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If insurers paid out maximum compensation on each and every claim, there wouldn’t be any need for personal injury lawyers or paralegals who focus on benefit accident claims.

Why does an injured accident victim or disability claimant need a lawyer, if the insurer is paying them out the full value of their claim up front; without any hassle?

But, if an insurer paid out the maximum value of each and every claim which came across their table, chances are they wouldn’t be as profitable as they are; or profitable at all.

As much as we are made to believe that insurers are there to look out for our best interests and pay out when they are supposed to; at the end of the day; insurance companies exist to MAKE MONEY.

Many Canadian insurance companies trade on the Toronto Stock Exchange (TSX). Here are a few examples along with their stock symbols, along with current share values as of the time of preparing this Toronto Injury Lawyer Blog Post on July 7, 2015:

Intact Financial Corp: IFC $90.57

Sun Life Financial: SLF $41.80

Manulife Financial: MLF $23.03

Co-Operators General Insurance: CCS-PS $23.79

Those are just a few of the examples of insurance companies which do business in Canada, who trade of the Toronto Stock Exchange.

Those stock symbols and share prices are VERY important. If those share prices drop significantly, millions, if not billions of dollars will be lost value and options for shareholders around the world.

If one of these insurers paid out ALL claims, regardless of merit of an entire year, chances are those stock values would dip dramatically.

So, when accident victims or disability claimants wonder why so many claims are denied at first instance, or why insurers refused to believe what their doctors have to say about their injuries, there is a financial reason for this.

The more money an insurer pays out to your for your claim, the less money they get to report in profits for their share holders.There are certainly a variety of their factors involved in insurer profits, but this is one of the most tangible concepts for accident victims and disability claimants to understand.

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Happy Canada Day! It’s a time to celebrate our beautiful country, friends and family. For many, Canada Day will involve good food, good beverage, and participating in outdoor activities.

In the days following Canada Day, our law firm often gets a number of calls and inquiries regarding injuries which took place in the great outdoors during Canada Day celebrations. There is a common thread with these calls, which I would like to share with you in order to ensure that your holiday is a safe one. Because afterall, who wants their Canada Day celebration ruined on account of a serious injury or accident. This is the last thing you want over a long weekend.

So without further a due, here are Goldfinger Personal Injury Law’s top safety tips for the Canada Day holiday:

1. Drinking and Driving; Drugs and Driving and Texing and Driving is always a dumb decision. Don’t do it. But let me take this one step further in tip #2…

2. Alcohol, or Drugs and Any MOTORIZED equipment don’t mix either! Operating a chain saw, a scooter,an e-bike, a small engine boat, an ATV, a Sea-Do; you name it. If it’s motorized and you’ve been drinking or have taken a narcotic; it’s not a good mix. You would be amazed at the amount of weird fact pattern calls we get following summer long weekends involving operating some sort of motorized vehicle and drinking. Often, these vehicles aren’t insured, and are being operated where they shouldn’t be operated. Play it safe from the start so you don’t need a personal injury lawyer to figure out how an insurer is going to respond and perhaps pay out for such a claim. There is no magic pill to get your health back, and no amount of money; no matter how large will ever restore your health. People don’t often understand that concept. A million dollar, or two million dollar award, or even higher will NEVER restore an accident victim’s ability to walk.

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You’ve been injured in a car accident, or you’ve made a claim for Long Term Disability Benefits.

Benefits have not yet been paid. The insurance is giving you a tough time. They’re treating you like you’ve done something wrong; when all you’ve done is been in the wrong place at the wrong time resulting in serious injuries. All you want are the benefits you need to help you get better, and make ends meet. After all, isn’t that what insurance is for? Isn’t that why you’ve paid mountains of money in premiums all of these years.

You receive a notice in the mail from your insurer. They want you to attend an IME (Independent Medical Examination) with some doctor or therapist who you’ve never heard of, in a strip plaza or office tower that’s far away from home.

Transportation has been arranged, but the assessment is still going to take up a lot of your time.

You have yet to receive any benefits so why should you bother to attend? You don’t want some strange doctor or therapist touching you, or asking you all sorts of personal questions, and then reporting their findings to strangers at the insurance company. It all seems weird. And who’s paying for these examinations anyway? They aren’t covered by OHIP, and you know that doctors’ time isn’t cheap.

If the request for an IME is as a result of a car accident, unfortunately, the Insurance Act and the Statutory Accident Benefits Schedule (that’s the law dealing with car accident benefit claims) requires that you attend.

Here is an excerpt of the relevant section of the SABS:

Examination Required by Insurer

42.  (1)  For the purposes of assisting an insurer determine if an insured person is or continues to be entitled to a benefit under this Regulation for which an application is made, an insurer may, as often as is reasonably necessary, require an insured person to be examined under this section by one or more persons chosen by the insurer who are members of a health profession or are social workers or who have expertise in vocational rehabilitation. O. Reg. 546/05, s. 21.

So, you’ve now read the law which basically requires your attendance at these examinations. Still..what happens if you just don’t go? Read on and we will tell you!

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One of the most commonly asked questions of clients at my law firm is “how much is my case worth?

This is never an easy question to answer.  When assessing the value of a claim, particularly an LTD claim, there are a variety of factors which need to be examined such as:

  • The age of the LTD Claimant
  • The duration which benefits are payable under the policy (age 65 or earlier?)
  • Were any back payments/arrears paid out by the LTD Insurer or not?
  • The value of the monthly LTD benefit
  • Are there any set offs which the LTD insurer is entitled to under the policy such as CPP, WSIB or otherwise
  • Is there an all source maximum deduction at play
  • What are the nature of the injuries causing the disability and are those injuries likely to heal
  • What the claimant’s doctors have to say about a potential return to work
  • What the insurer doctors have to say about the injuries and the potential return to work
  • Has the insurer conducted any surveillance (real time, online, cyber or otherwise) and what does that surveillance show
  • What sort of education, training and work experience does the claimant have
  • Can the claimant read and write in English or French
  • What is the employability potential of the claimant following the LTD claim
  • Has there been any bad faith handling of the LTD file on the part of the insurer. If so, what is the nature of that bad faith claims handling and how has it impacted the claimant’s entitlement to LTD benefits?

The value of the LTD claim depends in large part on how the above noted questions are answered, amongst other factors which may be unique to one’s case.

Unlike other injury or accident cases, LTD claims are largely assessed based on mathematical equations. Take the value of the LTD benefit, less any off sets, by the number of months owing in arrears and future benefits owing by the insurer; et voila; you will have the maximum exposure owing by an insurer.

In a car accident claim, the award for pain and suffering, is somewhat subjectively based on historical precedent of cases built over the years. There are different heads of damages for car accident claims such as pain and suffering, past/future income loss, housekeeping claim, attendant care claim, claim for out of pocket expenses, claim for past and future care costs, claim for a modified home or vehicle, family law act claim for loss of guidance care and companionship etc. On the tort end of a car accident claim, there are a variety of heads of damages upon which to base a claim.

LTD claims are different because many of these heads of damages simply don’t exist. LTD claims are contract claims. No contract of insurance; NO CLAIM. Because they are contractual claims, they are based primarily on what’s contained inside of the policy and its wording. These are NOT claims for pain and suffering. These are claims for past and future benefits, based on an amount as defined and calculated pursuant to the policy. Therefore, establishing damages is not based on legal precedent. It’s based on what the policy says, along with the factors set out above.

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Our law firm does NOT handle any WSIB matters. Imagine that…a personal injury law firm refusing work!

But that’s right; our law firm doesn’t touch WSIB work. There are a lot of reasons we don’t practice in this area. Aside from the WSIB being an archaic, overly complicated system; the reality is that it does not adequately compensate injured workers. The awards are rather pitiful, hard for workers to get, and their system of unbiased assessments is “impartial assessors” is a farce. There are a number of economic reasons why our law firm doesn’t do WSIB work, but that’s pretty much all you need to know about WSIB.

You will be hard pressed to find a reputable lawyer in Ontario who does exclusively WSIB work, but there are a handful of them around if you’re lucky enough to find one and have them take on your case at a reasonable rate.

There are times when WSIB and civil tort law intertwine. When this happens, we are there to help people make the right decisions so that their cases get off on the right foot.

For starters, you CANNOT receive bot WSIB benefits and SUE. You can’t have both. You either get one, or the other. This is very important for any accident victim to know.

There are instances where injured workers CANNOT sue. If they’ve been hurt or injured on the job site, there are instances where the injured party MUST pursue a WSIB claim. In such instances, it’s important to find out if your employer is a Schedule 1 or Schedule 2 employer. The difference is that is that you CANNOT sue a Schedule 1 employer; while you can sue a Schedule 2 employer. How do you find out if you’re dealing with a Schedule 1 or a Schedule 2 employer? That’s easy. All it takes is a call to the WSIB at 1-800-387-0750. Just ask the person who picks up the phone. It’s an easy search for their staff to make.

Banks, Veterinarians, Law Firms and some other employers are NOT require to have any form of WSIB coverage. So, it’s open season to sue these employers for their wrong doing.

At the end of the day, it’s important to keep in mind that WSIB acts as a shield for employers. They pay in to an insurance plan known as WSIB, and it’s there to protect them in the event of a worker getting injured.

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A Long Term Disability policy of insurance (LTD Policy), is a policy designed to cover the insured for a monthly benefit in the event that person becomes disabled.

These policies are often offered by employers, to employees as a part of their benefits package. It’s a common perk of employment. Like saying that you work at Google, and they offer a generous benefits package. That package includes LTD Benefits. The nice thing about this is that the employee has a benefits package. The bad thing about it is that the employee doesn’t have much say about what goes in to that benefits package, how much those benefits are worth, and the benefits will likely cease when the employee ends his/her employment relationship with the employer. No longer an employee of Google? Then no more LTD benefits are available to you.

Other times, LTD Benefits are purchased privately through an insurance broker. In this instance, the policy holder (that’s you) gets to pick the right amount of coverage which best suits their lifestyle and financial situation. The LTD benefits are NOT tied down to a specific employer. They follow the insured person from job to job. These benefits are great for contractors, self-employed persons, people who don’t have benefits offered through their employer, or even people who have benefits offered through their employer, but just want additional coverage because the coverage offered through their employer isn’t necessarily the best.

Some of the large companies who offer LTD benefits (both group and individual policies) are Great West Life, Canada Life, Sun Life, Standard Life, Manulife, RBC Insurance, Industrial Alliance, Co-Operators Insurance, Desjardins, SSQ and Equitable Life just to name a few.

As you can see, there are quite a few LTD Insurers out there to chose from. It’s important to note that each policy is different. What’s most important to the insured, is how the policy works to get you paid in the event of disability.

The term “disability” is a VERY broad term. Don’t believe me? Here are a few insurance examples from car insurance policies, and LTD policies which define what it means to be “disabled” to receive benefits under their policies.

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First and foremost, I want to send special recognition my friend David Siegel, who told me last night that he stopped following his mother, sister, father, the best man at his wedding, and his Grade 8 Karate teacher on Twitter. BUT, he continues to follow @GoldfingerLaw on Twitter. David told me that he can’t get enough of the Toronto Injury Lawyer Blog, along with the daily insight and tidbits from our law firm’s Twitter Feed. You can’t follow David on Twitter, but you can follow his dog, @RockySeigel for the latest in the life of his pooch.

On to some law talk? Sure. Why not.

My law firm gets calls from kind people all over Ontario who have been hurt or injured in an accident; or who have nowhere to turn after they’ve had their long term disability claims denied.

There are a lot of plaintiff personal injury law firms out there in Ontario. Goldfinger Personal Injury Law doesn’t control 100% of the market. Sometimes (more often than I can to admit) we get calls from upset clients of other law firms; or accident victims who have contacted other law firms, prior to calling our office.

Some of the practices I’ve heard from these clients from other law firms, whether true or not, are quite disturbing. I can relate to the anger and frustration of those who contact my office after being treated they way they’ve suggested. The tears say it all. There are no words to describe the upset feelings and disappointment these people have to share. Continue reading →

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Intact Insurance has some great television commercials where an terrible accident happens (like a car driving in to a swimming pool); followed by a scene involving an insurance policy holder calling the insurer over the phone. The next scene is that of a well lit and pleasant call centre whereby an insurance agent from Intact proceeds to collect that person’s information and open up a claim in 5 minutes or less. Pretty impressive! The ad is meant to show the ease and speed in which Intact can open a file and process your claim.

Because that’s exactly what all Ontarians are looking for when choosing an insurance company. We’re not looking for low rates, or good customer service. We’re looking for speedy claims opening procedures. They’re fast, so we know they’re good.

The commercials are pleasant and well executed. They are.

A casual observation from this injury lawyer: the television commercials don’t show any personal injuries, and physical injuries. The only damage is comical or cartoonish.

One ad has the car driving in to the swimming pool, another ad has a car driving in to a mail box. Nobody is hurt. It all looks like an honest mistake where everyone is calm, able to smile, and having a relatively good time. Of course, all of this is intentional to keep the air of the ads light; rather than be downers and show catastrophically injured accident victims and crying family members waiting attentively by a hospital bedside attending to their seriously injured loved ones.

Here is the reality of most claims:

1) If it’s a car crash, there are likely injures. In many cases, there are serious injuries. Sometimes the injuries are so serious that the accident victim can’t talk.

2) The claimant isn’t all bubbly and happy when making the call, no matter how pleasant the agent is on the other line. The claimant is upset, mad, stressed, nervous, anxious, or pi$$ed off for lack of a better term that they were involved in a serious accident and now have to make a claim.

3) The claimant might not speak the best English; making reporting the claim difficult. Language can always be a barrier to getting these things sorted out.

4) The person on the other line might not be as bubbly, welcoming and friendly as they appear in the commercials

Here’s something which you probably didn’t pay attention to in these commercials. The person who was working in the call centre for the insurer was sitting at a desk, in front of a computer and inputting information in to their system. They may be taking notes of the conversation, OR the conversation may be recorded for “customer service purposes“. The claimant who initiated the telephone conversation isn’t taking any notes, nor are they depicted as sitting at a computer an inputting information in to a computer system.

Don’t overlook this tiny detail. It’s important. Want to know why? Read on and find out.

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For many, this May long weekend marks the official beginning of spring/summer; depending on how you evaluate the temperature. After a very long, cold and windy winter, this May long weekend is a warm welcome; even if the temperatures aren’t “July in Windsor warm“.

As an accident lawyer, our firm has seen many cases over the years, which have stemmed from negligence or bad decisions over long weekends.

With this edition of the Toronto Injury Lawyer Blog, we wanted to give you some safety tips; do’s and dont’s; to make sure that this May long weekend is a pleasant and safe one, for you, your family and those around you.

1. Don’t drink and drive. Whether it’s a car, motorcycle, ATV, E-bike, Sea-doo, or a boat; alcohol and motor engines don’t mix. I can’t begin to tell you about the spike in calls that our law firm receives following long weekends with respect to alcohol related injuries, or drunk driving accidents. When you drink, your judgement is impaired. So is your co-ordination. Getting behind the wheel of a motor vehicle after drinking not only puts your own life at risk, but also the lives of your passengers and other motorists with whom you’re sharing the road or waterway. We all have seen the public service advertisements from such groups as Mothers Against Drunk Driving, or Ontario Students Against Impaired Driving. Driving drunk is ALWAYS a bad decision whereby you’re putting somebody’s life at risk. The consequences can last forever so be smart about it.

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The governing Liberals announced Ontario’s budget on April 23, 2015. Finance Minister Charles Sousa, backed by Premier Kathleen Wynne were in fine form that day. When one thinks of the term “budget“, we would think of all things financial, including taxes, public spending on healthcare, infrastructure, and education. And to be fair, healthcare, infrastructure and education were all addressed in the 2015 budget.

But what often gets swept under the rug without any debate, deliberation or consultation with stake holders is CAR INSURANCE.

Why is this such an important topic? Well, for starters, if you want to drive a car in Ontario, you need to have car insurance. It’s the law. Check the Compulsory Automobile Insurance Act. That’s right. Ontario has a specific act regarding operating a motor vehicle WITH car insurance.

So, if Ontarians are required to operate a motor vehicle with car insurance, then it’s going to be important to all motorists in the province. This amounts to a lot of people. And if all of these people need to have car insurance, then the product they’re required to purchase better be a good product, and protect their rights in the event of property or physical damage.

For insurance companies, car insurance is important because it’s a way for them to make money. What the legislation says regarding what insurers are required, and not provided to require under these policies of insurance goes straight to their bottom lines. The more they can charge by providing the least amount of benefits will increase their profits and make their shareholders happy.

For politicians car insurance is important because if rates are too high, then voters are unhappy. So, the aim of politicians when tinkering with car insurance is to get the cost of car insurance down. But how do they do that? The government doesn’t set car insurance rates. But they do however legislate what benefits are required to be provided in said policies and how benefits work; which ought to have some form of correlation with the price of car insurance (among other factors such as driving record, age, where you reside, driving experience, and the type of vehicle your drive).

So how has car insurance in Ontario been affected since the new budget was announced? Keep reading and I will share that with you.

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