Accident Benefits

Published on: August 16, 2023

Was it an Accident involving the use or operation of an automobile; or not? It’s important to know this for your personal injury case

Some fact patterns regarding car accident cases can’t be made up. I suppose that you could try; but the reality of what actually happened often exceeds the bounds of your imagination. They are often unthinkable scenarios fit for a law school exam.

To be eligible for accident benefits in Ontario, an injured accident victim must prove the incident meets the definition of an accident under subsection 3(1) of the the Statutory Accident Benefits Schedule. An accident is defined as:

“an incident in which the use or operation of an automobile directly causes an impairment …”

The key words here are “the use or operation of an automobile”. Those words have been defined rather broadly. They are largely fact specific.

If the Plaintiff can establish that the incident arose out of the use or operation of an automobile; then the Plaintiff will be eligible to claim accident benefits. Things like an income replacement benefit; an attendant care benefit; and medical/rehabilitation benefits which are not covered by OHIP. These benefits can really help make ends meet; and can go a long way on the road to recovery following a serious accident. If the accident is deemed as “catastrophic”, these accident benefits will exceed $1,000,000 in value. Being eligible for accident benefits is also important because they will be paid out irrespective of fault. That means where the accident is an “act of G-d”, or some strange fluke; or a single vehicle accident with nobody to sue; then the Plaintiff regardless of fault will be eligible for benefits which is very important.

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Published on: July 5, 2023

Dealing with the Insurance Company After a Car Accident in Ontario

By Goldfinger Injury Lawyers

Everyday, our personal injury law firm receives calls from people who have been involved in car accidents in Ontario.

Some people reside in Ontario.

Other people reside outside of Ontario.

Some accident victims have their own car insurance.

Others have no form of car insurance whatsoever.

Their common connection is that they’ve been involved in a car accident in Ontario; and now; don’t know what to do; or where to turn.

They don’t know the right things to do. They don’t want to do the wrong things either. It’s their first time being involved in a serious car accident and they are looking for answers.

People tell me that they weren’t taught in school how to handle a car accident case with an insurance company. Nor is there any quick and easy book on what to do after they’ve been involved in a car accident. They are right in stating that what to do after a car accident isn’t on the standard school curriculum. But, there is a fast and quick guide on what to do after they’ve been involved in a car accident in Ontario. The Goldfinger Guide to Fair Compensation is a great starting point and it can be found in the link above. Reading the Toronto Injury Lawyer Blog (as you are right now!) is another great resource.

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Published on: June 19, 2023

Denied Treatment Plan (OCF-18)? It’s not the end of the world.

By Goldfinger Injury Lawyers

After a car accident, an innocent accident victim needs care and treatment to recover from their accident related injuries.

Treatment like physiotherapy, massage, chiropractic care and seeing a psychologist are not free. These items are not covered by OHIP for accident victims. If you want any of this sort of treatment, you will either need to pay out for it out of your own pocket, have an insurer agree to pay for it; or work out some deal with the provider that they provide care now; and that someone (you or an insurer) pays for it later. If the insurer doesn’t agree to pay under this last model, you are the one who will end up paying for it personally.

This is when the OCF-18 Treatment Plan comes in to play. This is essentially a permission slip; whereby the service provider puts forth a plan to provide treatment to an injured accident victim at a set rate. The insurer will either approve (or partially approve) for the treatment. Or they will deny it.

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Published on: September 29, 2022

When Occupational Therapists and Insurance Companies Try to Fool You

By Goldfinger Injury Lawyers

Insurance companies along with their third party contractor occupational therapists and rehabilitation companies seek to take advantage of innocent accident victims when they are at their most vulnerable. Immediately following a serious accident.

Innocent accident victims are shook following a serious car accident. Their world has been turned upside-down.

They have to manage a boat load of little emergencies because life as they know it has changed. They might be non-weight bearing in hospital in need of 24/7 attendant care, but life still goes on.

Who is going to look after the kids while you’re injured?

Who is going to walk the dog, get the groceries or take out the garbage?

How am I going to manage my work obligations?

How am I going to pay my bills?

Who is going to pay for all of the treatment and medication I need?

Who is going to help me fill out the pile of forms which the insurance companies are asking me for?

How do I apply for Government assistance?

The last thing you need is a stranger doing an assessment of you when you’re in such a vulnerable physical and emotional state.

Yet this is exactly what seems to happen time and time again.

Your car insurer will hear about your car accident one way or another. The more serious the accident, the greater the chance that your insurer will find out about the accident rather quickly, even if you have not reported it. Chances are the other party or parties who were involved in the car accident have. The insurer can track the party involved just by virtue of a quick license plate check; or by checking up the information contained in the Police Report or Occurrence Summary.

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Published on: August 12, 2022

Non Earner Benefits: What are they?

By Goldfinger Injury Lawyers

Let’s break things down in really easy to understand terms.

If you have been involved in a car accident, you are entitled to accident benefits from your own car insurance company.

If you didn’t have car insurance at the time of the accident because you were a passenger, cyclist or pedestrian; then don’t worry. The law has thought of that. Under the priority rules of the Insurance Act, the other motorist’s car insurance needs to cover your accident benefits.

If the other driver didn’t have any car insurance; and you didn’t have any car insurance; and nobody can find a car insurer to claim from in relation to the subject car accident: don’t worry! The law has thought of that as well. Under the priority rules of the Insurance Act, the Motor Vehicle Accident Claims Fund (MVACF) steps in to the shoes of where the auto insurer should be and pays out of the claim. Basically, the government steps in to the shoes of the hole left by the lack of private insurance for the case.

Once we have established insurance, it’s time for the injured accident victim to make a claim for benefits.

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Published on: May 26, 2022

Hitting a Deer or a Moose with your car

By Goldfinger Injury Lawyers

The heading of this edition of the Toronto Injury Lawyer Blog “Hitting a Deer or a Moose with your car” may seem like some sort of joke, or click bait; but I can assure you; it’s not.

Hitting a deer or a moose with your car is very real; hence the signage you may see on highways for “Deer or Moose Crossing”. The Minister of Transportation knows of it’s danger, and so should you.

In all of my years of practicing personal injury law, I’ve never handled a case where someone struck a deer or a moose in an urban/city setting. These cases happen in rural, forest and remote settings. And while the chances of striking a deer or a moose with your car may seem awfully remote; and perhaps laughable; these cases are nothing to joke about.

Some of the most serious injuries I’ve seen have resulted from collisions with a deer or a moose. No joke.

Why is that?

For starters, these sort of cases take place on highways or rural roads. The vehicles which hits the moose or deer is generally travelling at a high rate of speed. The faster you’re travelling, the greater the impact and the greater the chance for catastrophic injury.

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Published on: May 10, 2022

Car Insurance Benefits Denied? Apply to the LAT and wait wait wait

By Goldfinger Injury Lawyers

April 1, 2016 was an important date for car accident victims across Ontario. Not because it was April Fools Day. But because on this date, everything to do with hearing and adjudicating accident benefit disputes in Ontario changed.

All accident benefit disputes filed on or after April 1, 2016 which used to be heard at the Financial Services Commission of Ontario were from that point forward heard at the License Appeals Tribunal or LAT for short.

Only around 2 or 3 adjudicators from FSCO transferred over to the LAT, so there was no real continuity or institutional knowledge which had carried over from FSCO to the LAT.

Adjudicators at the LAT were not bound by any precedent set by the years of caselaw developed at FSCO.

There were new shorter time lines which the parties had to deal with. New rules regarding expert reports and expert qualifications.

Costs only awarded in rare circumstances, and when costs are awarded, they are under the low end of the spectrum.

The cost burden shifted significantly to the injured accident victim who has much less money to spend on legal fees than does the insurance company who they are fighting against.

At FSCO the accident victim simply filed for mediation. The cost of filing for mediation was free to the accident victim. If the mediation failed, the accident victim could give up on the case, pay $100 to file for Arbitration, or elect to sue in Superior Court.

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Published on: March 29, 2022

Getting paid interim benefits after you get hurt or seriously injured in Ontario

By Goldfinger Injury Lawyers

There are serious misconceptions of how people get paid, or receive benefits after they’ve been seriously hurt or injured in an accident.

You’ve likely heard stories of insurance companies paying for an accident victim’s lost wages, treatment costs or even getting them a modified vehicle or modified home before their case even settles.

Some of these things might be true. Some of these things might be false.

At the end of the day, it’s this sort of misinformation which creates large scale confusion as to what benefits get paid, and what benefits don’t get paid before a case even settles.

Goldfinger Injury Lawyers would like to set the record straight with this instalment of the Toronto Injury Lawyer Blog.

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Published on: March 1, 2022

OCF-1

By Goldfinger Injury Lawyers

The OCF-1 is the Application for Accident Benefits.

How do I get an OCF-1?

Getting an OCF-1 Application for Accident Benefits is very easy. You can download a copy here at from the website of the Financial Services Commission of Ontario. But most people get the OCF-1 from their car insurance company after a car accident. The car insurer will send the OCF-1 Application for Accident Benefits to you by regular mail, courier or by email. You can also ask a personal injury lawyer for the OCF-1. Most personal injury lawyers have access to these forms; not that it’s anything special because these are public forms.

The only problem with getting the OCF-1 on your own (not from the car insurer) is that you won’t know your claim number, or the name and contact information of the insurance adjuster who is assigned to your claim. What you don’t want happening is submitting the OCF-1 to the car insurer only for it to “get lost” in the void of mail which car insurers receive everyday. If there is no claim number and no adjuster assigned, you would hope that a file gets opened. But more often than not what happens is that the claim gets put aside and a file does not get opened. This isn’t right, but this is what can and what often happens if there isn’t a claim number or an insurance adjuster assigned.

Can an insurer be penalized for this sort lack of attention to a file? Sure. But getting to the bottom of that could take months or years. In the meantime the accident victim is not receiving the benefits which s/he needs. Take a more practical approach to this. Ask for a claim number and get the name and contact information of the insurance adjuster. Send the OCF-1 to him/her by email, fax and registered mail so that you know the adjuster receives it. This way your claim will get moving forward and you will get the benefits you need in a timely manner (we hope).

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Published on: February 9, 2022

Treatment after a car accident in Ontario

By Goldfinger Injury Lawyers

Many clients and prospective clients want to know where they should go for treatment after a serious car accident in Ontario.

It’s a common question because there are so many options and there is no “right way” of doing it. But there is certainly a wrong way of getting treatment.

For starters, there is no substitute for seeing your family doctor, or any other doctor for that matter who is covered by OHIP. These doctors are free and have no vested interest in your personal injury case. All they want to do is see that you get better and get the treatment you need. There’s nothing wrong with that.

Where people go wrong is that they leave their family doctor (or nurse practitioner) out of the picture when it comes to their post accident wellness and rehabilitation. Your family doctor is probably THE MOST IMPORTANT person when it comes to getting the treatment you need.

Lawyers and Judges rely heavily on the clinical notes and records of your family doctor.

Your family doctor can prescribe you with medication to get better. Your family doctor can make referrals to other specialists to help you recover. Your family doctor can request an x-ray, CT Scan, MRI or refer you to a pain clinic or brain injury program (all covered by OHIP). These are indicators to lawyers and to insurers that a Plaintiff is in pain and that something has gone wrong. If those diagnostic tests come back with objective evidence of a serious injury then it’s very hard for an insurer to refute that nothing is wrong with that Plaintiff. The doctor will know what’s wrong with his/her patient so that the patient can get the treatment which s/he needs. Don’t leave your family doctor or nurse practitioner out of the loop. A physiotherapist, occupational therapist, naturopath, chiropractor or social worker is NO SUBSTITUTE for your family doctor or nurse practitioner.

If you don’t have a family doctor or nurse practitioner, don’t fret. Get on a waitlist. These waitlists clear up faster than you would think. While you’re waiting, go to a Walk In Clinic or to your local Urgent Care or Emergency Department for check ups or for pain management. If you go to the same Walk In Clinic with frequency, they will get a sense of what you’re going through. It will be reflected in the records. Walk In Clinic doctors can make the same referrals and prescribe the same medication as a treating family doctor. If you have a health card, then you have access to a walk in clinic or urgent care clinic.

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