Insurance Coverage

Published on: June 28, 2022

An Arborist, a Can of Beer and a Chainsaw

By Goldfinger Injury Lawyers

Sounds like a typical law school fact pattern for a tort case.

A property owner retains an arborist to do a routine pruning job on a set of Norwich Maple Trees in his yard.

The arborist advertises that he is both “licensed” and insured.

Upon attending at the job site, the arborist begins to unload his equipment from his van. It includes all of the normal stuff which any arborist would carry: spikes for climbing trees, ropes, counter weights, pylons and chain saws etc. But is also includes something which you shouldn’t find on any job site; an open container of alcohol; in this case a tall boy of beer.

Having an open can of beer may not seem like a big deal. The general labourers there to help the arborist tell the property owner that having a beer on the job site isn’t a problem; and that they do it all the time. They tell the property owner that this is just the way that the licensed arborist works. He needs beer to concentrate and do his job. They are trying to pass this off like it’s all normal.

The notion that a man climbing 20+ feet in the air; with a large gas powered chainsaw; needs to be fueled by alcohol isn’t normal whatsoever.

Yet, this is what the arborist and his friends tried to convey to the property owner.

In case you are wondering, that property owner was me. And I’m a personal injury lawyer. And I wasn’t having anything of it.

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Published on: March 16, 2022

Loosening of Pandemic Restrictions and Personal Injury Claims

By Goldfinger Injury Lawyers

Ontario is scheduled to drop most mask mandates by March 21, 2022. Whether or not this is the right move or not has nothing to do with being a personal injury lawyer; so I’ll just stay in my lane.

But, in creeping closer to this date we have seen an uptick of assault calls surfacing at our law firm. These assault claims are no uncommon, only we have seen more and more of them as the pandemic has dragged on.

It has become apparent to me that over the course of the pandemic we have forgotten how to interact with one another and share public spaces. It seems that more of us have a sense of entitlement, together with a disregard or a lack of respect for the safety and security in public places. In other words, we forgot how to share space and how to interact in public groups. This is something that will take time to re-learn. But, we will get there.

In the meantime, what do you do when a stranger assaults you? Do you have a personal injury case? And if so, how do you pursue that claim?

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Published on: March 10, 2022

Critical Illness Claims

By Goldfinger Injury Lawyers

Sometimes things which are presented to you sound too good to be true. This can ring true in the sale of insurance products; such as critical illness insurance. When things sound too good to be true, they should be looked at with skepticism.

Our law firm handles critical illness claims. Anyone can purchase a critical illness policy and receive coverage (provided that they are approved for said coverage). More often than not these policies are sold by independent insurance brokers/agents.

As with any industry, there are some excellent brokers/agents. And there are some less than excellent agents/brokers.

Ultimately selling insurance is largely a commission based business. The more policies which an insurance broker sells, the more money s/he will earn. That means there is a direct financial incentive for a broker to sell you a policy of insurance; whatever that policy might be.

Many people want to protect themselves in the event of injury, disability or illness. One of the ways of doing so is by purchasing a critical illness policy. Of all of the living policies, the critical illness policy is the equivalent to hitting the jackpot on the slots in Vegas. It’s a lump sum payout for a critical illness as defined by the policy. This is attractive for many consumers when comparing it to a disability policy which pays a monthly disability benefit which is subject to an all source offset and whereby the definition of disability changes at the two year mark. One lump sum from the insurance company sounds much better to most people. There is no need to worry about an on going multi year relationship with the insurance company. If all goes well the insured can receive his/her lump sum payout and move on with their lives. As oppose to a long term disability claim where the insured will be in a month to month relationship with the insurance company until the end of the claim (which can take many years to wrap up).

Critical illness policies are high risk, high reward policies which insurance companies don’t so easily pay out on. They will require substantial medical evidence in order to approve your claim. It’s not as easy to get approved as you will think.

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Published on: September 10, 2021

Serious Accident? Insurance matters!

By Goldfinger Injury Lawyers

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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Published on: June 1, 2021

Why WSIB claims and personal injury claims don’t mix

By Goldfinger Injury Lawyers

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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Published on: January 26, 2021

The Division of Policy Limits is a Zero Sum Game in Car Accident Cases (Ontario)

By Goldfinger Injury Lawyers

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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Published on: January 20, 2021

Consent is the big issue for determining coverage in a car accident case (Ontario)

By Goldfinger Injury Lawyers

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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