Articles Posted in Accident Benefits

It has been a busy week at Goldfinger Injury Lawyers, and we have some exciting news to share with the readership of the Toronto Injury Lawyer Blog.

We’re excited to announce the hiring of a new lawyer, Afsoun Amirsolaimani. Afsoun comes to us having graduated from the Faculty of Law at the University of Ottawa, and articled at a boutique personal injury law firm in Hamilton. She gained valuable experience in car accident, slip and fall, accident benefits, dog bite and long term disability claims. Outside of work, Afsoun is a fantastic amateur photographer. We are confident that Afsoun will bring her enthusiasm, dedication and passion for justice to our law firm in order to better serve our clients across Ontario. 

Another important announcement is that our Toronto Office has expanded! Yet again! This is our 4th office expansion in Toronto over the past 9 years. Please don’t get the impression that our law firm are bad tenants. It’s just that our law firm has been growing year after year, and we need to increase our space in order to accommodate our needs. We have been able to grow by serving our clients as best we can. Growing one satisfied client at a time. We aren’t going anywhere far. Same building at Yonge/Sheppard. Same floor. Just larger space. We’re still accessible off of Highway 401 at Yonge Street and also accessible via two subway lines. We’re also steps away from OHIP, ODSP, FSCO along with two Court Reporter’s Offices which is very convenient for our lawyers and clients alike. Our law firm is handicap accessible. What’s not to like about Yonge and Sheppard?

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If you drive a car in Ontario, every year or so, your car insurance needs to get renewed. Come renewal time, your premiums may go up, they may go down, or just stay the same.

Ontario drivers need to purchase insurance in order to drive. This is a requirement under the Compulsory Automobile Insurance Act R.S.O., 1990 c. C. 25: which states:

Compulsory automobile insurance

2. (1) Subject to the regulations, no owner or lessee of a motor vehicle shall,

(a) operate the motor vehicle; or

(b) cause or permit the motor vehicle to be operated,

on a highway unless the motor vehicle is insured under a contract of automobile insurance.

In plain English, if you drive a vehicle; that vehicle needs to be insured. That means that you, or somebody else needs to pay money to an insurer to have that vehicle insured.

You see a lot of advertising from insurance companies on TV, the internet, at hockey games, even on billboards on our roads. There’s that Knight Mascot from Belair Direct. The “under five minutes” to start your claim schtick from Intact. State Farm has ads which feature different celebrities. They’re all fighting for you business as a consumer of insurance (car, home or otherwise).

But as consumers, insurance is one of the few products which in general, consumers don’t really understand. This is not like buying a pair of shoes or a loaf of bread. Have you ever read the fine print contained in those lengthy policies of insurance? Probably not. It’s all in legalese. Even the personal injury lawyers, insurers and judges don’t get it right sometimes!

Even more remarkable is that the majority of insurance consumers purchase these products without knowing what benefits come with the product. All people care about is the bottom line. How much will their insurance cost? They don’t bother asking the question; what benefits am I entitled to receive from this insurance product in the event of a car collision? How will my insurance protect me in the event of a serious car accident?

None of these questions are asked, or even thought of until it’s too late.

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The road to recovery can be a long one following a serious accident. You’ll need all the help you can get; and sometimes the help provided through the publicly funded OHIP system just isn’t enough.

Treatment like physiotherapy, occupational therapy, massage, psychological counselling, speech language pathology and chiropractic treatment in the majority of cases aren’t covered by the OHIP system.

Sometimes insurers will pay for this sort of treatment while the case is still open; in order to support your wellness and rehabilitation.

In car accident cases, these treatments can be paid for by way of an accident benefit claim via OCF-18 Treatment Plan. The car insurer will only pay for the treatment provided that they deem the treatment to be both “reasonable and necessary“. Unfortunately, the insurer gets to act as Judge, Jury and Executioner in deeming whether or not the proposed treatment via OCF-18 Treatment Plan is “reasonable and necessary“; which can be very frustrating for clients.

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The most important form to get treatment (physio, chrio, massage, occupational therapy, counselling, speech language etc.) after a car accident in Ontario is called the OCF-18 Treatment Plan.

This is a magical form. If the OCF-18 Treatment Plan is completed properly; then your treatment will be approved and paid for by the car insurance company.

If the OCF-18 Treatment Plan isn’t completed properly, then your treatment will be denied and you may have to pay for treatment out of your own pocket. Having Treatment Plans denied can be incredibly frustrating on your road to recovery following a serious car accident.

What’s incredible and rather perplexing for the lawyers at our office is given the importance of the OCF-18, how many times this form is updated, revised or changed. There are so many different versions of the OCF-18 it’s getting hard to keep up. Just 27 days ago (October 1, 2016), the OCF-18 Treatment Plan form was revised and changed yet again! Keep in mind that the OCF-18 is just one of the many OCF forms required in an accident benefit claim. There are over 18 other forms you may need to use during the course of your accident benefit claim.

If you visit the Financial Services Commission of Ontario website (FSCO, which is the home of the OCF forms for car accidents), you will see that there are different versions of the OCF-18 Treatment Plan, along with a wide other variety of OCF Claim Forms. For Example:

There is a Revised OCF-18 Effective October 1, 2016

There is an OCF-18 Effective June 1, 2016

There is an OCF-18 Effective November 1, 2014

There is an OCF-18 Effective February 1, 2014

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In last week’s Toronto Injury Lawyer Blog, I briefly shared with you our law firm’s experience seeing and reporting auto/accident benefit fraud.

We had many calls following that blog post wanting to know more, as I didn’t really expand on what had happened.

This week, we will take this opportunity to examine what happened to our clients, and to our law firm when faced with what appeared to be a clear cut case of lies, deception and manipulation amounting to an attempted accident benefit fraud on our clients.

A friend of mine referred me to lovely family who had been involved in a serious car accident. The mom was still in hospital with a broken leg which had been operated on. She remains unable to walk, work, or engage in her normal activities of daily living. She was staying in the Ortho Floor at Credit Valley Hospital in Mississauga.

I made arrangements and eventually met with the entire family at the hospital. This is normal for personal injury lawyers to do. Hospital meetings are sometimes necessary, and at our law firm, they are free of charge.

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Here’s the scenario:

You or a loved one was hit by a negligent driver. The driver was texting on their cell phone at the time of the collision. The driver was charged and convicted of distracted driving and careless driving under the Highway Traffic Act.

Liability is clearly not an issue. The distracted driver was at fault. There will be no arguments from the Defendant Insurer’s Lawyer in that regard.

As a result of the collision, the Plaintiff sustained a brain injury, along with multiple orthopedic injuries to her neck, back, knees and wrists. The injured accident victim has under gone  6 surgeries at different hospitals across Ontario; each with different orthopedic analyst. After each surgery, the accident victim has been bed ridden for between 1-3 weeks at a time.

The person’s arms will never be the same.

The person’s legs will never be the same.

The person’s back will never be the same.

The person’s mind will never be the same.

The accident victim is completely BROKEN, and no amount of treatment, therapy, surgery or medication will ever make them whole again.

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One of the most commonly asked questions of our personal injury lawyers is how innocent car accident victims can get the insurance company to pay for their medical/rehab treatment following a car accident. This involves the proposed service provider completing the OCF-18 Treatment Plan Form.The Toronto Injury Lawyer Blog has already written on the topic of completing the OCF-18 Treatment Plan Form. This previous entry can be accessed here. But, since this question is asked of us so much, we thought it would be of great use to re-visit the topic. After all; getting the car insurer to pay for your post accident treatment is important to your rehabilitation and peace of mind. It certainly seems unfair if you would have to pay for the treatment out of your own pocket when you’re not able to earn an income following a serious collision.

Treatment payments are generally covered after a car accident through Ontario’s No Fault Accident Benefit regime. But, the accident benefit scheme is very complicated and can be very tricky to manage on your own. Even for lawyers, the system is tricky.

For starters, the first form that needs to be completed is the OCF-1 Application for Accident Benefits. This form opens up an accident benefit claim for the insurance company. Once an accident benefit claim has been opened, you’re then eligible for med/rehab benefits such that the insurer ought to pay for the cost of your treatment.

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For anyone who practices in the field of accident benefit law (dare I now call it litigation), what we all need is more paper work, more records, and more forms to be completed by insureds, and insurers alike. What is already a complicated and confusing system has been rendered even more complex with the shift of accident benefit disputes from the Financial Services Commission of Ontario (FSCO) to the Safety, Licensing Appeals and Standards Tribunals of Ontario (SLASTO) License Appeals Tribunal (LAT). How’s that for a mouthful?

Accident benefits, at their most basic, are designed to protect an insured accident victims following a motor vehicle accident. The Insurance Act is consumer protection legislation supposedly aimed to help rehabilitate and make ends meet for somebody whose livelihood and health has been impaired in an accident. Items in dispute can range from simple physiotherapy treatment, to weekly income replacement benefits, to more complicated catastrophic disputes.

Since 1997, FSCO has been hearing accident benefit disputes between injured car accident victims and their accident benefit insurers. FSCO was mandated to hear these types of cases. FSCO had its own mediators, arbitrators, practice code and a wealth of case law built over the years to guide the public and insurers. Continue reading →