes, E-Bikes, scooters. segways, etc. We get a lot of crazy calls of people riding anything with wheels (motorized or non-motorized) after having consumed a few too many drinks with catastrophic consequences. Drinking and driving is always a choice. Make the right one and arrive alive and in one piece. You’re not just putting your life at risk, but also the lives of other innocent people and their families at risk as well. No amount of money can ever properly compensate somebody for a loss of limb, a catastrophic brain injury, or the loss of a loved one. Continue reading →

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Not too long ago, the Toronto Injury Lawyer Blog focused on limitation periods in the context of Long Term Disability Claims, and how insurers will delay, delay, delay such that enough time has passed that they could ask the Court to dismiss your claim. Delay is the enemy of a Plaintiff and the friend of an insurer.

The longer a denied claim goes without litigation, the greater the chance that the delay argument will swing in the favour of the LTD insurer. It’s clear that time is NOT on the claimant’s side when it comes to filing an LTD claim, and then litigating it at Court.

One of the larger LTD Insurers, RBC Life Insurance Company recently brought their delay argument to the Ontario Court of Appeal in the hopes of having a claimant’s case dismissed completely.

The case is Dube v. RBC Life Insurance Company and the initial decision at the Superior Court level can be found in the above noted link.

In this case Mr. Dube was a full time employee of the Windsor Essex Housing Corporation. He began working there in around November 2008. He was entitled to benefits under a group disability policy with RBC. One of those benefits was Long Term Disability Benefits. These benefits were supposed to pay for a percentage of Mr. Dube’s salary, in the event of serious injury, illness and/or disability. Basically, if you’re too hurt to work, RBC will pay you a portion of your salary to help make ends meet. In theory, this sounds like a great thing. Almost too good to be true…

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It seems that every few months or so, the Toronto Injury Lawyer Blog is discussing the topics to changes in car insurance and accident benefit disputes in Ontario. Is it because we LOVE blogging about accident benefits? Not really. Accident benefits are quite frankly, an incredibly complicated and dense area of the law. The rules for accident benefits, in many respects, are made in favour of large insurance companies and designed to limit an injured claimant’s ability to recover an income. It’s not a committee of accident victims who sit around and make these laws, and tweek them ever so slightly. Rather, it’s deep pocketed insurers and so called “insurance experts” who do so at the behest of the large insurance lobby.

A few quick examples of some arbitrary decisions which accident benefit laws have imposed:

  • No monetary reimbursement for a trip to the doctor which is under 50km. Why 50km? Who picked the 50km distance? Your guess is as good as mine
  • A maximum recovery of just $3,500 for soft tissue injuries which are classified to fit under the Minor Injury Guideline. Why just $3,500? Because that’s what insurers and our government deems to be reasonable. Interesting enough, that $3,500 is less than you paying the full value of your car insurance premiums over a 3 year period in Toronto, London, Ottawa or another large city in Ontario.
  • A maximum recover of $50,000 for claims which aren’t catastrophic, but not Minor. Why a $50,000 limit? Beats me.
  • An income replacement benefit of a maximum of just $400/week under a standard Ontario Automobile Policy, which has NOT increased to reflect inflation over the past 15 years.
  • A deductible which will be increasing from $30,000 to $36,500 for pain and suffering claims. Why $36,500? Beats me.

As you can see, many of the monetary limits imposed in accident benefit law in Ontario are just numbers which seem to be picked out of a hat to favour insurers. Not once have I ever met an injured accident victim, or an ordinary person who believes that these limits are reasonable or helpful for claims.

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Our law firm handles a wide variety of Long Term Disability (LTD) Claims against pretty much every deep pocketed insurer you can think of: Manulife, SunLife, Great West Life, Desjardins, SSQ, RBC Insurance, Empire Life, Canada Life, Industrial Alliance, Equitable Life, Co-Operators, Standard Life (Now Manulife). If you can name them, we have probably sued them.

Although every LTD claim is different, and every insurer handles claims in their own way, our lawyers see many similarities for these denied claims. Because we have years of experience helping people get the benefits they deserve, we are able to share some of our wisdom with you, our readers of the Toronto Injury Lawyer Blog.

For today’s instalment, we would like you share with some of the top reasons why Long Term Disability Insurers deny claims.

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The OCF-6 Application for Expenses or Expenses Claim Form is the MOST IMPORTANT FORM to get paid back for your out of pocket expenses following a car or motor vehicle accident.

Immediately after a serious accident, the bills and expenses can quickly add up. Hospital parking is a fortune these days. Hospital meals, medication, the ambulance bill, damaged clothing, broken glasses, equipment rental for ramps, crutches, a wheelchair or simply purchasing a cheap cane from a drug store. All of these expenses quickly add up.

Some of the first questions from prospective clients isn’t how much their case is worth. It’s how can I get re-reimbursed for my out of pocket expenses?

I’ve always found this a bit odd; but I suppose it’s human nature. In the context of a multi million dollar claim, we are worried and insurers fight over the smaller $10 expenses; yet they are willing to pay out $1,500/month for attendant care benefits without issue; or pay out much larger amounts on a periodic basis.

In any event, the purpose of this Toronto Injury Lawyer Blog is to assist you in preparing your OCF-6 the right way, so that your out of pocket expense claims gets approved instead of denied.

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The most serious motor vehicle accidents in Ontario are classified as “Catastrophic” by our Ontario insurance law. The term “Catastrophic” is a term of art; meaning that it carries its own legal definition; separate and apart from the common definition you would find in an English dictionary.

Being designated “Catastrophic” or “CAT” as its known in the medico-legal community is significant, as it provides accident victims and their families to a wider array of accident benefits, over a longer period of time. The advantages are significant such that insurers will fight very hard to find serious injured accident victims as not meeting the catastrophic definition.

Just because you’ve been involved in a serious car accident doesn’t mean that you will automatically be found to be catastrophic. There are a number of medico-legal tests which need to be met. In addition, there is one VERY important form that needs to be completed. This form is called the OCF-19 Application for Determination of Catastrophic Impairment form.  You can find a link to the OCF-19 CAT form, along with other OCF claim forms on the Goldfinger Personal Injury Law website here.

The OCF-19 is only two pages in length. Which, by comparison to some other forms (like the OCF-1 or the OCF-3) makes it a short form. But just because the OCF-19 CAT Claim Form is short, by no means is it not important or can it be completed carelessly.

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Over the past few months, we have seen a war play out in the media between Ontario doctors and the Ontario government. Doctors and the province have been operating without a proper contract in place for quite some time. Neither side can agree to terms. Ontario unilaterally cut doctor fees, along with certain billing codes. The result is that it has presented a cut to Ontario’s thousands of doctors. Doctors are fighting this in Court by way of Charter challenge. It’s pretty interesting to see the public relations battle play out in the media. Not to mention that Ontario doctors are actually launching a Charter challenge, which gets any lawyer excited.

Some doctors are chosing to scale back their hours (why work more for less), close clinics, or move out of unprofitable centres. This was discussed in yesterday’s Globe and Mail which examined how some doctors were closing clinics (methadone and radiology) on account of the cuts to the OHIP system and billings.

The purpose of this edition of the Toronto Injury Lawyer Blog is to examine the crucial role which family doctors play in the context of a personal injury or long term disability case. At the end of the day, the family doctor can be the MOST IMPORTANT person on an injured accident victim or disability claimant’s team.

The great thing about Canada, is seeing a medical doctor is FREE. This is in stark contrast to the United States, whereby, for the most part, every time you visit you doctor, you have to pay for the visit (not withstanding Obama Care).

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Many people have benefits through work. Most understand those benefits to cover medical expenses such as massage, physiotherapy, medication, and dental expenses. Few think of those benefits as covering a portion of your income while you’re disabled and unable to work. This concept is called “disability benefits” or “disability insurance“.

These disability benefits are VERY important. Having them is excellent and great idea. Even if they aren’t offered through your employer’s benefit program; you can still purchase such benefits on your own from an insurer, or from an insurance company. These benefits are commonly referred to as Short Term Disability Benefits, and Long Term Disability Benefits. They typically run up until the age of 65 in the event of disability. Large insurers which offer LTD insurance are such companies as Manulife, Great West Life, Canada Life, Sun Life, Industrial Alliance, SSQ, Desjardins, RBC Insurance, Co-Operators, Equitable Life amongst others.

But it’s not enough to have access to this insurance. It’s important to understand HOW IT WORKS, and how to apply for it in the event of disability. Every policy is unique. Every policy will contain it’s own definitions of disability, their own exclusions, along with their own benefit amounts. Some policies are better than others. A BAD LTD policy is ALWAYS better than NO POLICY whatsoever. Usually, you get what you pay for. And, just because your employer offers LTD insurance through work, doesn’t mean that it’s a good LTD policy. Check it out for yourself how it works or talk you a broker or a lawyer about it.

As with any insurance, just because you’re hurt, doesn’t mean that benefits will automatically begin to flow. You have to jump through some hoops in order to get those benefits to begin. At the end of the day, you have something the insurance company has; and which the insurance company does NOT want to give up; it’s their money!

The first rule of insurance is that if you don’t claim for it; you won’t get it. The same applies to your LTD policy. If you don’t make a claim on it, then you won’t be able to collect benefits on the policy. But claiming these benefits isn’t as simple as putting in a phone call, or filling out a form online. There are a few forms which you, and your doctor  and employer will need to complete. The whole process can take some time.

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