Articles Posted in Accident Benefits

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Part of the secret to defending a personal injury case, isn’t in the defence of the case on its merits itself. Rather, it’s all about trying to find alternative sources of income or benefits which the Plaintiff is entitled to so that that money offsets any potential award. This way, if even if an at fault Defendant or large insurer looses the case; their damages exposure is limited by the amount of collateral benefits which a Plaintiff has received; or which a Plaintiff is entitled to.

The term collateral benefits is often misunderstood by Plaintiffs, or disability claimants. But, it’s a very important term for any Plaintiff in a personal injury case to understand.

Think of collateral benefits as an amount of money (or benefit) which a Plaintiff is entitled to. The Plaintiff may be receiving that money; or they may not. The money might not be coming in because the Plaintiff has not applied, or thought of applying for that benefit. We see this frequently. There is no playbook for getting injured. Nor is there a playbook for what benefits to apply for after a serious accident, injury or disability claim. Many Plaintiffs don’t know that they might be entitled to benefits; or they don’t know how or when to apply for said benefits. Unfortunately neither the law nor insurers care about that. If you are entitled or eligible for said benefit, you should apply even if you didn’t know the benefit existed. The law will treat the Plaintiff as if they knew about said benefit, and as if they were eligible to receive said benefit; even if they didn’t receive it. The set off will be applied irrespective of whether or not the application for the benefit was made or not.

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In school, you’re not taught what to do after a serious car accident. There is no course or classroom lesson. This is something which people will learn from friends, family members, lawyers, reading, or through life experience.

While car accidents happen everyday,  the same people aren’t involved in car accidents everyday. They are the exception, and not the norm for individuals. But, the opposite is true for insurance companies. They handle hundreds of calls a day, and thousands of cases each year across the country. Handling car insurance cases is part of their business model. They are familiar with the ins, and outs, and what has to get done in order to process a claim and see it through.

Our personal injury lawyers have seen that people want advice in their time of need right after a car accident. They don’t know where to turn, what to do, or who to trust. Innocent accident victims are shaken up, and in a vulnerable state. They want to trust their insurance company to given them advice, and to point them in the right direction. But, the insurer has their best interests in mind, and not yours. They will try to set up the claim in such a way as to best limit their exposure in an effort to maximize their profits. So, injured accident victims need to beware, and take everything which the insurance company says with a grain of salt (or a large mound of it). The relationship between injured accident victim and insurance adjuster can get off on the right foot, but can quickly sour thereafter. A few denials here and there. An assessment with an “independent” specialist to justify a denied treatment plan. Things can get messy really quickly. Here are some quick tips on things to avoid with your insurance company following a serious car accident:

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There are so many tall tales in personal injury law. Things which you hear from your friends, family, therapists, neighbours, acquaintances, or random people in your community are so far off from the reality of what actually happens behind the scenes, and the work involved in a personal injury case.

The only people who really know what happens, and how things happened are the lawyers themselves.

There are a lot of reasons for this.

For starters, personal injury cases deal with new litigants, who are unfamiliar with personal injury cases, or how the law works. This is completely normal as for the majority of clients, it’s their first time hiring a personal injury lawyer, or a lawyer all together. When you are new to litigation, it’s hard to understand how things get done. It’s perfectly ok to be a first time litigant. In fact, if you’re a multiple time litigant for a personal injury case, it will give your lawyer cause for concern. You must be terribly unlucky, finding yourself repeatedly in the wrong place, at the wrong time. You will also likely have an extensive pre-accident history which will invariably come up in your personal injury case.

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Most people aren’t familiar with how car insurance disputes work until they have to go through the process.

Most would think that if there’s a dispute for benefits, they can sue the insurer which is denying those benefits and then a Judge can decide. That seems simple and straight forward. Unfortunately, simple and straight forward is not the way which car accident cases work in Ontario.

Long ago, accident victims had the right to sue the insurance company which was denying their accident benefits following a car accident. That case could be heard by a Judge, in regular Court. The court date however would only trigger if the parties had attempted and failed a mediation at the Financial Services Commission of Ontario (FSCO). That way, the parties gave it an honest try to see if they could resolve their dispute at mediation, without the need for litigation in Court. This made a lot of sense, and was easy for unsophisticated and inexperienced litigants to understand.

But the rights of accident victims to sue over denied accident benefits following a car accident were stripped from everyone in Ontario. Yes: imagine that. In a democracy, the government took away your right to sue, and access to the Courts.

Instead, innocent accident victims were required to have their disputes heard at the License Appeals Tribunal (LAT). The LAT is not a Court. It’s a tribunal. There are no Judges at the LAT. Instead, there are adjudicators who work there, who may, or may not, have any experience hearing or ruling on car accident cases. The barrier to entry to become an adjudicator at the LAT is much lower than the barrier to entry to become a Judge of the Ontario Superior Court of Justice.

Since the LAT became the ruling body over accident benefit disputes, it’s been an unfriendly place to accident victims (likely by design), and surrounded with controversy. It’s a really strange place.

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When an international student or a visitor to Canada has a serious accident in Ontario, it can get very complicated.

Who will pay for the medical treatment? The hospital visits? The ambulance? The out of pocket expenses? What about the loss of opportunity to pursue their studies, or the wage loss from a part time job?

These are really hard questions, and all depend on the facts of the case, along with the coverage of the injured party.

For starters, people in Canada on Student Visas, or a Visitors Permit won’t have access to the publicly funded OHIP system, the same way that Canadian Resident will. This is why it’s so important for the student or visitor to Canada to make sure that they have proper health care coverage before they come to Canada.

Having bad insurance will end up in a less desirable result. Just because an insurance plan is the cheapest, doesn’t mean that it’s the best. Often, you get what you pay for. Nobody ever expects to be involved in a serious accident, but if one happens, it sure helps to have a responsive and supportive insurer; rather than an insurance company which is the habit of denying claims, or being non-responsive to their insured.

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Personal Injury Lawyers are familiar with hospitals. Visiting the hospital in order to see an innocent accident victim to conduct a consultation and explain to them their rights is part of the job as a personal injury lawyer. As such, personal injury lawyers get to know the ins and outs and routines at many hospitals. We also see some pretty weird stuff at hospital as well. And these weird occurrences are through no fault of the people hospitalized. It just so happens that hospital can be very strange places. How so you might ask?

For starters, there are no barriers to entry at the hospital. Every Canadian has free healthcare. You don’t have to pay, or pass security in order to get inside of a hospital. As such, you might have people wandering the hallways looking for shelter, a warm bed, pills to steal, supplies like sheets or pillows, or people looking to scam patients who are not at their best. As a personal injury lawyer, I’ve had many clients tell me that while they are staying at hospital, they’ve had strangers approach their bed purporting to be a hospital worker asking for their banking information. I can assure you that hospital staff are not asking patients for their banking information. This doesn’t happen. It can however happen that people with ill intentions enter the hospital trying to defraud or steal patients. While all hospital do have some form of security, it’s never enough to monitor an entire hospital. And, by the time that people have found out that they’ve been stolen from, or defrauded, it’s too late. The focus while staying in hospital is rarely about money or security because hospitals should be (and often are) safe spaces. Rather, it’s about health, recovery, and getting home.

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Ontario has a no fault system of accident benefits if you’ve been involved in a car accident.

Understanding the concept of “no fault” is hard to grasp (even for lawyers!).

You would think that if you’re not at fault, then the at fault driver’s insurer should pay for everything.

But, that’s not how things work in Ontario’s no fault system. We have a first party pays system.

What this means is that regardless of fault, your own car insurer is responsible to pay for accident benefits in your car accident case.

This means that the other driver could have been drunk, high, on his/her cell phone, having run a red light; and still your own car insurer is the primary payor for accident benefits.

Even more strange is that if you had collateral benefits at the time of the accident, such as health, disability or anything else through work; those benefits kick in BEFORE the car insurance benefits kick in. Even though your collateral benefits have nothing to do with car insurance, those collateral benefits must be used up before the car insurer has to pay anything. How does that make sense? It’s like a disability insurer telling you that they will not pay any disability benefits until you’ve purchased 3 lottery tickets to see if you win. In the event you win, then they disability insurer does not pay because you’ve been paid lottery winnings. If you loose the lottery, and only once you’ve lost and submitted proof of losing that they will pay. All of these laws defy logic, but this is how Ontario’s archaic system of accident benefits has been designed.

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If you are injured in a motor vehicle accident, regardless of whose fault the accident is; you are entitled to claim an income replacement benefit of up to $400/week. That income replacement benefit can be increased to $800/week if you purchase an optional rider on your car insurance policy.

The income replacement benefit was automatic if you were an income earner, and if you met the disability test. This means that you needed to show that you made money (hard to show cash income) and that you were too disabled from returning to work.

You did not have to purchase any additional benefits, or pay extra on your policy to qualify for the income replacement benefit. It was part of the standard automobile policy in Ontario.

Even if you didn’t own a car, or have a driver’s license, you were still entitled to claim the income replacement benefit if you were hurt or injured in a motor vehicle accident. That meant that innocent pedestrians, cyclists, or simply those who didn’t drive had the same access to income replacement benefits as those who did drive.

Things are changing when it comes to the income replacement benefit.

Ontario Regulation 383/24 was announced in the Ontario Gazette on October 11, 2024. Beginning on July 1, 2026, the income replacement benefit will now be optional:

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It’s golf season.

People use golf carts on golf courses.

People get injured using golf carts.

Sounds really weird when you put that in writing, but they’re all true statements!

People get injured in very strange, and sometime very serious (often catastrophic) ways in the use or operating of golf carts.

Do I have an explanation as to why this happens? I can put out a few theories:

1. Alcohol. Drinking on the golf course is a thing. Alcohol impairs your judgment. This impaired judgment and liquid courage to do things you normally wouldn’t can lead to disaster.

2. Inexperienced golf cart drivers. There is no driving test to operate a golf cart. Anyone can operate one on the course. It’s not like there are police officers on the golf course pulling people over for their erratic driving

3. Driving on terrain not suitable for a golf cart. Golf carts don’t really operate as a traditional off road vehicle with the large grippy tires, roll bars, or reinforced panelling. They tend to be flimsy buggies, meant to transport people and their golf clubs on relatively even terrain.

4. Speed and erratic driving. The top speed of a golf cart isn’t very fast, but it’s just fast enough to cause serious injury.  They aren’t meant for rolling hills, steep drops, or sharp turns at their top speed. Their centre of gravity isn’t the best, and they’re prone to tip over, unlike other off road vehicles which have a wider base and lower centre of gravity. They aren’t bumper cars, or dune buggies, though people tend to operate them as such.

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For those unfamiliar with personal injury law, and more specifically, the law surrounding motor vehicle accidents (car crashes, motorcycle accidents, pedestrian-car accidents, bike-car accidents), the idea of what the law should be and how it works is perceived to be rather straight forward.

Car accident. Innocent accident victim not at fault. They were in the wrong place, and the wrong time and sustained injuries. Those injuries ought to be compensated by the car insurer for the at fault driver. Case closed.

Unfortunately, that’s not the way things work in Ontario.

We have take an easy to understand event (a car accident) and complicated that event tremendously.  The complexities have been created by the government at the behest of the insurance industry in order to keep the number of car accident claims down; and to limit the compensation available to innocent accident victims.

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