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The term “long term disability benefits” would lead one to believe that those benefits should last for a long time.

But the term “long” can be misleading and subject to interpretation. Like many things in the practice of the law, the devil’s in the details and you gotta read the fine print.

So while your friends and family may tell you that your “long” term disability benefits will last for a “long” period of time (like your entire life); don’t be mislead.

Different policies of insurance carry different definitions for the duration of those long term disability benefits.

Here are a few examples:

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If you have been hurt or injured in a car accident in Ontario, you may be entitled to an income replacement benefit of up to $400/week (or more if you paid an additional insurance premium to increase your IRB level).

$400/week isn’t very much money. But before you complain, all Ontario drivers are eligible to purchase optional benefits to increase the IRB level. Unfortunately, very few Ontario motorists opt to purchase this coverage because it tacks more money on to their existing premium. Let’s be honest, the majority of people are simply looking for the cheapest rates around, without giving much thought to what they are, or aren’t covered for and regardless of the ultimate benefit which is paid out.

If I told you that you could increase your liability coverage from $1,000,000 to $2,000,000 per year by paying an extra $20/year, would you take it? Sounds like a pretty good deal right? Paying just $20/year for an extra $1,000,000 in coverage. This is one of the best bangs for the buck on the car insurance market, but few people opt for this additional coverage benefit. The cheapest coverage is the default coverage of choice for the majority of Ontario drivers.

When you think of the term income replacement benefits, it would lead you to believe that the benefit will replace your entire income for the period you’re too injured to work following a car accident. NOT TRUE.

The term income replacement benefit is somewhat misleading, as it doesn’t entirely replace your income, and it’s not as automatic as the term “benefit” would lead you to believe.

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It’s hot. That means more people are outside doing “outdoorsey” stuff like hiking, cycling, rollerblading and skateboarding.

The activities are suppose to be fun and safe. But sometimes things can go wrong. And when they do, our law firm usually hears about it.

Accidents whereby skateboarders, cyclists and rollerbladers are hit by cars are usually very serious. Want to know why?

The average weight of a large car is over 4,000 pounds! The average weight of a Canadian male is 177 pounds.

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One of the most common orthopedic injuries our personal injury lawyers see in slip and fall cases are broken ankle.

Not sprained. Not bruised. Broken ankles. Like the ankles when you fall you may hear a snap, crackle or pop; but in a bad way and not in the breakfast cereal type of way.

A broken ankle injury is very serious. Think about it for a moment.

When you stand, pressure is applied to your ankle.

When you walk, your ankle needs to flex. When you rotate, jump, bend, kneel; all of these movements puts pressure and strain on your ankle.

If your ankle goes in to a hard plaster cast, you’re out of commission. You can’t walk, run, or jump. Your doctor will recommend that you are non weight bearing. That means you’re not to put weight or pressure on your ankle. Translation: no walking or putting pressure on the ankle. Or if you are getting around, you will need to do so with crutches, a wheelchair, or one of those scooters you may see that allows you to raise an ankle while rolling around.

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Ride hailing companies like Uber and Lyft have dramatically changed the way we get around. Hailing a car from a ride share service is convenient, fast and easy.

The increased popularity of these services has created many hiccups for personal injury lawyers, and insurance companies alike.

To give you an idea of the popularity of drive sharing services, in March 2019 in Toronto, nearly 176,000 trips were taken. That’s a lot of trips!

The first major pitfall we saw as personal injury lawyers is what policy of insurance was appropriate for ride share drivers?

A standard car insurance policy wouldn’t cut it because these vehicles were being used for commercial purposes. There are different driving patterns and risks associated with insuring commercial vehicles versus insuring normal residential communing vehicles. Add to that the additional risk of drivers taking on strangers in their cars, driving to/from unfamiliar places with timing constraints to get to a certain destination on time; it all adds to additional risk for insurers.

The first drive share cases which personal injury lawyers saw dealt with accidents involving such vehicles, where insurance companies were denying coverage because the driver failed to disclose that they were driving the vehicle for commercial purposes.

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Everyone loves a good acronym. It’s fun to guess what the letters in the acronym stand for…..or don’t.

Here are a few non legal examples:

BRB Be right back

GTG Got to Go

LOL Laugh Out Loud

Here are a few legal examples of acronyms which personal injury lawyers in Ontario see everyday:

IRB Income Replacement Benefit

NEB Non Earner Benefit

SOC Statement of Claim

ACB Attendant Care Benefit

Here is one acronym which has been in use for over 20 years in legal circles which will soon go extinct:

FSCO Financial Services Commission of Ontario

The Financial Services Commission of Ontario is a regulatory agency of the Ontario Government that use to regulate insurance, pension plans, loan and trust companies, credit unions, caisses populaires, mortgage brokers, and co-operative corporations in Ontario. FSCO regulated or registered:

  • 316 insurance companies
  • 7,022 pension plans
  • 98 credit unions and caisses populaires
  • 57 loan and trust corporations
  • 1,216 mortgage brokerages
  • 2,754 mortgage brokers
  • 12,275 mortgage agents
  • 184 mortgage administrators
  • 4,630 accident benefit service providers
  • 1,764 co-operative corporations
  • 54,128 insurance agents
  • 5,911 corporate insurance agencies
  • 1,740 insurance adjusters 

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The Ontario Government announced (this week or last, it’s not clear because it came out of nowhere) that they are planning to amend the Occupiers Liability Act.

For those of you who don’t know, the Occupiers Liability Act sets out the laws for slip and fall cases on private property.

The Occupiers Liability Act describes who an owner is (“occupier“) what their duties are and so forth. It also sets out what an (“invitee“) is, and sets out their rights as well. An occupier has a positive duty both in statute and in common law to ensure that their premises are safe for invitees to their premises. Failure to uphold that duty will result in liability to the occupier. The result is that an insurer will respond to the claim to cover the occupier and indemnify the invitee. If the occupier did not have insurance on their premises, then they will be responsible to pay for the cost of litigation and pay out on the case out of their own pocket (whether that’s a personal or corporate pocket depends on the ownership structure).

The standard limitation period for slip and fall cases is 2 years from the date of loss. Failure to commence a claim within that period of time, will result in a limitation period lapsing. Limitation periods, unless otherwise specified in another act, are set forth in the Limitations Act, 2002.

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Every single client that personal injury lawyer Brian Goldfinger has met believes that his/her case is worth at the very least, $1,000,000 (if not more).

But why stop at $1,000,000?

Why not $2,000,000?

Or $3,000,000?

How about $10,000,000?

Better yet, let’s make it $50,000,000 plus three Ferraris, a life time supply of groceries and a lakefront Muskoka cottage.

There are no limits to our imaginations and expectations for our respective cases.

But unfortunately, there are limitations at law for how much you can receive in your personal injury case, along with what exactly you can claim for.

When clients here about these limitations (essentially how the law works in Ontario), they are left disappointed and thinking that “the law sucks“. I agree. The law does suck. And it sucks especially hard for innocent car accident victims who did NOTHING WRONG, except for being in the wrong place, at the wrong time and suffering a serious injury as a result of the negligence of another individual.

When reading this installment of the Toronto Injury Lawyer Blog, please keep this in mind. All the law can do is try to make you whole, to compensate you “fairly” for your injuries. The law only in very rare cases punishes defendants with punitive or aggravated damages. Defendants are entitled to more protections under the law than innocent plaintiffs. We see these protections in the form of caps on general damages, secret credits called “deductibles“, medico-legal thresholds to hit in order to recover compensation along with damage set offs or credits for at fault defendants.

Car accident laws in Ontario have been drafted, crafted, carefully thought out and manipulated by large deep pocketed insurance companies to reduce their risk and exposure in cases like yours. The lower their risk and exposure, the more profitable these insurance companies can be.

The Ontario government for many years has caved in to insurance company demands with respect to the laws, in particular for car accident claims. The thinking was that the more insurers saved, the easier they would be able to pass along these savings to the consumer to reduce car insurance rates to make everyone happy. But ask yourself, over the past decade have your car insurance rates decreased? Likely not. But the benefits you’re eligible to receive have been slashed significantly. The end result is that Ontario consumers are paying MORE for car insurance, but getting LESS coverage and benefits under their plans.

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The last installment of the Toronto Injury Lawyer Blog dealt specifically with tips and tricks for long term disability claims in Ontario.

That Blog entry was a resounding success. We received considerable positive feedback and inquiries that we thought we would keep the ball rolling with a second installment of tips and tricks for long term disability claims in Ontario.

These tips and tricks are based on what our long term disability lawyers see in our every day practice. We see a variety of pitfalls which trip up our clients which we would like you to avoid. Knowing how to deal with a long term disability insurer and making the right moves at the outset of your long term disability claim will help get your claim started on the right foot so hopefully, you don’t get denied.

But if your long term disability claim does in fact get denied, feel free to contact Goldfinger Injury Lawyers in confidence for your free no hassle, confidential consultation. All of our cases are taken on a contingency fee basis meaning you don’t pay any upfront legal fees, unless we win the case for you. This gives you the client access to our Court system which is very expensive and acts as a barrier for most people to bring claims against large deep pocketed insurance companies.

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Lots of people call my law firm for legal advice for their long term disability claims. Often for these people, it’s their first time dealing with a large insurance company over a claim of significant value which can impact the course of their financial security for the rest of their lives.

Questions like:

What should I (or shouldn’t) say to the adjuster over the phone?

How do I complete all of these forms?

Who should complete these forms?

When should I apply for long term disability benefits?

How can I apply for long term disability benefits?

What must I do once my long term disability claim gets denied?

Should I appeal the long term disability insurer’s decision; and if so; how do I go about that?

When should I retain a long term disability lawyer?

How much will retaining a long term disability lawyer cost?

How long will my case take to get settled or go to trial?

As you can see, people have a lot of questions regarding their long term disability claims. This is completely understandable. Long Term Disability claims are hard to understand right off the bat! They are contractual disputes. The terms of each contract are different. They all depend on the wording of the policy and each policy of insurance is similar; but it’s NOT the same. This is what makes things a bit confusing.

A car accident is easy to understand. In a car accident case, an at fault driver causes a car accident and is held accountable for the pain, suffering and ensuing economic losses they have created through their own negligence.

A long term disability case is based on the wording contained in the policy of long term disability insurance. These policies are long, verbose and hard to understand. There are multiple clauses, exceptions, time periods etc which makes hard even for an experienced long term disability lawyer to understand.

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