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Articles Posted in Accident Benefits

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The OCF-1 Application for Accident Benefits is the first, and arguably, the most important form for starting any accident benefit claim following a car accident.

If you don’t know what accident benefits are; you can learn all about them on the Goldfinger Injury Lawyers Website, or the Toronto Injury Lawyers Blog. Our personal injury lawyers frequently discuss accident benefits, what they are, their value and how they work to clients and prospective clients alike. There is a lot of discussion about accident benefits because they’re so important (and confusing too!).

In Ontario, we have a no fault system of insurance following a car accident. These no fault benefits are referred to as accident benefits. They are NOT damages for pain and suffering. Accident Benefits are created by, and legislated under the Insurance Act and the Statutory Accident Benefits Schedule. These accident benefits are constantly changing because the provincial government is constantly tinkering with them. This results in many amendments to the Insurance Act and to the Statutory Accident Benefits Schedule which makes things very confusing for consumers, lawyers and insurance representatives alike.

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Wednesday July 1st is Canada Day. Can you believe it?

Because of COVID, most people are uncertain what day of the week it is. Let alone month or date. When it comes to stat holidays? Forget about it! Every day feels like a Tuesday on repeat like some cruel real life edition of the cult comedy Ground Hog Day starring Bill Murray.

For most, Canada Day is full of fond memories like spending time at the cottage, lake, pool, BBQs or at family get togethers. It’s a time to decompress, enjoy the warm summer weather and kick back. It’s also a time where you get a day off work to relax.

This Canada Day will likely be a really weird one because of COVID.

For starters, mass gatherings like those at a community picnic, BBQ, concert or celebration like we see across the nation (particularly in Ottawa) either won’t be happening or will be happening much differently and on a much smaller scale. I don’t expect to see any sort of mass gatherings like we are accustom to seeing for Canada Day 2020.

But this doesn’t mean that people aren’t going to be out and about trying to get the most out of this celebratory day.

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Continuing with our COVID theme of straight facts and no filler or wonky political spin, for this week’s edition of the Toronto Injury Lawyer Blog, we will be focusing on Accident Benefit Claims in Ontario.

Why are we doing this?

Because we are finding so much misinformation going around right now during the Pandemic, we want to give people easy to understand legal information which won’t take forever to sort through. It also won’t require the reader to be a political analyst or medical expert to understand.

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Did you know that Ontario car insurance companies are entitled to a secret credit approaching $40,000 for your pain and suffering in car accident cases? Probably not.

It’s one of the best kept secrets in the insurance industry which insurance companies don’t want you to know about.

In the past few days, the secret credit aka the deductible has been getting a bit of attention in the news. Here is an article from the Toronto Sun explaining the unfairness of the deductible.

In fairness, the current deductible does not actually stand at $40,000. Technically speaking, it sits at $39,556.53, but lawyers call it $40,000 because remembering the exact dollars and cents is a bit difficult to do. This $39,556.53 goes up each year on January 1st. So, while today the deductible sits at $39,556.53, by January 1st of next year, it will go up again, likely over $40,000 which is higher than the average net salary of many income earners in Ontario.

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Every once in a while, what appears to be an ordinary slip and fall case, isn’t as straight forward as you would think. It takes a keen legal eye, with significant experience to get to the bottom of some of these tricky cases. And believe me; some slip and fall cases can be very tricky.

Set aside the liability issues, property ownership issues, along with any coverage or damage issues for a moment. It should be noted that all of these issues are common place.

When a car accident happens, an accident victim is entitled to make an accident benefit claim through his/her own insurance company. Those accident benefits are separate and apart from any claim for pain and suffering against the at fault driver. Accident benefits are very helpful as they pay for reasonable and necessary medical costs, therapy costs, rehabilitation costs and attendant care costs. Accident benefits will also pay an income replacement benefit of up to $400/week under a standard auto policy, or a non earner benefit of up to $185/week for up to two years.

These accident benefits are NOT available in any other form of personal injury case like a normal slip and fall case, an assault case, or a dog bite case. In all of these sort of cases, the injured Plaintiff will need to pay for his/her rehabilitation costs which aren’t covered by OHIP out of their own pocket.

Enter the unique slip and fall case. The sort of slip and fall case which becomes a car accident claim.

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People who have been very very very seriously hurt in a motor vehicle accident need to know the ins and outs of the OCF-19 Application for Determination of Catastrophic Impairment Form.

If your insurer deems your injuries to be “catastrophic” your benefits will skyrocket from $3,500 under the minor injury guideline, or $65,000 up to $1,000,000 or $2,000,000 (depending on when your accident took place). Not only does the dollar amount of your benefits skyrocket, but so does the duration, along with the types of benefits which are available to catastrophically injured accident victims, vs. non-catastrophically injured accident victims.

The first step to being deemed catastrophic is having your doctor or treating specialist complete the OCF-19 Application for Determination of Catastrophic Impairment Form.

Finding the form can be a bit tricky. It’s not a typical form that insurance companies include in the standard Accident Benefit Package which is sent to injured accident victims.

Your personal injury lawyer will know how to find the form. You can also find the form on the website of the Financial Services Commission of Ontario, link here. 

When printing off the OCF-19, make sure that you are printing off the right form.

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Summer long weekends can bring out the best, and worst in people.

As a personal injury lawyer, we are consulted in situations where bad things happen. Often bad things happen to very good people. This can have a devastating impact on the lives of the injured party, along with the lives of their families and loved ones. The future of one’s life can be altered for the worst in an instant thanks to some bad decisions.

Our law firm helps people from across the province of Ontario get the compensation they deserve. But Brian Goldfinger has seen far too often that the laws to compensate innocent accident victims, particularly in car accidents aren’t fair.

  • There is a secret credit for each car accident case whereby the first $38,818.97 for every award under $129,395.49 vanishes! That means if a Judge or Jury awards you $40,000 in damages for your pain and suffering in a serious car accident case which isn’t your fault, that $38,818.97 is subtracted from that amount leaving you with only $1,181.03! If a Judge and Jury award you $35,000, you are left with ZERO after the $38,818.97 deductible is applied. At law it’s called a deductible, but in reality, it’s a secret credit
  • Your personal injury lawyer CANNOT mention the aforementioned secret credit to the Jury at trial and the majority of people and juries alike don’t even know that a deductible applies which contemplating awards for car accident cases.
  • If your personal injury lawyer mentions the deductible aka secret credit, a Judge may declare a mistrial and seek that the Plaintiff and his/her personal injury lawyer pay costs to the defendant.
  • The will of the jury is usurped by the law when the deductible aka secret credit is applied. If a jury intends to award a Plaintiff $50,000, they should get the $50,000 award as the jury intended. But instead, the will of the governments supersedes the will of the jury which sat through the evidence and heard the case when the deductible is automatically applied.

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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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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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If you are hurt or injured in a car accident in Ontario, you will be entitled to an array of accident benefits.

These accident benefits are paid by your own car insurer, regardless of fault. If you did not have car insurance at the time of the car accident, the order of who pays for those accident benefits is determined based on a set of priority rules as defined under the Insurance Act and the Statutory Accident Benefits Schedule (“SABS”). This is often why you see insurance companies fighting not against a Plaintiff, but against each other in an attempt to “pass the buck” so to say to determine who is responsible for paying an injured accident victim’s accident benefits. Because the truth is insurance companies would rather not pay if they don’t have to. Can you blame them?

Speaking of passing the buck, one of the benefits which an injured accident victim may be eligible for is called the income replacement benefit or IRB.

The income replacement benefit is only available to income earners. If you were not earning an income at the time of the accident, or not employed but either worked 26 off the 52 weeks for the accident, you will not be entitled to the income replacement benefit. Self employed people are considered employed and working. But, recovering the income replacement benefit for self employed plaintiff’s can be very difficult. Establishing an income in a cash business, or in a business with limited record keeping makes it hard for insurers and their accountants to verify that you were working and entitled to the income replacement benefit. If they can establish that you are entitled to the income replacement benefit, quantifying that benefit can be very tricky. The reality is that self employed people often don’t show or report the entirety of their income because they don’t want to pay as much in tax. The problem with that is that you can only recover what you report to Revenue Canada. Your income replacement benefit is based on reportable income. The income replacement benefit is NOT based on unreported income, or moneys which are kept off the books. You can’t have it both ways. Continue reading →

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