Every once in a while, what appears to be an ordinary slip and fall case, isn’t as straight forward as you would think. It takes a keen legal eye, with significant experience to get to the bottom of some of these tricky cases. And believe me; some slip and fall cases can be very tricky.
Set aside the liability issues, property ownership issues, along with any coverage or damage issues for a moment. It should be noted that all of these issues are common place.
When a car accident happens, an accident victim is entitled to make an accident benefit claim through his/her own insurance company. Those accident benefits are separate and apart from any claim for pain and suffering against the at fault driver. Accident benefits are very helpful as they pay for reasonable and necessary medical costs, therapy costs, rehabilitation costs and attendant care costs. Accident benefits will also pay an income replacement benefit of up to $400/week under a standard auto policy, or a non earner benefit of up to $185/week for up to two years.
These accident benefits are NOT available in any other form of personal injury case like a normal slip and fall case, an assault case, or a dog bite case. In all of these sort of cases, the injured Plaintiff will need to pay for his/her rehabilitation costs which aren’t covered by OHIP out of their own pocket.
Enter the unique slip and fall case. The sort of slip and fall case which becomes a car accident claim.
You car insurer doesn’t want you to know about these cases, because that means their on the hook for your benefits which they would rather not pay. Car insurers don’t advertise that they cover certain types of slip and fall cases. But good personal injury lawyers know.
It actually goes so far that when you call a 24 hour claims hotline to report a claim; and you seek to report a slip and fall case; the intake person may actively try to turn your case away and refuse to even open up a file or investigate the possibility of an active claim.
Here are the magic words. This is how a simple slip and fall case becomes more than that. This is how a slip and fall claimant gets access to accident benefits. The little secret car insurers don’t want you to know about:
If your slip and fall arose out of the use or operation of a motor vehicle, it will be eligible for accident benefits under your standard car insurance policy. This potentially gives claimant access to THOUSANDS of dollars in income replacement, med/rehab and attendant care benefits. If the claim is deemed catastrophic, those benefits are up to 2 million.
The definition of “use or operation of a motor vehicle” is a pretty broad definition. There are loads of cases from the now defunct Financial Services Commission of Ontario which have ruled on this issue. Here are a few examples which come to mind:
- Claimant slips and falls breaking a leg on ice getting out or getting in to his/her own vehicle
- Claimant slips and falls holding the keys trying to get in to his/her own vehicle
- Claimant slips and falls filling up gas at the pump
- Claimant slips and falls clearing the ice/snow off his/her own vehicle
- Claimant slips and falls getting out of his/her own vehicle having taken a few steps from the door
- Claimant slips and falls attempting to set up a tow line, or cable boosters to another vehicle
- Claimant slips fitting a boat, or ski-do to the back of their pick up truck
- Claimant falls loading a groceries in to the back of their vehicle or on their tow bed
In all of these cases, the clamant can sue for negligence in the event there was a hazard on the property which caused the slip and fall: think failure to sand/salt ice, or a big pot hot. In addition, because these accidents arose out of the use or operation of a motor vehicle, the claimant will also be entitled to make an accident benefit claim with his/her own insurer.
Most people don’t know about this. Well, now you know.
Are these accident benefits handy? YES! If you can’t work, you have access to an income replacement benefit. If you need physio, the the accident benefit insurer will pay. If you need attendant care because you’re non weight bearing, the insurer will pay. If you have an ambulance bill, or prescription expenses; the accident benefit insurer will pay for those as well provided that they are deemed “reasonable and necessary“.
Many people want to know whether or not the premiums will rise in the event they make an accident benefit claim arising from a slip and fall case.
I confess that I don’t work for an insurance company, but in my 17 years working in the personal injury field; I have NEVER seen premiums rise on account of making such a claim. Why would they? You weren’t driving. It’s a slip and fall case! It would be considered a non moving claim whereby you aren’t at fault, so I would have a hard time seeing your premiums go up on account of such a claim. That’s not to say that a vengeful insurer won’t do what they want; but I’ve never seen nor heard of it happening on account of a slip and fall case.
So there you have it. The little secret insurers don’t want you to know about. This is how a slip and fall case, can turn in to a car accident case. It gives the claimant an additional pocket to collect from. But more importantly, it will provide the claimant with the interim benefits they need to make ends meet, and to get the attendant care and rehabilitative assistance they need on the road to recovery.
If the claimant did not have access to his/her own car insurance policy the same priority rules will apply as we have discussed before in the Toronto Injury Lawyer Blog. Best to contact personal injury lawyer Brian Goldfinger about these rules, or about how the law will apply to your own unique case.