Articles Posted in Accident Benefits

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Car accident law shouldn’t be confusing. But it is!

Workplace injury law shouldn’t be confusing either. But it is!

Part of the reason that both car accident law and workplace injury law are both so confusing is because there are man made laws behind both; which usurp natural law.

For car accident claims we look to the Insurance Act and the Statutory Accident Benefits Schedule. Both pieces of legislation are dense; and require that the injured claimant complete a bunch of confusing standard forms.

For workplace injury claims we look to the Workplace Safety Act, the Occupational Health and Safety Act along with the First Aid Requirements Regulation 1101

These pieces of legislation are also dense, and require that the injured worker complete a bunch of confusing standard forms.

You cannot sue your car insurer in regular Court over an accident benefit dispute for a car accident claim. Instead you must start a proceeding before the License Appeals Tribunal or LAT in the Automobile Accident Benefits Service or AABS

You cannot sue your employer in regular Court over a workplace accident. Instead you must start a proceeding before the Workplace Safety and Insurance Board or WSIB.

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The majority of insurance adjusters I have spoken to during the COVID Pandemic are all working remotely from home. I know this because I speak with, or correspond with insurance adjusters every day. It goes with the territory being a personal injury lawyer.

In phone calls, or Zoom calls I can see their children or pets whistling by. Their attention is divided between parenting, insurance adjusting, and surviving. And that’s ok. We’re all walking on egg shells and doing our very best to manage day by day during these difficult times.

The fact that so many insurance adjusters are working remotely from home tells me something. The insurance companies respect the Stay At Home Orders and warnings from the Government and medical officers across the land.

It also sends a message that these insurance companies care about protecting their employees from COVID. Having hundreds of employees work from their offices, cubicles or in a call centre isn’t ideal towards curbing the spread of COVID. Allowing their employees to work for home is a strong signal that they care about the health and well being of their work force.

It’s unfortunate this same degree of care, understanding and compassion which the insurance industry has shown to their employees hasn’t trickled down to its customers.

What do I mean by that?

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I think it’s fair to say that North American society has become more skeptical over the years. We are more skeptical of government. More skeptical of science. More skeptical of our leaders. More skeptical of large businesses. More skeptical in general.

Or perhaps, a more accurate comment is that social media has amplified voices for skeptics and conspiracy theorists alike.

The internet has also amplified our access to information and misinformation as well; thus giving rise to easily accessible and LOUD opinions online.

What always amazes me is that with the vast amount of information available at our fingertips; that people don’t research very basic things about their health; particularly when it comes to car accident cases.

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After you’ve been seriously injured, or even not so seriously injured in a car accident, or motorcycle accident in Ontario, the injured party; regardless of fault is entitle to accident benefits.

This is what Ontario’s “no fault” scheme of accident benefits is all about.

If you are not at fault for the car accident you’re entitled to receive accident benefits.

If you are completely at fault for the car accident you’re entitled to receive accident benefits.

If you were the passenger of a vehicle involved in a car accident you’re entitled to receive accident benefits.

If you were a pedestrian or cyclist struck by a motor vehicle; even if you don’t know the identity of the other driver; guess what: you’re entitled to receive accident benefits (even if you’re at fault for causing the car accident in the first place!).

Crazy right? Even if you cause the accident, you are entitled to receive accident benefits to assist with your recovery, attendant care needs, income replacement benefits or non earner benefits.

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The OCF-1 Application for Accident Benefits is the first, and arguably, the most important form for starting any accident benefit claim following a car accident.

If you don’t know what accident benefits are; you can learn all about them on the Goldfinger Injury Lawyers Website, or the Toronto Injury Lawyers Blog. Our personal injury lawyers frequently discuss accident benefits, what they are, their value and how they work to clients and prospective clients alike. There is a lot of discussion about accident benefits because they’re so important (and confusing too!).

In Ontario, we have a no fault system of insurance following a car accident. These no fault benefits are referred to as accident benefits. They are NOT damages for pain and suffering. Accident Benefits are created by, and legislated under the Insurance Act and the Statutory Accident Benefits Schedule. These accident benefits are constantly changing because the provincial government is constantly tinkering with them. This results in many amendments to the Insurance Act and to the Statutory Accident Benefits Schedule which makes things very confusing for consumers, lawyers and insurance representatives alike.

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Wednesday July 1st is Canada Day. Can you believe it?

Because of COVID, most people are uncertain what day of the week it is. Let alone month or date. When it comes to stat holidays? Forget about it! Every day feels like a Tuesday on repeat like some cruel real life edition of the cult comedy Ground Hog Day starring Bill Murray.

For most, Canada Day is full of fond memories like spending time at the cottage, lake, pool, BBQs or at family get togethers. It’s a time to decompress, enjoy the warm summer weather and kick back. It’s also a time where you get a day off work to relax.

This Canada Day will likely be a really weird one because of COVID.

For starters, mass gatherings like those at a community picnic, BBQ, concert or celebration like we see across the nation (particularly in Ottawa) either won’t be happening or will be happening much differently and on a much smaller scale. I don’t expect to see any sort of mass gatherings like we are accustom to seeing for Canada Day 2020.

But this doesn’t mean that people aren’t going to be out and about trying to get the most out of this celebratory day.

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Continuing with our COVID theme of straight facts and no filler or wonky political spin, for this week’s edition of the Toronto Injury Lawyer Blog, we will be focusing on Accident Benefit Claims in Ontario.

Why are we doing this?

Because we are finding so much misinformation going around right now during the Pandemic, we want to give people easy to understand legal information which won’t take forever to sort through. It also won’t require the reader to be a political analyst or medical expert to understand.

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Did you know that Ontario car insurance companies are entitled to a secret credit approaching $40,000 for your pain and suffering in car accident cases? Probably not.

It’s one of the best kept secrets in the insurance industry which insurance companies don’t want you to know about.

In the past few days, the secret credit aka the deductible has been getting a bit of attention in the news. Here is an article from the Toronto Sun explaining the unfairness of the deductible.

In fairness, the current deductible does not actually stand at $40,000. Technically speaking, it sits at $39,556.53, but lawyers call it $40,000 because remembering the exact dollars and cents is a bit difficult to do. This $39,556.53 goes up each year on January 1st. So, while today the deductible sits at $39,556.53, by January 1st of next year, it will go up again, likely over $40,000 which is higher than the average net salary of many income earners in Ontario.

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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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People who have been very very very seriously hurt in a motor vehicle accident need to know the ins and outs of the OCF-19 Application for Determination of Catastrophic Impairment Form.

If your insurer deems your injuries to be “catastrophic” your benefits will skyrocket from $3,500 under the minor injury guideline, or $65,000 up to $1,000,000 or $2,000,000 (depending on when your accident took place). Not only does the dollar amount of your benefits skyrocket, but so does the duration, along with the types of benefits which are available to catastrophically injured accident victims, vs. non-catastrophically injured accident victims.

The first step to being deemed catastrophic is having your doctor or treating specialist complete the OCF-19 Application for Determination of Catastrophic Impairment Form.

Finding the form can be a bit tricky. It’s not a typical form that insurance companies include in the standard Accident Benefit Package which is sent to injured accident victims.

Your personal injury lawyer will know how to find the form. You can also find the form on the website of the Financial Services Commission of Ontario, link here. 

When printing off the OCF-19, make sure that you are printing off the right form.

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