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For anyone who practices in the field of accident benefit law (dare I now call it litigation), what we all need is more paper work, more records, and more forms to be completed by insureds, and insurers alike. What is already a complicated and confusing system has been rendered even more complex with the shift of accident benefit disputes from the Financial Services Commission of Ontario (FSCO) to the Safety, Licensing Appeals and Standards Tribunals of Ontario (SLASTO) License Appeals Tribunal (LAT). How’s that for a mouthful?

Accident benefits, at their most basic, are designed to protect an insured accident victims following a motor vehicle accident. The Insurance Act is consumer protection legislation supposedly aimed to help rehabilitate and make ends meet for somebody whose livelihood and health has been impaired in an accident. Items in dispute can range from simple physiotherapy treatment, to weekly income replacement benefits, to more complicated catastrophic disputes.

Since 1997, FSCO has been hearing accident benefit disputes between injured car accident victims and their accident benefit insurers. FSCO was mandated to hear these types of cases. FSCO had its own mediators, arbitrators, practice code and a wealth of case law built over the years to guide the public and insurers. Continue reading →

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Long Term Disability Insurance, and Critical Illness insurance are both “living policies“. They differ from a death benefit or life insurance policy in that the insured is still alive and the beneficiary; while alive; is able to recover the benefits.

In a “death policy” or “non living policy” only the designated living beneficiary, trust or corporation can recover the benefit. Somebody will need to have died in order to make a claim or recover benefits.

When making a claim for long term disability or critical illness benefits, it’s important to know what you’re getting in for.

Those application forms and questionnaires are very important. They are source documents for your case. They will go on to provide evidence upon which an insurer will use to potentially defeat your claim. These forms will also be scrutinized by a Judge or Jury with respect to how they were completed, what they say, and even when they where filled out.

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Recently, contingency fee agreements in Ontario for personal injury cases have come under attack. Seeing this sort of news is very disappointing and disheartening. A recent decision from the Ontario Court of Appeal on this issue was highlighted in the news. Here is a link to a quick article. I cannot comment on what the former lawyer did in that case, but it’s certainly does not appear to be good for the legal profession.

A contingency fee agreement is a fancy legal term for an agreement between an client (injured accident victim) and a lawyer/law firm whereby the law firm’s legal fees are based entirely on the success of the case. If the lawyer works many many years, and invests many many hours on a case, but the lawyer isn’t able to recover any money on the case, then the lawyer gets ZERO. But, if the lawyer is successful in winning/resolving the case for fair compensation, then the lawyer gets paid their legal fees based on a percentage of the recovery in the case. If there is no money at stake in a case, then a contingency fee cannot work. Contingency fee agreements don’t only exist in personal injury cases. Other lawyers in different practice areas use them as well.Contingency fees in the context of criminal cases are rare, if not unheard of. I have never heard of a criminal lawyer take a case on the basis that s/he will only get paid if s/he wins on behalf of their client. I suppose it can happen, but what that fee will be for winning would have to be worked out at the outset of the case.

In a contingency fee relationship, the client and the lawyer form a team. I like that. The more money the lawyer recovers on behalf of the client, the more money the lawyer can recover in legal fees. And vice versa, if the lawyer recovers ZERO, then the lawyer gets ZERO. This sort of arrangement works for a variety of reasons.

I would like to illustrate one of the biggest reasons by sharing a story with you.

When I was in University, I worked for Sears Canada. I worked in the hardware and paint departments. This was an odd fit, because I’m neither a handy person nor a painter. But, I must admit that I learned a lot; both about hardware and painting. The money I earned from Sears went towards my University education. I paid for school by working at Sears. For this reason alone, I appreciated that Sears kept me gainfully employed throughout my College years so that I could make ends meet.

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The Criminal Injuries Compensation Board (CICB) is a government body which awards compensation to victims of crime and their families following a criminal act.

It’s an important tribunal because for many victims of crime, it’s the only way they can recover compensation for their injuries.

The first rule of personal injury law (or litigation for that matter) is to sue a party with deep pockets. You can’t get blood from a stone in the Courtroom. So, if you sue, and get a Judgment against a party who can never pay the value of the Judgment; then the Judgment itself is without any value. The only value that the Judgment has is knowing that you won in Court. But winning in Court where the only award is damages is a hollow award.Imagine paying a lawyer $20,000 in legal fees, and the lawyer wins a Judgment for you at trial. But after trial, when the lawyer seeks to recover payment on that $20,000 and cannot deliver because the Defendant is broke without assets, then what value is that $20,000 Judgment to you? It’s essentially worthless.

In a car accident or slip and fall case, there is generally some form of insurance behind the at fault party. In Ontario, driving with insurance is mandatory.

But there is no every day insurance to protect you from an act of criminal violence. The same way that an insurer will not insure people for committing criminal acts.

Unless the at fault criminal is a multi millionaire with debt free real estate holdings, your chances of recover against the at fault party in Court are slim. Keep in mind that the wealthiest of people are normally very good at hiding their assets to make sure that they’re judgment proof.

This is where the Criminal Injuries Compensation Board comes in to play. The Ontario Government has set aside a pool of money to compensate victims of crime and their loved ones following a criminal act. This ensure that innocent victims of crime are properly compensated.

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A number of our clients ask our lawyers whether or not they should try returning to work after they’ve been denied Long Term Disability Benefits, denied Income Replacement Benefits, denied CPP Disability Benefits, or are simply recovering from a serious injury caused by an accident; car, motorcycle, fall, or otherwise.

Let’s first paint a clear picture.

You’ve been hurt or injured in a serious car accident. Or, you have a medical condition (psychological, physical or otherwise) which is preventing you from returning to work.

Your doctors tell you that it’s not safe for you to work, and that you should take time off.

Your application for Long Term Disability Benefits, Income Replacement Benefits, or CPP Disability Benefits has been denied.

Your savings have been run dry. You’re borrowing money from friends and family members. You’re cashing out on your RRSP’s and other retirement savings in order to make ends meet. Your visa and credit are maxed out to the limit and those interest payments are accumulating. To say that you’re having financial difficulty is an understatement.

What do you do in this situation?

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A lot of our practice is focused on litigating short term, and long term disability claims against large insurance companies such as Manulife, Great West Life, Sun Life, Industrial Alliance, RBC Insurance, La Capitale Insurance, Co-Operators Insurance, Equitable Life, Canada Life etc.

These claims arise when a policy holder, of disability claimant; makes a claim on their Long Term Disability Policy (LTD), but their claim gets denied by the insurer. When that happens, people call our law firm and we’re able to help them get the benefits and justice which they deserve.

The area of Long Term Disability Law can be very confusing. Unlike a car accident, slip and fall or dog bite claim where we are able to clearly identify the wrong doing or negligence, a Long Term Disability Claim is purely contractual. That means if you don’t have an LTD policy, then you can’t have an LTD claim. It’s that simple.

The parameters of the claim are set up by the wording of the policy. Because every LTD policy is unique, every claim is very different.

Here’s a quick example. Some LTD Policies provide for benefits at 65% of your gross monthly earnings. Other policies provide for benefits at 75% of your net monthly earnings. Some policies provide for LTD benefits up to the age of 65 years old. Other policies provide for LTD benefits for just 5 years. The definitions of disability in each policy is also different and can vary dramatically from policy to policy. Some policies contain onerous exclusions for disability if based on a soft tissue injury or psychological illness. Other policies don’t contain those sort of exclusions.

The level and amount of coverage all depends on the policy, and how good (or bad) it is for the claimant. The claimant didn’t draft the policy. They were drafted by insurers, for the benefit of insurers to limit their potential exposure.

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Did summer hit, or is it just me? With a quick snap of the fingers, we’re already in June with some fantastic weather. I’ll take it after a long, cold winter.

When we get nicer weather in Ontario, people are more inclined to ride their motorcycles and bikes. The rules of the road and the way personal injury law works in Ontario for motorcyclist and cyclists can get a bit tricky…but it shouldn’t.

The purpose of this Toronto Injury Lawyer Blog Post is to examine the law and how it relates to accidents involving motorcycles and bikes, and how this can differ (or be the same) from your normal car accident case.

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Did you know that your car insurance coverage for accident claims is changing effective June 1, 2016?

If you’re answer is “NO“, then you’re not alone.

To be frank, the only reason I know about these changes is because I’m a personal injury lawyer and it’s my job to do so. But if you’re reading this Toronto Injury Lawyer Blog Post, chances are you’re not a personal injury lawyer like me, and these changes are new to you.

Why are these changes being introduced in the first place?Good question!

I didn’t ask for them…. You didn’t ask for them…..

The only people who asked for these changes were the car insurance companies and their lobbyist group in order to save them MONEY. These changes aren’t about you ,the consumer. They aren’t about protecting the public. They’re about making MONEY for those large, multi-national corporations who provide insurance services in Ontario.

The logic is that the savings for large, deep pocketed insurers are supposed to be passed along to the average, every day, Ontario motorist. These changes have been coming fast and furious to save insurers money.

Yet, in Goldfinger Personal Injury Law’s informal poll of 10 drivers asked in Toronto; 10 drivers asked in Peterborough; 10 drivers asked in London; 10 drivers asked in Kitchener; and 10 drivers asked in Vaughan; NONE OF THEM REPORTED ANY SAVINGS ON THEIR CAR INSURANCE IN THE PAST 3 YEARS!! The only savings that were reported were from those motorists who stopped driving, or instead of insuring 2 vehicles, they new only insured 1 vehicle. Conducting these polls was very easy for our law firm because we have offices in all of these Cities, with the exception of the City of Vaughan.

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Mediation is a popular tool used by lawyers to settle personal injury cases in Ontario. In some jurisdictions (Toronto, Windsor and Ottawa) mediating a personal injury case is mandatory before it can proceed to trial. The Insurance Act also contains provisions requiring mediation for an accident benefit dispute in Ontario. Some Courts have even found that a car insurer’s refusal to participate in a mediation is bad faith claims handling and awarded the Plaintiff damages in this regard.

Whether or not a mediation is mandatory; this does not change what a mediation is, and how mediation works.

If you have never mediated a case before, don’t worry. You’re not alone. 99% of our clients have never participated in a formal, legal, mediation before. BUT, 100% of our clients have participated in some form of informal mediation at one point or another in their lives!! Don’t believe me?

Ever had a dispute with your spouse or family member and you needed to call in a close friend to chat with the parties and help solve the problem? That’s mediation. When your Uncle Larry is talking to your Uncle Ned, did you need to call in Grandma to help cooler heads prevail? That’s mediation too!

Mediation is a form of dispute resolution. The nature of the dispute doesn’t matter. If there’s conflict; mediation can help resolve that conflict. Just because the dispute resolution technique isn’t labelled as a mediation, doesn’t mean it’s not.

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Personal Injury lawyers across North America widely advertise that they provide “free consultations“. It’s a widely accepted industry standard. I don’t know any reputable personal injury law firms who don’t provide a free consultation, or free consultations thereafter. You may be hard pressed to find another area of the law where face to face consultations are provided for free. A lawyer’s commodity is their time. Lawyers don’t have any dry goods to sell you like bagels, I-Phones or shoes. All lawyers have is their time, and the work product from that time which generally manifests in the form of thoughtful and meticulously prepared letters, pleadings and other documents which clients have requested or need for their respective cases.

So, when a lawyer provides you with a free consultation, it’s important for that consultation not to be a waste of time. How can we make these consultations as productive as possible for everyone involved.

Generally, the lawyer will already have done his/her research on you, the client, BEFORE you step foot through the door. A quick Google Search, or search on Facebook, LinkedIn or Twitter can tell us volumes. If the accident was a high profile accident that was covered on TV or in newspapers, then a quick internet search can give us a good starting point in terms of how the accident, where, and when the accident took place. It can also give the lawyer a starting point on the nature of the injuries, if these were reported accurately. Certainly, the client’s version of events will be more important than what’s been reported in the media as it’s not often accurate. But, it does give the lawyer a starting point.

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