Articles Posted in Insurance

Let me preface this Toronto Injury Lawyer Blog Post by stating that I have nothing against insurance adjusters. Really. I don’t. It’s a job. The work is steady. The hours are probably ok. The so called “work-life” balance is there. Pay is good. Benefits gotta be good if you’re working for an insurer.

We get calls at our office from people who have recently been involved in all sorts of accidents. Car crashes, motorcycle accidents, dog bites, slip and falls. You name it. Our law firm hears about it.

People call us in a panic. Sometimes it’s because their lives have been traumatized on account of the accident. Sometimes it’s because they’re in shock. But most times it’s because they fell overwhelmed at what their next step is. The most common question we get is “WHAT AM I SUPPOSED TO DO NEXT!?!?!?!“.
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Lots of injury and insurance lawyers across Ontario have been looking for some guidance with respect to what sort of cases rightly, or wrongly fall in to the Minor Inury Guideline or MIG as it’s known in the industry.

If you’ve never heard of the MIG, that’s ok. You’re not alone. Probably 99% of Ontarians have never heard of it, despite of the fact that it now applies to 100% of insured motorists in the province.

After a car accident, people are entitled to no fault benefits from their car insurer. These no fault or accident benefits are intented to help the accident victim get better following the collision. They pay for such things as physiotherapy, massage, chriopractic care, occupational therapy, speech language therapy, or just a gym membership.

The MIG was introduced by Ontario’s Provincial Government and took place effective September 1, 2010. Insurers and their lobbysists pushed for its introduction. Essentially, it allowed insurance companies to cut your medical and rehabilitative benefits from $50,000 down to $3,500. The justification for this was that insurers were paying too much to litigate matters, too much on rehab following car crashes, and spending too much money on fraud. Here is a copy of the MIG
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Clients are constantly asking me for the best way to get the insurance company to pay for treatment following an accident.

There are no quick and dirty legal answers to this question, but there are certainly a few routes which need to be explored. While we have a great OHIP system here in Ontario, some forms of treatment simply aren’t covered by OHIP, or they take far too long to get via the public system.

The first question one must ask is whether or not you have private medical benefits offered through your employer, or a private insurance plan. Some people have work coverage for up to $500 in massage, physio, chiro treatment etc offered through their workplace. This would be your first source of recovery for treament funding, regardless of whether or not you’re entitled to accident benefits or not. Under the Insurance Act, the law requires that your first exhaust your private or “collateral benefits”, before you can even touch your accident benefits via Ontario’s complicated No Fault Accident Benefit Regime.
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We get lots of calls at our law firm from accident victims across Ontario all with the same simple inquiry:

“I’ve been hurt in a car accident. I applied for accident benefits through my car insurance company. And now the car insurance company isn’t paying any accident benefits! Why is that and what can you do to help me?”

Our lawyers do our very best to help every person who calls our office with such an inquiry. We understand that people become very dependent on the benefits which an insurance company provides for them following a serious car crash. An insurer may pay you up to $400/week for an Income Replacement Benefit. They may pay you up to $1,500/month in an Attendant Care Benefit. They may also be paying for your massage, physiotherapy, pain management clinic, psychological counseling, or some other form of treatment which is not covered by OHIP. On the other hand, an insurance company may refuse to pay you anything.

There are plenty of reasons why your accident benefits might not be getting paid. Maybe you’ve changed your address and you haven’t replied to any letters which the insurance adjuster has been sending you? Maybe the insurance company hired a private investigator to take photos/video of you and caught you doing the death walk along the top of Toronto’s CN Tower. Maybe you haven’t even completed the requisite paperwork to get your case started in the first place.
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In a car accident involving pedestrian vs. car; car usually wins. If your name isn’t Superman, then it’s safe to say that the car will knock down and injure the pedestrian time and time again.

The question in pedestrian vs. car accidents isn’t always a question of damages; meaning I got hit by a car now pay me. The question can be hotly contested on the issue liability. That means who’s at fault for the accident. Who is to blame. Is the car driver 100% at fault? Was the pedestrian responsible for the accident, and if so, what percentage of liability ought to rest on his or her shoulders? At law, this apportionment of liability (like dividing up a piece of pie) is also expressed as contributory negligence.

Some of the worst car accident cases which my law firm has ever seen have involved cars hitting pedestrians while they’re trying to cross the road. One of the hardest parts of my job is having to explain the theory of contributory negligence to a client. The more injured the client, the more difficult the explanation becomes (not that every explanation isn’t difficult to begin with).
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