COVID-19 Update: How We Are Serving and Protecting Our Clients

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If you have been denied long term disability benefits, you are likely wondering what your next steps are. The purpose of this week’s installment of the Toronto Injury Lawyer Blog is to give you some tips on what those next steps are towards getting the long term disability benefits which you deserve.

Long Term Disability Benefits are very topical for this week’s blog post given that yesterday was Bell Let’s Talk Day to raise awareness for mental health. The thing about mental health is that it’s invisible. When you break a leg, you’re put in to a cast and the whole world can see that you’re injured and not able to walk properly.

In contrast, mental health is invisible to the naked eye. Everyday people walk around with mental health issues which the outside world isn’t aware of, or doesn’t understand.

This dovetails nicely with long term disability claims not only because mental health can have long term consequences on one’s ability to work; but also because the vast majority of our long term disability clients suffer from mental health issues. It’s because mental health issues are invisible, and can be subjective in nature; which gives long term disability insurers an easy out to write them off as “made up“, “exaggerated“, or which won’t impact your ability to work. Mental health issues won’t show up on an x-ray, CT Scan or MRI. That gives a long term disability insurer a reason to say that the mental health issues which you are struggling with are simply a fabrication of your mind or that mental health isn’t a big deal and that you should be able to work.

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We must admit, long term disability cases can be very strange. Liability and calculating damages is not straight forward like in a dog bite or car accident case. The reason for that is long term disability cases are contractual in nature. That means that they are based upon, and defined by your long term disability contract.

This long term disability contract can be under a group benefits plan, or an individual policy of insurance.

Either way, chances are you haven’t taken the time to read the entirely of your long term disability contract because the majority of people (who aren’t lawyers or insurance professionals) simply don’t. Why curl up with a good book when you can read over your long term disability contract right?

Determining liability in a dog bite case is easy. Bad dog bites innocent passerby and causes damages. Liability has been established and now we can move along to damages.

Calculating damages in a dog bite case is easy as well. What are the injuries; look up similar fact case law and damage awards and then process those figures. Factor in the person’s age, education, employment, and how the injuries impact their daily lives along with any past/future care needs.

It’s not so easy when it comes to long term disability claims. Every contract is different, every disability is different as well. There are lots of terms and conditions contained in the long term disability policies our lawyers have seen which are real head scratchers for our clients.

Here are a few of those clauses which tend to confuse long term disability claimants.

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A lot of the clients at Goldfinger Injury Lawyers suffer from Chronic Pain, Fibromyalgia and Depression. It’s not easy because nobody seems to understand these conditions. More on that later.

We have expertise in handling chronic pain, fibromyalgia and depression cases which present in a variety of forms such as car accident cases, accident benefit claims, short term disability cases, long term disability cases, Canada Pension Plan Disability Appeals, dog bite cases, slip and fall cases, assault cases and bike accident cases just to name a few.

There are a few things which chronic pain, fibromyalgia and depression have in common.

For starters, they are are invisible to the naked eye. Your chronic pain, fibromyalgia or depression does not show up on any x-ray, CT Scan or MRI. There are no objective diagnostic tests which show that you have chronic pain, fibromyalgia or depression.

Normally, your family doctor or treating specialist (like a rheumatologist, psychiatrist, physiatrist or psychologist) will make a diagnosis of chronic pain, fibromyalgia and depression (depending on their specialty).

But for every specialist who will attest that you cannot function or cannot work on account of your chronic pain, fibromyalgia and depression; there will be another specialist who will say the opposite. Usually that specialist is retained by, or contracted by the insurance company in the context of an accident benefit, long term disability benefit or tort claim. Because they have been retained by the insurance company; and the insurance company is paying the cost of the assessment; you must take their findings with a grain of salt.

But despite this, too many negative reports against the Plaintiff/Claimant will create a compelling chain of denials making it harder and harder for a Plaintiff/Claimant to get the results/benefits which s/he deserves.

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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.

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It’s that time of year. Slip and Fall season is upon us in Ontario.

Before we get in too deep on this edition of the Toronto Injury Lawyer Blog, all of us here at Goldfinger Injury Lawyers would like to thank our readership for their support over this past year. We appreciate your positive and constructive feedback. In 2020, we hope to bring you more interesting to read legal content so that you can better understand the world of personal injury and disability law in Ontario. If there are any topics which you would like covered that we have yet to touch upon, send us an email to info@goldfingerlaw.com with subject title “Blog” and we will do our best to accommodate your request. You can always dig in to our archives on the Toronto Injury Lawyer Blog page.

This week’s topic will cover slip and trip and falls. We always notice a spike in these sort of calls around this time of year. This year is no exception with the steady freeze, thaw, freeze, thaw weather we’ve had across the province, it’s kept everyone on their toes so to speak.

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Personal Injury Lawyers across Ontario are all talking about the dramatic changes to the Rules of Civil Procedure which take place on January 1, 2020.

The most notable change is that being made to Simplified Procedure.

The amount you can claim for Simplified Procedure claims will double from $100,000 to $200,000, exclusive of interest.

This is significant for personal injury lawyers because damages for pain and suffering claims across Canada are capped at around $388,604 depending on who you ask. We found our best reference guide here with an actuarial/accounting company who focuses their time on personal injury claims. This cap on general damages goes up (or down) each month with the cost of inflation.

The cap on general damages is also significant when taking in to consideration the deductible for car accident cases in Ontario. As of the time of preparing this edition of the Toronto Injury Lawyer Blog, the deductible for general damages in motor vehicle accident claims sits at $38,818.97 and is set to increase on January 1, 2020.

When you take in to consideration the cap on general damages in Canada, along with the deductible for pain and suffering in car accident cases in Ontario, many personal injury lawyer across Ontario will look to take advantage of bringing claims under the New Simplified Procedure Rules.

The New Simplified Procedure puts a cap on cost recovery at $50,000; along with a cap on disbursement recovery at $25,000.

What’s important to note here is that the recoveries are limited at these amounts. But there is nothing preventing another party from spending well over these amounts. That means that a deep pocketed insurer can spend $500,000 on a case limited to just $200,000 under the Simplified Rules, and only recover $50,000 in costs and $25,000 in disbursements. It wouldn’t surprise any of the personal injury lawyers at our office if any insurer spend 10x of the value of the case in order to prove a point. There is NOTHING preventing a party from over spending on a case. What doesn’t make good business sense has never stopped an insurer from attempting to prove a point. How this plays out we have yet to see.

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The Holidays are a wonderful time. Celebrations with family, friends, co-wokers can be a lot of fun, and a time to reflect on the past year and the year to come.

A few things I would like to comment on with respect to the holidays. Back in 2008, the Goldfinger Personal Injury Law, now Goldfinger Injury Lawyers use to send out a large mailer of holiday greeting cards. They were a big hit. More interesting was the reaction of the people who didn’t receive the cards or who were not on our mailing list. Many found out about our holiday cards, and their reaction to not receiving a card was even loud than those who received one. It sucks feeling left out, but that certainly wasn’t our intention. We simply couldn’t mail out to everyone in the world.

Fast forward to 2015. Fewer law firms are sending out traditional holiday cards in the mail. Instead law firms are sending out e-cards. They’re faster, more efficient, easier to send, less of an environmental footprint, more practical and more economical. We were quick to jump on the trend. It allowed us to reach our client base, along with people we were close with our acquaintances.

Some people replied to our first round of Holiday E-Greetings indicating that they considered our e-cards spam and a violation of Canada’s Anti-Spam Legislation (CASL) which as introduced in around 2014. The simplest definition of spam is unsolicited email, though it can also include unsolicited text messages and software.

Can the Goldfinger Injury Lawyers’ Holiday E-Greeting be considered spam?  I don’t know, but I certainly don’t want to test that boundary. Who knows. Someone has a bad day, your Holiday Greeting is the straw that broke their inbox and the next thing you know you are fighting CASL charges for sending out an innocent holiday greeting. Reporting spam is really easy. It’s as easy as a quick click online on this government website. 

I cannot begin to tell you the amount of unsolicited holiday e-greetings I’ve received in my mailbox; and likely yours too! Do I want to be the Grinch who reports unsolicited spam in the form of Holiday E-Greetings? Nope. Are there a bunch of Grinches out there who will do so because they’re having a bad day or who want to see you go down in flames? Yup.

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Winning a car accident case in Ontario is difficult.

It’s not enough to have been involved in a car accident, and that accident is not your fault.

A Plaintiff also has to establish injuries/damages. The Plaintiff must also establish that his/her damages are related to the subject car accident. This is called causation.

At the end of the day, these are called personal injury cases for a reason. There must be an injury, otherwise there will be no compensation.

What makes things particularly difficult in Ontario, is that regardless of fault, the injuries are subject to two giant legal hurdles meant to defeat the Plaintiff’s case and limits their recovery.

The first hurdle is the threshold. Your injuries need to defined as a serious and permanent impairment of an important bodily function. If the injuries are not permanent, then you get zero. If the injuries are not deemed serious, then you get zero. If the injury just lasted 8 months, and then you made a full or close to full recovery, the you get zero.

All of this seems unfair; and I agree with you if you feel this way.

The second hurdle is the deductible. The insurer is entitled to a secret credit on all damages for pain and suffering. The first $38,818.97 of your award vanishes! It’s credited directly to the insurer. Is that fair? No it’s not, but this is the laws that personal injury lawyers have to work with for car accident cases in Ontario.

What’s even more disturbing is that if it’s a jury trial, your personal injury lawyer cannot mention the concept of the threshold or deductible to the jury. If your personal injury lawyer mentions these concepts, the defendant insurer will likely move for a mistrial and seek their legal costs.

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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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Buying insurance is more complicated than buying a loaf of bread or a new pair of shoes. For starters, neither bread nor shoes are meant to last a lifetime, nor do they come with a fine print policy or instruction manual explaining what they’re all about. There’s no fine print when it comes to bread or shoes (other than perhaps the list of ingredients contained in the bread).

What you see with bread or shoes, is what you get.

The same can’t be said for purchasing insurance. There are thousands of twists, turns, bobs and weaves contained in each different policy of insurance; regardless of what the insurance is being purchased for. Often what you think you’re purchasing isn’t exactly so; or the insurance product doesn’t work the way you expect it to to work.

Case in point, let’s take the example of long term disability insurance. Here are some common misconceptions:

  1. My long term disability benefits will cover 100% of my income: WRONG! Most policies only cover around 60-80%. Some lesser policies only cover 50% of your pre-disability income.
  2. My long term disability benefits will last for the rest of my life: WRONG! Most policies terminate benefits at the age of 65, despite the fact you may have intended to work until the age of 70. Other less policies only cover benefits for a maximum duration of 5 years, or up to the age of 65; whichever period comes first.
  3. I don’t have to pay any tax on my long term disability benefits. WRONG! Whether or not you pay income tax on your long term disability benefits depends on the wording contained in your policy. Rule of thumb: If your employer pays your premiums, then your long term disability benefits are taxable. Rule of thumb #2: If you lump out your long term disability claim with your insurer; only past benefits are taxable. Future benefits are not.
  4. My long term disability benefits are paid in addition to my CPP Disability benefits and other collateral disability benefits so that I can double dip and make just as much money disabled (or more) than I made while I worked. WRONG! Nearly every Long Term Disability policy our lawyer have seen contains a set of provision whereby to long term disability insurer is entitled to a dollar for dollar set off for any disability income you are receiving; thereby reducing the amount of long term disability benefits owing to you.

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