The purpose of this instalment of the Toronto Injury Lawyer Blog is not about settling a personal injury case fast.
Rather, it’s about what money can be claimed, and recovered relatively quickly, after an innocent accident victim cannot return to work and earn an income after a serious accident.
Getting paid benefits quickly to supplement one’s lost income, because one cannot work after a serious accident is a very common concern for clients. Legitimately so. A Plaintiff goes from earning a gainful income one day; to being disabled and unable to do so the next. The bill collectors don’t care that you’ve been involved in a serious accident. All that they care about is that their bills get paid.
It’s our hope that this instalment of the Toronto Injury Lawyer Blog gives you some insight on sources to claim benefits in order to make ends meet.
Before we examine those sources, here are a few practical tips to claiming benefits:
- Ask, and you shall receive. It never hurts to ask, or to claim a benefit. Even if you think that you are not entitled to it, or won’t qualify, it doesn’t hurt to apply. The worst that they payor can say is “no”. It costs you nothing to apply, other than your time and a bit of thought (perhaps some postage costs).
- If you don’t apply for it, you won’t get it. Money in the form of benefits does NOT simply fall from the sky. If you do nothing, you will get nothing. See tip #1 above.
- Don’t delay in applying for benefits! Many benefits have hard and fast deadlines in which to apply. Insurers and governments who are responsible to pay out benefits don’t like, and don’t want to hear excuses. They want to see that you’ve followed their rules.
- Insurers will look for any flaw in your application, or piece of evidence to deny your claim. Do you really think that a private insurer is in the business of gratuitously handing out money to everyone; and to anyone who asks? You can’t be so naive. They are looking from the outset for any strand of evidence or excuse to deny your claim. It’s best to follow their rules and get your claim in on time, and submit it properly.
The first source of payment, should be through the Federal Government for EI Sickness Benefits.
EI Sickness benefits have been increased from up to 15 weeks of payments, to up to 26 weeks of payments, to a maximum of $650/week. This is nothing to ignore and the benefits should be claimed. In order to claim these benefits, you will need to meet a disability test, and your doctor will need to complete a medical certificate. Your doctor has likely completed plenty of these certificates in the past. You will need to show that:
- you’re unable to work for medical reasons
- your regular weekly earnings from work have decreased by more than 40% for at least 1 week
- you accumulated 600 insured hours of work in the 52 weeks before the start of your claim or since the start of your last claim, whichever is shorter
The EI Sickness/Disability Benefits will likely be the fastest way to get paid, while you’re unable to work. Private insurers have a tendency to drag their feet (even more than the government). They also do not have then authority to require that the claimant attend a medico-legal assessment with one of their hired gun doctors to defeat your claim; or conduct surveillance on you; to do any of those other things which we see private insurers do.
The second source of income should be through a private disability plan (short term disability) offered through work, or which the injured party holds privately. These benefits are held by many unionized employees as a perk of employment. Teachers, postal workers and most unionized factory workers have short term disability benefits. These benefits will pay up to 100% (or less) of the lost income as a result of an injury or disability over a defined period of time as set out in the policy. Every policy of short term disability insurance is different, so it really depends on what the policy says. These short term disability benefits can be paid out directly by a self insured employer; or can be paid out and administered through a private disability insurer like Manulife, SunLife, Desjardins, Blue Cross, SSQ, Industrial Alliance, RBC Insurance etc., just to name a few. The short term disability benefits will either get approved, or get denied. If they get denied, you can retain a personal injury lawyer to contest the denial and work on getting the benefits which you deserve.
The third source of benefits only applies if you’ve been involved in a car accident. These are called income replacement benefits (IRBs). IRBs are only payable up to a maximum of $400/week. That number increases if you paid extra for optional benefits to increase this amount. Very few people opt to pay for the rider to increase the IRB from the base amount of $400/week. Keep in mind that this base amount of $400/week has not increased under a standard auto policy for over 2 decades. Inflation anyone? What’s also important to note is that the auto insurer will receive a set off for most income/benefits which you are receiving from any other source, like EI Disability. Car insurers LOVE when a Plaintiff receives other collateral benefits. It means that they get to pay less in IRB payments to a claimant because the laws are written in a way which best protect their interests, along with their money. The calculation of the IRB also hurts people who work on a commission structure, or people who work in a cash based business (taxi drivers, hairdressers, salon workers, restaurant/hospitality workers, artists etc.). Rule of thumb: if you don’t claim the income on your tax returns, you won’t get to rely on that invisible income in the calculation of your income benefit. Out of all of the benefits, we find the income replacement to be one of the most hotly contested benefits of all of the benefits listed in this blog post.