Articles Posted in Insurance

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Insurance companies love to hear when clients have “After The Event” insurance or “ATE” as it is known in the industry.

What is ATE?

At trial, a Judge can order that the losing party pay for the winning party’s legal costs. ATE is a policy of insurance meant to cover a Plaintiff if they lose at trial and they are ordered to pay the insurance company’s legal costs. This means that the Plaintiff would be covered up to the limits of the ATE policy. The amount of coverage depends on the policy itself. The better the policy, the more the Plaintiff would be covered should things go wrong after a loss at trial.

How are ATE Policies Sold?

ATE is an insurance policy which is generally sold to personal injury law firms to insure ALL of their personal injury clients; or clients with similar contingency fee arrangements. You won’t see ATE insurance for clients in non-litigation sorts of cases. ATE can be sold on individual policies, but generally, these are either hard to come by, or very expensive. The companies which sell ATE typically sell them to personal injury law firms to cover all of their files, some of their files; or more than 1 file. The business model is set up for bulk files and not individual files.

Can I take out my own individual ATE policy?

I have never seen an individual Plaintiff take out and pay for their own individual ATE policy, although I suspect that it’s entirely possible. I suspect that the answer to this is “no“, but it really depends on the appetite for risk of the insurance company. They would want the peace of mind knowing that there is a competent lawyer advancing the case rather than a self represented Plaintiff. But, anything can be sold at the right price if the insurer is flexible. I would imagine that the premiums for an individual policy without a lawyer would be very high to the point of prohibitive. But, if you told an insurer that a Plaintiff was willing to pay $500,000 for an ATE policy worth up to $200,000; I don’t think the insurer would be opposed to selling the policy knowing that they would be guaranteed to make $300,000 on the sale  of policy. Anything can be sold for the right price. Continue reading →

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I saw a YouTube Clip of a prominent American Trial Lawyer not long ago. It was very “us against them” in tone, but the messaging rang true.

For years, and in some cases, for decades, hard working people pay their hard earned after tax dollars to car insurers for premium payments. In Ontario, it’s illegal to drive a car without car insurance. So, paying your car premiums is the law; so you have to pay these premiums if you want to drive legaly.

More often than not, these payments are made to the same insurance company for years because studies show that people don’t often change insurance companies. That means you’re dealing with the same insurance company year, after year.

And year after year, nothing out of the ordinary will happen. You will pay your insurance premiums, and receive the occasional letter from your car insurer enclosing updated policy information and slips. But that’s pretty much it. You won’t ask a lot from your car insurer. And, in return, they won’t ask a lot from you aside from demanding the payment of premiums.

Car accidents and catastrophic events are the exception. They aren’t the rule. You can go your whole life without ever being involved in a serious car accident. And, let’s hope that’s the case because nobody wants to be involved in a car accident.

But, in the rare circumstance that you’ve been hurt or injured in a car accident; you would expect that the insurer who you have been dealing with for years to be there at your side in order to pay you the compensation which you deserve.

At the end of the day, you were in the wrong place, at the wrong time and have done nothing wrong. All that you are seeking is that you are compensated fairly for your losses, along with your pain and suffering.

But this is not how things work in personal injury cases. Instead of helping you out, the insurance company will use their immense resources to fight your claim every step of the way. They will pay experts, investigators and their lawyers thousands and thousands of dollars (if not more), to make sure that you aren’t compensated a single dime.

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Thou shall not lie” is the ninth commandment, and it’s a pretty good commandment to abide by. This is reaffirmed at law when before a witness steps on the stand, or provide oral evidence at their examination for discovery; the witness either swears on the bible or affirms to tell the truth and not to lie.

But people are not followed around by Court Reporters and lawyers in their everyday lives. You are not required to swear to tell the truth before you start your day in the morning. Nor are you required to swear to tell the truth when you fill out some form of application. It’s just expected that you fill in the application truthfully, and not lie.

But, what are the consequences for lying on an application which may be relied on in the Courts? That’s a very good question. If often comes up in the form of insurance applications; like for life insurance, short term disability, long term disability or for mortgage insurance.

Often, at the top of these insurance applications, or on the first page there is some form of disclaimer or warning requiring the applicant to be truthful in completing the application, and identifying the consequences for not being truthful. But, few people play close attention to these details which may not be in fine print. The words might be in bold in order to better alert the applicant to the consequences, yet, they still go ignored in many cases because people have a habit of not reading (or not properly reading) standard forms.

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It’s not everyday you have to deal with an insurance company. It’s not an interaction which people are accustomed to.

Think about it.

You don’t need legal advice to buy a pair of shoes.

You don’t need legal advice when negotiating a price for a new/used car.

You don’t need legal advice for a parent/teacher conference at school.

You don’t need legal advice opening a bank account, or negotiating the terms of your mortgage.

What’s set out above are adult interactions which we are used to in everyday life.

But, when it comes to personal injury, car insurance and disability claims, we do need legal advice. We need legal advice because these interactions don’t happen everyday for consumers.  We need legal advice because there are complicated laws around getting compensation. We need legal advice because more often than not, these claims are disputed and often end up being litigated in Court.

Given that our personal injury lawyers deal with insurance companies on a daily basis, here are some tips which we’ve procured for you based on our experience and expertise in dealing with them.

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As the title to this Toronto Injury Lawyer Blog Post will tell you, there are so many forms in personal injury cases. If you wanted the Coles Notes version of this entry, I suppose that you can stop reading here. But, if you’re more interested about the details behind these forms then please keep on reading!

At times, it’s difficult to understand why there are so many forms to complete after you’ve been hurt or injured in an accident. If you don’t want any medical assistance, benefits, or compensation, then you don’t have to complete any forms at all. But, that’s not most people. Most people aren’t seeking compensation for their injuries. They are seeking to be made whole from the financial losses which they’ve sustained; or they are seeking treatment for their injuries which are not covered under the public health care system. This is a common theme. If you’ve missed out on work and income, people want that income back. If you need physiotherapy treatment, you should not be out of pocket having to pay for that treatment. All people want, for the most part, is to be made whole following an injury or accident which puts them out of commission. This isn’t so much to ask….Or is it?

One of the themes in personal injury law, as in life, is that if you don’t ask for something, you will get nothing in return. In personal injury cases, money will not fall from the sky. Nor will your out of pocket treatment, or attendant care, be paid out of thin air because a Defendant, or their insurer is being nice. One must ask for these things to get paid.

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The fine print matters. It especially matters in long term disability claims.

The overwhelming majority of personal injury cases are tort cases. They are not predicated on a contract.

Car Accident Cases

Dog Bite Cases

Slip and Fall Cases

Assault Cases

Product Liability Cases

All of these claims are based on negligence in tort law. They are not based on a contract.

Long Term Disability cases are very different because they are entirely based on contracts. That means that the wording of the long term disability policy (the contract) is very important to whether or not the case succeeds, or fails. One word in the contract can change the entire case.

A Plaintiff can be very seriously injured. But, if the wording of the long term disability contract is not in their favour, they might not win the case.

It’s important for a Plaintiff to know that the wording of every long term disability policy is different. This is significant because just because somebody you know won their long term disability case does not mean that you will win your case as well. There are so many different variables which go in to winning (or losing) a long term disability case. The wording of the long term disability policy is a great place to start.

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This week, the Provincial Government of Alberta will announce that people will no longer be able to sue for personal injuries arising from a car accident. I hate seeing when governments take away the rights of innocent people to best suit their corporate overlords.

This dramatic change to the law means innocent accident victims won’t be able to sue for personal injuries against:

  • Drunk Drivers
  • Distracted Drivers
  • Drugged Up Drivers
  • Incapacitated Drivers
  • Careless Drivers
  • Drivers too high to operate a vehicle
  • Driving driving illegally without a license
  • Grossly negligent drivers
  • Drag Racers
  • Stunt Drivers
  • Criminals who have stolen a car and who operate their vehicle like it’s Grand Theft Auto causing a serious collision and life threatening injuries. See the serious collision which took place on November 18, 2024 at Bathurst and Wilson in North York where a driver on bail operating a stolen vehicle hit a TTC Bus, injuring 9 innocent individuals.
  • Defendants who drive their vehicles so poorly, and so negligently, that they cause death to innocent people who are simply in the wrong place, at the wrong time
  • Anyone else who acts a fool behind then wheel and causes injuries to another innocent person

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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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Long Term Disability Law can be rather complicated.

It’s complicated because Long Term Disability is based in contract, and every contract is different.

For many people, understanding the words and concepts contained in these long term disability contracts is hard to grasp, and confusing. I can’t say that I blame them.

Take a dog bite case for example. If a dog attacks you, and causes injury to you, then the owner of the dog ought to be held responsible for your injuries and losses.

Long Term Disability cases don’t work that way. Simply because you are disabled, or unable to return to work, does not necessarily mean that you are entitled to long term disability benefits.

And, even if you are eligible for long term disability benefits, the quantum of that benefit, along with the payment duration will be in question as well.

There are a lot of fluctuating variables when assessing and quantifying a long term disability case. We call these moving targets. Those targets don’t move as often, or as frequently, with a straight tort claim, like a dog bite case, as they do with a long term disability claim.

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Over the past decade, personal injury lawyers have seen an explosion of a new insurance product offered to their law firms and to their personal injury clients. It’s called Adverse Cost Insurance or After-The Event Insurance.

How does it work and what does it do?

Adverse Cost Insurance or After-The Event Insurance serves to protect a Plaintiff from an adverse cost award following an unsuccessful trial.  At trial, if a party loses, the Judge will generally order that the losing party pay the winning party’s legal fees. Those legal fees, especially after a trial can be very high. This insurance product is there to cover all, or part, of those legal fees which the losing party is ordered to pay by the Judge.

What are the benefits to this insurance?

In theory, the insurance will pay for part, or all of the legal costs if you’re unable to do so on your own.

Let’s imagine a scenario whereby a Plaintiff in a car accident case loses his/her case. After the lengthy trial, the Judge dismisses the Plaintiff’s case, and orders that the Plaintiff pay the Defendant’s legal costs in the amount of $500,000. This is entirely possible. In fact, it recently happened in the case of Belton v. Spencer. In that case, Belton sued Spencer for damages as against Spencer as a result of an accident that he sustained while walking Spencer’s horse .

Following a trial lasting over eight weeks, Belton’s action was dismissed as against Spencer. The Judge ordered that the Plaintiff Belton to pay $350,000 in legal fees plus HST, and $74,472.52 in disbursements, for a total of $469,972.52 to the Defendant Spencer. Ouch!

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