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Articles Posted in Insurance

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The cost of Physiotherapy is NOT covered by OHIP. That means that if you need physiotherapy, someone needs to pay for it.

The cost of chiropractic treatment is NOT covered by OHIP. That means that if you need chiropractic treatment, someone needs to pay for it.

The cost of out of hospital occupational therapy is NOT covered by OHIP. That means if you need to see an occupational therapist,  someone needs to pay for it.

The same applies to psychotherapy, massage, cranial sacral treatment, nutritionist, a rehab coach, a PSW, an RSW, social work for a car accident case outside of hospital, speech language therapy, neuropsychological testing, driver retraining, case management services, psychology (not to be confused with psychiatry); even some forms of medicinal cannabis for pain management are not covered by OHIP.

All of these services are very important to accident victims for the long roads to recovery following a accident; motor vehicle or otherwise.

If the accident victim has their own form of collateral benefits with an insurer like Blue Cross, Manulife, SunLife, GreenShield, Canada Life etc.; some or percentage of those benefits may be covered. Most policies differ; but it’s not uncommon to see a cap for these services set at around $500 or $750 per year.

If the accident victim was involved in a motor vehicle accident; or an accident arising from the use or operation of motor vehicle s/he will have access to accident benefits to pay for these services.

The level of accident benefits available to each person varies depending on the coverage purchased under the policy along with the degree of injury. For the most minor accidents, people will only have access to $3,500 in benefits. For more serious accidents there is a blended level of $65,000. For the most serious accidents, there is $1,000,000 available in coverage.

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Let me tell you a story.

It’s about an insurance company which deals with long term disability policies.

The size of the insurance company is irrelevant for this story, because most insurers are very similar in their approach. But in fairness, they are not all the same.

The insurance company underwrites thousands and thousands of group and individual long term disability policies.

If the insurance company pays out long term disability benefits on each and every long term disability claim that gets filed; then their profitability as a company suffers.

If the insurance company does not pay out on each and every long term disability claim that gets filed; then they become more profitable.

The more money which an insurance company pays out in benefits; the less money they get to keep and report as profit.

Some long term disability claims are denied for good reason. Some long term disability claims are denied for other reasons which have little merit.

This is where a personal injury or long term disability lawyer comes in to the mix.

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After a serious accident or collision, the injured party will require treatment.

Sometimes the treatment is covered by OHIP. Seeing your family doctor, getting surgery, assistance through LHIN, seeing a specialist, publicly funded physiotherapy; these are all examples of treatment which is covered under the OHIP system. That means that regardless of who was at fault for the accident, that you don’t need to pay for the treatment. This type of treatment is of particular important for all manners of accident and injury cases. If you hold a valid Health Card, there is no excuse for not at the very least, seeing your doctor. It’s free.

Sometimes treatment is NOT covered under the publicly funded OHIP system. Seeing a psychologist, a physiotherapist, occupational therapist, chiropractor, speech language pathologist, massage therapist; these are examples of treatment which is NOT commonly covered by OHIP.

To get these forms of treatment which are not covered, accident victims have a few options to access treatment.

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When it comes to your home, there is nothing more terrifying or tragic than a house fire. All of your possessions, belongings and memories are stashed away in that home. Once it goes up in a blaze, all of those things are gone forever. House fires are devastating for a family.

Fires are also devastating for commercial properties and business owners. Having a businesses’ merchandise and goods lost to fire can completely destroy a company, leaving it’s employees and shareholders in ruins.

People call Goldfinger Injury Lawyers when faced with fire loss. Our lawyers assist families and businesses recoup their losses, and stand up to the insurance company so that our clients get the compensation and peace of mind which they deserve.

The purpose of this Toronto Injury Lawyer Blog Post is to go over the basics of fire loss claims and how to get them started; along with what to expect.

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Long Term Disability insurance is based on the basic premise that you are too disabled to work, and that you are insured for a percentage of your pre-disability income. This percentage can vary anywhere from as low as 50% to as high as 80%, depending on the wording of the policy along with the riders contained in the policy.

You know what your pre-disability income was. But your long term disability insurer does not.

Chances are, your long term disability insurer has never heard of you, met you, or hasn’t the faintest idea what you do for a living until you’ve applied for long term disability insurance.

Once you’ve applied, the only way the insurance company has a chance to get to know you is on paper; based on the forms you’ve submitted to them in support of your application for long term disability insurance.

A very important form is the Employer’s Statement, or Employer’s Declaration.

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The term “long term disability benefits” would lead one to believe that those benefits should last for a long time.

But the term “long” can be misleading and subject to interpretation. Like many things in the practice of the law, the devil’s in the details and you gotta read the fine print.

So while your friends and family may tell you that your “long” term disability benefits will last for a “long” period of time (like your entire life); don’t be mislead.

Different policies of insurance carry different definitions for the duration of those long term disability benefits.

Here are a few examples:

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Ride hailing companies like Uber and Lyft have dramatically changed the way we get around. Hailing a car from a ride share service is convenient, fast and easy.

The increased popularity of these services has created many hiccups for personal injury lawyers, and insurance companies alike.

To give you an idea of the popularity of drive sharing services, in March 2019 in Toronto, nearly 176,000 trips were taken. That’s a lot of trips!

The first major pitfall we saw as personal injury lawyers is what policy of insurance was appropriate for ride share drivers?

A standard car insurance policy wouldn’t cut it because these vehicles were being used for commercial purposes. There are different driving patterns and risks associated with insuring commercial vehicles versus insuring normal residential communing vehicles. Add to that the additional risk of drivers taking on strangers in their cars, driving to/from unfamiliar places with timing constraints to get to a certain destination on time; it all adds to additional risk for insurers.

The first drive share cases which personal injury lawyers saw dealt with accidents involving such vehicles, where insurance companies were denying coverage because the driver failed to disclose that they were driving the vehicle for commercial purposes.

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Lots of people call my law firm for legal advice for their long term disability claims. Often for these people, it’s their first time dealing with a large insurance company over a claim of significant value which can impact the course of their financial security for the rest of their lives.

Questions like:

What should I (or shouldn’t) say to the adjuster over the phone?

How do I complete all of these forms?

Who should complete these forms?

When should I apply for long term disability benefits?

How can I apply for long term disability benefits?

What must I do once my long term disability claim gets denied?

Should I appeal the long term disability insurer’s decision; and if so; how do I go about that?

When should I retain a long term disability lawyer?

How much will retaining a long term disability lawyer cost?

How long will my case take to get settled or go to trial?

As you can see, people have a lot of questions regarding their long term disability claims. This is completely understandable. Long Term Disability claims are hard to understand right off the bat! They are contractual disputes. The terms of each contract are different. They all depend on the wording of the policy and each policy of insurance is similar; but it’s NOT the same. This is what makes things a bit confusing.

A car accident is easy to understand. In a car accident case, an at fault driver causes a car accident and is held accountable for the pain, suffering and ensuing economic losses they have created through their own negligence.

A long term disability case is based on the wording contained in the policy of long term disability insurance. These policies are long, verbose and hard to understand. There are multiple clauses, exceptions, time periods etc which makes hard even for an experienced long term disability lawyer to understand.

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Long Term Disability insurance isn’t easy to understand. It’s not a common tort or a common cause of action.

It’s not an intentional act which causes harm, or a negligent act by an individual defendant which causes harm. That means it’s not easy for many people to understand.

Here’s a concept that’s easy for people to understand:

A Red Honda Civic runs a red light and t-bones a Blue Cadillac. The driver of the Red Honda Civic which ran the red light is charged and convicted for his bad driving. The passengers in the Blue Cadillac are all seriously injured in the car accident. The innocent accident victims in the Blue Cadillac sue the at fault driver of the Red Honda Civic.

In this very brief fact pattern, we have liability (the driver of the Red Honda Civic is at fault), and we also have damages and causation (the passengers of the Blue Cadillac got injured; and those injuries were a direct result of the negligence of the Red Honda Civic driver). The personal injury case against the at fault driver of the Red Honda Civic is clear and easy to understand.  This case is built in tort and based on negligence.

These concepts are relatively easy (in comparison to other causes of action) to understand.

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It’s not often that the Toronto Injury Lawyer Blog comments on cases decided at the Human Rights Tribunal of Ontario.

The reason being is that car accident cases, slip and falls, long term disability cases, motorcycle accidents etc. are all dealt with before the Ontario Superior Court; not the Human Rights Tribunal.

But ever so often, cases heard at the Human Rights Tribunal of Ontario intercede with cases relevant to the field of personal injury law in Ontario.

Talos v. Grand Erie District School Board is one of those cases.We here at Goldfinger Injury Lawyers believe this to be a very important decision for employees, employers, insurance companies and lawyers alike.

In 2006, the Province of Ontario passed a law that ENDED an employer’s right to terminate an employee at the age of 65. This allowed people to work much longer, and ended discriminatory practices based on age to people over 65.

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