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Articles Posted in Insurance Coverage

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In tort law, one of the first and most important things lawyers are taught is to sue a Defendant with deep pockets and an ability to pay out a Judgment.

The only remedy in a personal injury case is money.

There is no ticker tape parade for the victor of a lawsuit. The Court cannot order the Defendant apologize, or be your servant for as long as it takes a Plaintiff to recover from his/her injuries. All which a Judge or Jury can do is order that the Defendant pay you compensation for your injuries and damages.

If a Defendant does not have the ability to pay the Judgment, it doesn’t mean that they go to jail. It also doesn’t mean that they can’t drive a car, work, or otherwise have their freedoms taken away. If a Defendant doesn’t pay, and doesn’t have the assets to pay a Judgment; then the Plaintiff is out of luck. The Judgment is without any real monetary value. While it may be satisfying or vindicating for a Plaintiff to have “won” the case; if the Defendant doesn’t have the ability to pay the Judgment the Plaintiff won’t get any compensation.

This is why it’s so important for a Plaintiff to sue a Defendant who has the ability to payout on a potential Judgment. This is why insurance matters.

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The Workplace Safety Insurance Board (WSIB) provides no fault insurance coverage for injured workers in workplace accidents.

When workers have been injured in the course of their employment; often they look to our law firm to sue their employer.

But here’s the catch. And oh boy; is it ever a big catch.

You see, the thing is, in the vast majority of cases, you cannot sue your employer for your workplace injuries. There are certain exceptions like working for a bank, a law firm, or a funeral home. But in the vast majority of cases, you cannot sue your employer for their negligence giving rise to a workplace injury.

Employers are given one of two classifications. They are either classified as Schedule 1, or Schedule 2 employers. The marjority of employers fall under Schedule 1.

A Schedule 1 cannot sue his or her own Schedule 1 employer. They will be forced to make a WSIB claim. In the event that they find a personal injury lawyer to take on their case and sue their employer for their workplace injuries, the Defendant will bring an Application to the Worplace Safety and Insurance Appeals Tribunal (WSIAT) to have the lawsuit kicked out of Court and force the injured worker to pursue a WSIB claim.

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If you’ve sustained serious and permanent injuries in car accident, you recover damages against the at fault driver.

Standard policy limits in Ontario sit at $1,000,000. Ontarians can purchase optional benefits to increase their coverage, but only few ever pick up that option (mostly personal injury lawyers, insurance adjusters, insurance brokers and insurance defence lawyers…notice a trend…mostly people in the know).

In some cases, those policy limits are greater than $1,000,000. Often commercial carriers have policy limits of $5,000,000 or greater. Sometimes your car insurance combines with your home insurance creating what’s called an umbrella policy or umbrella coverage, thereby increasing the policy limits from $1,000,000 to $2,000,000 in coverage.

It’s a good thing for an injured accident victim when there are greater policy limits. It means that the injured party will realistically be able to recover more damages in their personal injury case, if they are entitled to those damages at law.

To understand this concept of recovery, let’s examine what happens when policy limits are inadequate to satisfy a claim.

Let’s say that the claim is worth $1,500,000, but there are is only a $1,000,000 limit under the policy. The first $1,000,000 will be covered by the insurance company pursuant to the insurance policy. This leaves a shortfall for the claim of $500,000.

It will be Defendant’s personal responsibility to cover this $500,000 shortfall in the event they don’t have a policy which will cover the excess amount owing. This $500,000 is not insurable under the standard car insurance policy. The Plaintiff can secure a judgment against the Defendant personally and seize or lien his/her assets; or even garnish his/her wages until the Judgment is satisfied. Please note that Ontario Works payments are NOT subject to garnishment. What is however subject to garnishment are regular pay cheques/wages.

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Has someone other than you driven your car without your knowledge?

What happens if that mystery person gets in to a car accident?

What happens if you knowingly loan your vehicle to someone else to drive; and that person gets in to a car accident; but it turns out that the driver was operating your vehicle without a driver’s license or with a suspended driver’s license?

What happens if you loan your vehicle to a driver who was specified as an excluded driver under the policy?

While these hypothetical fact patterns may seem a bit remote, or foolish, they happen more than you think!

Cases such as these often see their way up the the Court of Appeal, or try to get heard at the Supreme Court. Leave to appeal is sometimes granted, and sometimes denied. Nonetheless, these coverage issues do not stop the parties from trying to get their cases heard before the Supreme Court. These cases drive the law in one direction or another. Often large insurers will spend a disproportionate amount of money arguing these coverage claims given that they will impact present and future coverage disputes. What this means is if on the face of the claim, the parties agree that the damages would range between $40,000-$100,000; insurers will spend that money if not more arguing the disputes. These are business decisions based upon legal principals in order to get the law right. And when I mean right, I mean working in favour of an insurer to deny coverage and not the other way around.

The grand lesson from all of these hypotheticals and decisions is that it’s very important to know who you are loaning your car to, and to know whether or not that person is allowed to legally drive. If not, you could end up in the wrong without coverage.

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