Articles Posted in Accident Benefits

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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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The OCF-10 Election Form is important for your car accident case in Ontario. By completing the OCF-10 Election Form, the injured accident victim is telling the insurance company which benefit they are choosing to receive.

Completing the OCF-10 Election Form incorrectly, or late; can hurt a car accident case and prejudice your right to claim and recovery accident benefits which you will need to help make you whole.

Without further a due, here are Goldfinger Injury Lawyers’ Top Tips on completing the OCF-10 Election Form.

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Completing the Application for Accident Benefits is the single and most important step in any car accident case.

Without a completed Application for Accident Benefits, your car accident case; both for tort and accident benefits won’t get off the ground.

Failure to complete an Application for Accident Benefits can nullify your claim, no matter how legitimate that claim might be.

So where does one start? Good question!

After you’ve been involved in a serious car accident; or accident arising from the use or operation of a motor vehicle (motorcycle; bike/car; car/pedestrian; truck), you will first need to contact your own insurance company.

Sounds crazy right! Why on earth would you have to call your own insurance company to report a car accident that wasn’t even your fault.

But that’s how Ontario’s no fault system of accident benefits works. Regardless if the at fault driver was drunk driving, while texting and smoking cannabis all at the same time causing him to run a red light; you will still need to contact your own insurance company to make an accident benefit claim.

Your own insurance company is responsible for paying those accident benefits. It gets trickier if the injured party is a pedestrian, cyclist, or a passenger without insurance. It gets even tricker if none of the vehicles involved in the car accident didn’t have car insurance. That’s what insurance lawyers and personal injury lawyers are for. Sorting out those tricky and ever complex coverage disputes which insurers seem to love to argue over.

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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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