Articles Posted in Insurance

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When it comes to litigating Long Term Disability Claims, many disabled claimants don’t know where to start.

How do I sue?

Who do I sue?

Can I sue my own insurer?

If I sue, will I get fired?

How much can I sue for?

Will my case go to trial?

If my case settles, how does the settlement work?

How much do I have to pay a lawyer?

All of these are valid questions. The reality about our law firm is that around half of our clients have NEVER consulted with a lawyer, prior to meeting with one of our personal injury lawyers.

To take that statistic to the next level, did you know that over 95% of our clients have have NEVER consulted with a civil litigation lawyer before (a civil litigation lawyer is a lawyer who sues in Court; personal injury law falls under the realm of civil litigation).

The reality is that a great majority of people are not only new to the legal system, they are also new to the concept of having to sue for denied benefits. It’s understanding this reality which makes us perform betters as lawyers and advocates on behalf of our clients.

With that heartfelt preamble, we prepare the latest installment of the Toronto Injury Lawyer Blog in an effort to help others not so familiar with the law, better understand how the legal system works (when it comes to long term disability matters)

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Members of Goldfinger Personal Injury Law attended at a legal conference a few weeks ago. It had all sorts of lawyers, spanning a multitude of different practice areas. It was great chatting with different lawyers outside of the realm of personal injury law to hear about their success stories and struggles. Even though we may have practiced in completely different areas, we managed shared a lot of common ground aside from just being “lawyers“.

In one particular conversation, the lawyers at Goldfinger Injury Law were sharing our stories about the delay in having some of our accident cases heard in a timely matter. Even since the landmark Supreme Court of Canada decision in R. v. Jordan, we were still seeing significant delays on the Civil end of things.

The Criminal lawyers we were sharing that story with looked a bit perplexed. Those lawyers had seen a noticeable push by the Courts to have their cases expedited (even if it wasn’t in either party’s best interest).But when he heard that Court resources were being shifted to the criminal sphere at the expense of other areas (like car accident, disability and personal injury law), those lawyers seemed upset.

One lawyer in particular shared with me that he believed the legal system as we know it was rotting away, seemingly faster every day; and that only the lawyers on the front lines truly understood the decay. With the delays in Court, the lack of judicial resources, the depletion of the legal aid system; only the truly rich and wealthy will have the means to advance their claims, and endure the wait time (and associated legal bills) to have their day in Court.

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Depending on who you ask, Uber is either a fantastic service; or spells the death to hard working taxi drivers. Today, it was announced that the City of Toronto passed legislation which will regulate Uber and other private ride sharing services such that they can operate in the Toronto without further political controversy (we hope).

In case you’ve never heard of Uber before, it’s essentially a taxi dispatch service; only taxi drivers don’t necessarily make the pick ups. The pick ups can be done by every day motorists trying to make an extra buck. Sounds simple enough. The controversy lies in that the taxi regime in the City of Toronto is complex, and heavily taxed/regulated.

In order to operate a taxi, you need to have a special taxi license. These licenses are very expensive, and aren’t just handed out loosely by the City. There are a limited number of taxi licenses around. In addition, licensed taxis have to follow other regulations like how much they can charge per kilometre, what the set base fare charge is, insurance regulations, driver safety regulations, camera regulations etc.

UberX drivers didn’t have to follow any of that red tape. All they needed to do was download the app, and let Uber dispatch them to their next customer for a pick up so they could earn money. It was that easy, and that convenient. The reality was that it was and remains fantastic for consumers. But it undercut hard working taxi drivers who were just trying to earn a living and provide for their families. Fewer fares. Increased competition. Uneven playing field. It was a hard fight and became difficult to compete with effectively cheaper, more convenient and arguably faster and more pleasant Uber service drivers.

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Earlier this week, the Kathleen Wynne Ontario Provincial government announced unilateral cuts to all of its fees which it pays to doctors. The cuts around around 2.65% across the board for services. Ontario doctors have been without a proper contract with the Government since March 31, 2014. Contract negotiations have broken down such that the Ontario Medical Association (OMA) refuses to accept the provinces proposals; and the province refuses to give in to the OMA’s demands.

In addition to the 2.65% cut to all OHIP plan fees, the province will eliminate funding to doctors to take continuing medical education courses; will reduce the fees for walk-in visits by $1.70 to bring it in line with with the fee for regular visits to a family doctor; eliminate the premium for doctors to accept new patients who are healthy; and eliminate the number of family doctors in well-serviced areas who can join family health teams where doctors are paid by the number of patients they enroll (not fee for service).

10% of Ontario Provincial budget is devoted towards healthcare. Of that 10%; 25% is devoted towards paying doctors. I would be ok if that budget were higher on both ends, but that’s me. Now you know where I stand.

Are doctors happy with these unilateral terms imposed by the government? I haven’t spoken with a single doctor OR patient who has welcomed these changes.

Will doctors strike? No. But the reprecussions will be felt across the provincial health care system. More on that later.

How much does the Province predict they will save by these cuts and changes? Another good question. In fact, that question was so good, that Minister of Health, Dr. Eric Hoskins dodged the question when it was asked to him.

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If insurers paid out maximum compensation on each and every claim, there wouldn’t be any need for personal injury lawyers or paralegals who focus on benefit accident claims.

Why does an injured accident victim or disability claimant need a lawyer, if the insurer is paying them out the full value of their claim up front; without any hassle?

But, if an insurer paid out the maximum value of each and every claim which came across their table, chances are they wouldn’t be as profitable as they are; or profitable at all.

As much as we are made to believe that insurers are there to look out for our best interests and pay out when they are supposed to; at the end of the day; insurance companies exist to MAKE MONEY.

Many Canadian insurance companies trade on the Toronto Stock Exchange (TSX). Here are a few examples along with their stock symbols, along with current share values as of the time of preparing this Toronto Injury Lawyer Blog Post on July 7, 2015:

Intact Financial Corp: IFC $90.57

Sun Life Financial: SLF $41.80

Manulife Financial: MLF $23.03

Co-Operators General Insurance: CCS-PS $23.79

Those are just a few of the examples of insurance companies which do business in Canada, who trade of the Toronto Stock Exchange.

Those stock symbols and share prices are VERY important. If those share prices drop significantly, millions, if not billions of dollars will be lost value and options for shareholders around the world.

If one of these insurers paid out ALL claims, regardless of merit of an entire year, chances are those stock values would dip dramatically.

So, when accident victims or disability claimants wonder why so many claims are denied at first instance, or why insurers refused to believe what their doctors have to say about their injuries, there is a financial reason for this.

The more money an insurer pays out to your for your claim, the less money they get to report in profits for their share holders.There are certainly a variety of their factors involved in insurer profits, but this is one of the most tangible concepts for accident victims and disability claimants to understand.

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Our law firm does NOT handle any WSIB matters. Imagine that…a personal injury law firm refusing work!

But that’s right; our law firm doesn’t touch WSIB work. There are a lot of reasons we don’t practice in this area. Aside from the WSIB being an archaic, overly complicated system; the reality is that it does not adequately compensate injured workers. The awards are rather pitiful, hard for workers to get, and their system of unbiased assessments is “impartial assessors” is a farce. There are a number of economic reasons why our law firm doesn’t do WSIB work, but that’s pretty much all you need to know about WSIB.

You will be hard pressed to find a reputable lawyer in Ontario who does exclusively WSIB work, but there are a handful of them around if you’re lucky enough to find one and have them take on your case at a reasonable rate.

There are times when WSIB and civil tort law intertwine. When this happens, we are there to help people make the right decisions so that their cases get off on the right foot.

For starters, you CANNOT receive bot WSIB benefits and SUE. You can’t have both. You either get one, or the other. This is very important for any accident victim to know.

There are instances where injured workers CANNOT sue. If they’ve been hurt or injured on the job site, there are instances where the injured party MUST pursue a WSIB claim. In such instances, it’s important to find out if your employer is a Schedule 1 or Schedule 2 employer. The difference is that is that you CANNOT sue a Schedule 1 employer; while you can sue a Schedule 2 employer. How do you find out if you’re dealing with a Schedule 1 or a Schedule 2 employer? That’s easy. All it takes is a call to the WSIB at 1-800-387-0750. Just ask the person who picks up the phone. It’s an easy search for their staff to make.

Banks, Veterinarians, Law Firms and some other employers are NOT require to have any form of WSIB coverage. So, it’s open season to sue these employers for their wrong doing.

At the end of the day, it’s important to keep in mind that WSIB acts as a shield for employers. They pay in to an insurance plan known as WSIB, and it’s there to protect them in the event of a worker getting injured.

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Intact Insurance has some great television commercials where an terrible accident happens (like a car driving in to a swimming pool); followed by a scene involving an insurance policy holder calling the insurer over the phone. The next scene is that of a well lit and pleasant call centre whereby an insurance agent from Intact proceeds to collect that person’s information and open up a claim in 5 minutes or less. Pretty impressive! The ad is meant to show the ease and speed in which Intact can open a file and process your claim.

Because that’s exactly what all Ontarians are looking for when choosing an insurance company. We’re not looking for low rates, or good customer service. We’re looking for speedy claims opening procedures. They’re fast, so we know they’re good.

The commercials are pleasant and well executed. They are.

A casual observation from this injury lawyer: the television commercials don’t show any personal injuries, and physical injuries. The only damage is comical or cartoonish.

One ad has the car driving in to the swimming pool, another ad has a car driving in to a mail box. Nobody is hurt. It all looks like an honest mistake where everyone is calm, able to smile, and having a relatively good time. Of course, all of this is intentional to keep the air of the ads light; rather than be downers and show catastrophically injured accident victims and crying family members waiting attentively by a hospital bedside attending to their seriously injured loved ones.

Here is the reality of most claims:

1) If it’s a car crash, there are likely injures. In many cases, there are serious injuries. Sometimes the injuries are so serious that the accident victim can’t talk.

2) The claimant isn’t all bubbly and happy when making the call, no matter how pleasant the agent is on the other line. The claimant is upset, mad, stressed, nervous, anxious, or pi$$ed off for lack of a better term that they were involved in a serious accident and now have to make a claim.

3) The claimant might not speak the best English; making reporting the claim difficult. Language can always be a barrier to getting these things sorted out.

4) The person on the other line might not be as bubbly, welcoming and friendly as they appear in the commercials

Here’s something which you probably didn’t pay attention to in these commercials. The person who was working in the call centre for the insurer was sitting at a desk, in front of a computer and inputting information in to their system. They may be taking notes of the conversation, OR the conversation may be recorded for “customer service purposes“. The claimant who initiated the telephone conversation isn’t taking any notes, nor are they depicted as sitting at a computer an inputting information in to a computer system.

Don’t overlook this tiny detail. It’s important. Want to know why? Read on and find out.

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The governing Liberals announced Ontario’s budget on April 23, 2015. Finance Minister Charles Sousa, backed by Premier Kathleen Wynne were in fine form that day. When one thinks of the term “budget“, we would think of all things financial, including taxes, public spending on healthcare, infrastructure, and education. And to be fair, healthcare, infrastructure and education were all addressed in the 2015 budget.

But what often gets swept under the rug without any debate, deliberation or consultation with stake holders is CAR INSURANCE.

Why is this such an important topic? Well, for starters, if you want to drive a car in Ontario, you need to have car insurance. It’s the law. Check the Compulsory Automobile Insurance Act. That’s right. Ontario has a specific act regarding operating a motor vehicle WITH car insurance.

So, if Ontarians are required to operate a motor vehicle with car insurance, then it’s going to be important to all motorists in the province. This amounts to a lot of people. And if all of these people need to have car insurance, then the product they’re required to purchase better be a good product, and protect their rights in the event of property or physical damage.

For insurance companies, car insurance is important because it’s a way for them to make money. What the legislation says regarding what insurers are required, and not provided to require under these policies of insurance goes straight to their bottom lines. The more they can charge by providing the least amount of benefits will increase their profits and make their shareholders happy.

For politicians car insurance is important because if rates are too high, then voters are unhappy. So, the aim of politicians when tinkering with car insurance is to get the cost of car insurance down. But how do they do that? The government doesn’t set car insurance rates. But they do however legislate what benefits are required to be provided in said policies and how benefits work; which ought to have some form of correlation with the price of car insurance (among other factors such as driving record, age, where you reside, driving experience, and the type of vehicle your drive).

So how has car insurance in Ontario been affected since the new budget was announced? Keep reading and I will share that with you.

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There are three elements to any personal injury case.

Element #1: Liability: How did the accident happen and who’s to blame? The concept of liability is straight forward in many cases. A drunk driver runs a stop sign resulting in catastrophic motor vehicle accident. Establishing liability against the drunk driver is easy to establish. The driver was drunk and on top of that, they ran a stop sign. The drunk driver is at fault of the car accident. Liability is established. Sometimes liability isn’t so clear and an engineer or another expert will need to be retained to look in to this issue. This expert will be able to tell us whether or not we have a case and whether or not we can place blame on another party of the event giving rise to the litigation.

Element #2: Damages/Injuries: What are the injuries from the car accident. Is it a simple bruise which goes away in a week, or are the injuries severe, like a brain injury along with multiple orthopedic injuries. Understanding this concept is somewhat straight forward as well for many accident victims because it’s easy to visualize and more tangible than other legal concepts. If Superman were involved in a car accident, chances are he wouldn’t have sustained any injuries or damages. Hence: he wouldn’t have much of a personal injury case if Superman weren’t injured. Sorry Superman.

Element #3: Causation: : There must be some form of connection between the Bad Guy Defendant’s conduct and the Accident Victim’s injuries. This term is sometimes called “remoteness of damage” or “proximate cause“. Either way, this third element is the most difficult for accident victims to understand.

Sometimes causation is easy to prove. Suzy broker her leg in a car accident. Suzy is seeking compensation for her broken leg from the car accident. Thomas slipped and fell and bumped his head. Thomas is seeking compensation for his head injury from the slip and fall accident.

But sometimes causation is not so simple/clear. Johnny was in a car accident and hurt his knee. Now Johnny complains of headaches, fatigue and shortness of breath. Alice was bit by a dog and sustained abrasions to her legs. Now Alice is deeply depressed and can’t sleep. Marvcus lived in a mouldy apartment building. Now Marvcus has a bad cough. Marvcus has since moved out of the apartment building but still has a bad cough and can’t sleep properly.

The focus of this edition of the Toronto Injury Blog Post will examine the concept of Causation, along with the pitfalls many of us encounter along the way. It’s dedicated to a fellow colleague of mine based out of Toronto who gave sage advice to me in my youth and was a mentor of sort in assisting me in getting in to law school, so where we go.
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Every injury case is different. That’s because every person is different; every accident is different, every injury is different; and everyone’s pre and POST accident health is different.

But, there are many similarities to personal injury cases.

For starters, all car accidents will involve some sort of motor vehicle. Liability; the legal term to describe whose fault is the accident will be examined. The severity of the injuries will be examined. And, the cause of those injuries (causation) will be examined. The concept of damages will also have to be examined.

In order for lawyers, judges and juries to get answers to the above noted topics, they will all ask very similar questions to get the information they need to assess your case.

In this respect, many lawyers can predict and prepare our clients for the questions their clients will be asked during the course of their personal injury case.

And, it’s for those very same reasons that we here at the Toronto Injury Lawyer Blog will now provide you with a list of commonly asked questions of accident victims during the course of their case. We’ve picked some pretty obvious ones, and some not so obvious ones that you would never soon guess.
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