Articles Posted in Accident Benefits

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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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I’ve had a few interesting conversations over the past few days with some very thoughtful, rational, insightful and logical people. These people are not lawyers. They have no skin in the game when it comes to the field of personal injury law. That means that they are neither lawyers, insurance adjusters, service providers, doctors, or lobbyists. It’s always nice to get someone’s perspective on the law, and how they perceive it works (or doesn’t) from an “outsider“.

For whatever reason, they were thinking about how the law worked in Ontario. And, in particular, how auto insurance claims worked. They were thinking along these lines because recently, a friend or family member had either been involved in a serious car accident, or something bad happened to their car which required that they get the auto insurer involved.

All of their experiences shared some common threads.

For starters, the people didn’t understand why the insurance claims system was so complicated. Why did the system need to be so complex, with so many hard to understand forms? It was like you had to have a law degree or some expertise in personal injury just to get the insurer to approve a benefit. And just because a benefit was deemed approved, does not necessarily mean that the money would be flowing in a timely manner.

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It may be your first time being involved in a serious car accident where you have sustained serious injuries. These are not common events. And because these are not common events, few people know exactly what to after the accident, or how to deal with their car insurer.

The purpose of this edition of the Toronto Injury Lawyer Blog is to provide you with quick tips dealing with your Car Insurance Company after a serious collision.

1.You deal with your own car insurer first. Ontario  has a no fault system of accident benefits for car accident cases. That means that regardless of fault, the first insurer you will deal with is your own insurer. This seems counter intuitive, but this is how the law works. So, the at fault driver could have been drunk driving, high on drugs, texting on his phone, and ran multiple red lights. It does not matter. The first insurer you will deal with is your own insurer regardless of fault. Weird huh!

2. Watch what you say to the insurance adjuster. When you call most insurers, there is a recorded message saying that the call will be recorded for training and customer service. The call is being recorded so that if you put your foot in your mouth, and say something which is helpful to the insurer, but hurtful to your case; it can and will be used against you moving forward. Many claimants put their feet in their mouths and cause more harm than good in these recorded phone calls with their insurance adjusters. It’s much wiser to let an experienced personal injury lawyer handle it.

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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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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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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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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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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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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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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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