Articles Posted in Accident Benefits

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A recent appeal heard in the Ontario Divisional Court made my blood boil.

Why? Let’s set the context for modern car accident and personal injury law in Ontario.

Being a personal injury lawyer is an uphill battle. It’s a real life David vs. Goliath fight featuring what’s usually an unsophisticated accident victim of limited means who has never litigated a case in his/her life vs. a highly sophisticated multi billion dollar insurer whose litigation costs are a part of its business model.

The Plaintiff is seriously injured and looking to get the compensation they deserve so they can move on with their lives as best they can.

The Defendant is looking to minimize their cost exposure by any legal means necessary. The Defendant insurer will conduct “independent” medical examinations by doctors who are paid directly by the insurer or through third party contractors (also paid by the insurer) to defeat a Plaintiff’s case. The insurer will conduct in person and cyber surveillance to find out what a Plaintiff is up to to defeat their case. The insurer will constantly test and re-test the credibility of a Plaintiff because they don’t believe what they’re saying. The insurer has an unlimited war chest at its disposal.

Those are just some of the pitfalls and hurdles which personal injury lawyers have come to expect from the combative state of modern personal injury litigation in Ontario.

But there are also procedural pitfalls and hurdles which an injured Plaintiff must overcome as well. And it’s one of these procedural hurdles which is the focus of this week’s edition of the Toronto Injury Lawyer Blog.

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Earlier this week I was at lunch with a good friend of mine. He was involved in a car accident a few weeks ago. I (Brian Goldfinger) was the ideal person to lunch with because we could talk about my primary area of practice, personal injury law.

While my friend was driving around his subdivision, another driver ran a stop sign and t-boned his vehicle travelling at high speeds.

My friend’s vehicle was virtual write off; although the insurer is doing everything in their power to salvage the vehicle. It’s cheaper for them to pay for the labour and parts than it is to purchase a new vehicle.

My friend’s air bags deployed. He was knocked unconscious for a period of time. How long is uncertain.

My friend told me how hard the other guy’s insurance company was fighting with him. This seemed odd because the car accident only happened a few weeks ago, and here in Ontario, we have a no fault accident benefit system which is supposed to take away that fighting between the innocent accident victim and the other driver’s insurance company at such an early stage. If there is to be any fighting or disagreement, this would take place at a much later stage.

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Mistakes happen. Part of our job at Goldfinger Injury Lawyers is helping people better understand the law, and how car accident insurance works in Ontario.

Today the Toronto Injury Lawyer Blog is pleased to share Brian Goldfinger’s list of Top 6 Mistakes which people make after a serious car accident in Ontario.

If you or a loved one has been involved in a serious car collision, Brian Goldfinger and the team at Goldfinger Injury Lawyers urge you to read this list carefully to make sure that the same mistakes don’t happen do you or your loved ones. Your health is important and so is your case. Don’t get hurt twice.

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On December 5, 2017, Ontario Finance Minister Charles Sousa along with Attorney General Yasir Naqvi announced another set of major reforms to car insurance in Ontario. This set of reforms has a grandiose name, much like all of the other reforms which have been introduced in the 14+ years of Wynne rule in Ontario.

The “Fair Auto Insurance Plan” is intended to lower premiums in Ontario, and reduce fraud. Both sound like great things. Haven’t we been trying to reduce premiums over the past 30+ years? In that time period, have your premiums gone down? Have the premiums of your neighbours, friends, family members or loved ones even gone down in the past 5 years? Likely not according to our very informal survey of asking real people if their premiums have gone down.

The Fair Auto Insurance Plan is based on the recommendations from the Marshall Report, created by former head of the WSIB David Marshall. The Toronto Injury Lawyer Blog covered the Marshall Report entitled Fair Accident Benefits, Fairly Delivered in a previous entry here. If you haven’t read up on the Marshall Report, I suggest that you do if you want to better understand what the Liberal Government is hoping to accomplish.

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If you’ve been hurt or injured in a car accident, you are entitled to accident benefits from your own car insurer. These accident benefits are NOT damages for pain and suffering; nor are they compensation intended to make you whole for your attendant care, income loss, housekeeping claim, or loss of guidance, care and companionship with immediate family members.

Accident benefits are intended to help the injured accident victim get better following a car accident. They are also intended to supplement, to some form, for their income loss (up to $400/week) and attendant care (up to $3,000/month for non-catastrophic claims, and up to $6,000/month for catastrophic claims).

The problem lies herein. The insurance company supplying those accident benefits is typically your own car insurer; even though you or your insurer may have not even caused the car accident (hence the term no-fault benefits). But the accident benefit insurer gets to act as Judge, Jury and Executioner all in the same breath when determining which accident benefits they will pay, and which accident benefits they won’t pay.

If an insurer paid our on each and every claim, without contesting or opposing a treatment plan, they would not be nearly as profitable as they are today. Insurance companies are publicly traded corporations. Profits not only matter, but matter each and every quarter to ensure that the stock price increases for their share holders. Check the TSX for your favourite car insurers, which include but aren’t limited to Intact Insurance IFC.TO; Co-Operators General Insurance Company CCS-C; and Aviva PLC to name a few. The more money which insurers pay out to accident victims, the less money they get to retain in profit. That ultimately hurts their bottom line, and their share performance struggles on public stock exchanges.

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Attendant care benefits.

What are they?

How do they work?

How do I get compensated? For how much and for how long?

These are all important and common questions after a serious car accident in Ontario.

The law surrounding attendant care benefits has changed significantly since they were conceived under the Statutory Accident Benefits Schedule (SABS) and Insurance Act. For whatever reason, insurers and the government like to tinker with attendant care benefits thereby changing the laws on what seems to be an annual basis.

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Car accident cases in Ontario should be simple.

The premise of one car, hitting another car by mistake or negligence; and thereby causing damages/injuries to another party ought to be basic tort law.

Unfortunately in Ontario, this couldn’t be further from the truth. The Ontario Government, at the behest of large insurers has created a system whereby the rights of people are not equal to the rights of large insurance companies. This system has become very complicated.

The law has been crafted in such a way as to minimize the exposure/risk for insurers to boost their profits, at the expense of everyday people like you and me.

I have never met an individual unaffiliated with car insurance industry (doctor, therapist, adjuster, lobbyist, lawyer, insurance company employee/agent) who has lobbied for changes to accident benefits or the Insurance Act. Yet, major changes to accident benefits and the Insurance Act happen on a near annual basis.

The election issue of lowering car insurance premiums was admitted by Premier Wynne to be a “stretch goal“. But reforms to the accident benefit system, and how tort claims proceed through the Courts was not a election issue. Yet these items are constantly being tinkered with at the expense of innocent accident victims to bolster insurer profits.

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Our personal injury lawyers constantly field questions from prospective clients regarding the basic steps of what to do after they’ve been involved in a car accident in Ontario.

We must admit, the laws surrounding car accidents in Ontario are confusing. They certainly aren’t straight forward by any means. It comes as no surprise to our lawyers that people have questions, and LOTS of them!

This is why our law firm has put forward this easy to understand claims guide in order to assist you after you or a loved one has been involved in a car accident, motorcycle accident, or have been hit by a car as a pedestrian.

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Our law firm has written many articles on how to complete the OCF-3 Disability Certificate in previous editions of the Toronto Injury Lawyer Blog.

Your can read these previous articles here, here, or here.

Don’t get me wrong. Those articles are great and contain valuable information for accident victims, their loved ones, doctors, therapists, even insurance adjusters.

But those articles are dated. Accident benefit and car insurance law is ever changing!!!

The standard OCF claim forms are constantly being updated. We have no reasonable explanation as to why the OCF forms get changed around so often aside from the government is constantly changing car accident law to keep lawyers and insurers on their toes. These changes generally seem to favour large insurers, but that’s another story all together.

The end result is that injured accident victims, doctors, therapists and rehab clinics may be using old forms which won’t be accepted by the insurer when submitted.

In fact, we’ve had experience with more than one adjuster who has submitted the wrong/dated OCF form to our clients by mistake. Our lawyers don’t blame them. The system and the constant tweeks/updates to accident benefit and car insurance law has made an already complex system even more complex and burdensome to accident victims, service providers and insurers alike.

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Not many people know this, but my family used to own a farm in Brockville, ON. Brockville is east of Kingston, near the Ontario/Quebec border. My grandparents owned a large farm with hundreds of cows, some chickens and large vegetable garden. I still have memories of the farm. On occasion, my grandfather would threaten me if I didn’t listen by saying he would take my toys away and give them to the cows. I sure listened after that.

As Goldfinger legend has it, the farm house burned down on account of a spontaneous hey fire. The only things that were saved were the  family photo albums. And if you ask around, there are a few epic shots of yours truly hanging out with the cows we had.

The reason I’m bringing up Brockville is because it reminds me of a special client our law firm worked with. This client was involved in a single car motor vehicle accident just outside of Brockville. Years went by and this person never thought of retaining a lawyer. She was at fault for the single car accident, so there was nobody to sue (you can’t sue yourself for your own negligence). The person was scared to consult with a lawyer for these reasons. S/he didn’t know where to turn, what to do, or how the system worked. She was lost, and just went along with whatever the insurer suggested.

The person sustained multiple orthopaedic injuries and a brain injury in the car accident. This was by no means a minor collision, and the injuries were significant. I’ll talk more about the significance of those injuries later on in this Toronto Injury Lawyer Blog Post.

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