Articles Posted in Accident Benefits

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One of the hardest things for people to understand in Ontario is how our No Fault system of car insurance works.

Ask 10 drivers how their no fault accident benefits work, or how no fault car insurance works, you’ll get 10 different answers. All of them will likely be wrong. Ask 10 lawyers who don’t practice in the field of persona injury law, you’ll probably get the same wrong answers! Even funnier is if you ask 10 different politicians, the ones who actually passed the laws to create no fault accident benefit insurance in Ontario, and they won’t know either.

The only people who truly know how no fault insurance and accident benefits work are personal injury lawyers, insurance defence lawyers, people who work for insurance companies and those service providers who routinely bill insurers through IEs or through OCF claim forms.

What people have a hard time understanding, is that after an accident involving the “use or operation of a motor vehicle” , they will have TWO SEPARATE CLAIMS. The first claim is the claim for no fault accident benefits. These claims are guaranteed provided there are no policy breach issues. This first accident benefit claim is against your OWN INSURER, regardless of fault. If you didn’t have car insurance at the time of the accident, then there are loss transfer provisions under the Insurance Act which create a duty to defend or respond to the claim from another insurer, or, in the last case scenario, from the Ontario Motor Vehicle Accident Claims Fund. These accident benefits will cover such things as medical/rehab benefits, attendant care benefits, non earner benefits, income replacement benefits and out of pocket expenses related to the car accident. Accident Benefits do NOT cover pain and suffering.

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Uber is a really cool service. Using an App, you can get essentially get a taxi fare for a fraction of the price, with less wait time as well. The App tells you exactly what distance you’ve traveled, and how much the fare cost. The fare cost is then debited directly from your credit card to pay the driver. You can chose to tip the driver if you wish. You can also leave comments or ratings about that Uber experience and that particular driver. If one driver or vehicle has too many negative comments, then the driver won’t be allowed to use to service to provide others with rides. I must admit that all of the lawyers and staff here at Goldfinger Law love Uber and the service which it provides.

For your ordinary person looking to make a few extra dollars on the side driving people around; Uber is a blessing. Especially for those people who don’t have enough money to afford an expensive taxi license.

For those taxi drivers who have toiled with the long hard house and the red tape with respect to taxi licensing, Uber is undercutting their business. They aren’t following the same rules which apply to your ordinary taxi driver.

City Hall in Toronto has yet to sort out the details of how Uber will work on a go forward basis. Some cities have essentially regulated Uber and other ride sharing services. In Vancouver, you can’t use a ride sharing service like Uber for a fare which costs under $75. This has essentially killed Uber’s business out there where the fares tend to be short and fast ones.

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After you’ve been involved in a car accident, there are A LOT of forms to complete for the insurance company in order for you to start recovering benefits.

It’s not simple. You have to jump through a lot of hoops. The process can be long, tedious and very frustrating.

Why don’t they just make the process simple? I have no idea. The forms are created by the government, but are heavily influenced by the lobbying efforts of large insurance companies. So, the forms, along with the questions in the forms are skewed from the outset to create a bias against innocent accident victims and in favour of large, deep pocked insurance companies.

If English isn’t your first language, or you have problems completing paper work; or you have sustained a brain injury in the accident, then completing these forms will be particularly difficult. Get a lawyer to help you out.

The purpose of this Toronto Injury Lawyer Blog Post is to assist you in completing the somewhat tricky OCF-3 Disability Certificate follow a car accident.

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When injured accident victims think about damages, they often think of those valuations in very linear terms; as if they’re on a straight line.

Broken knee? $100,000 plus $150,000 loss of income = $250,000

Fractured wrist? $50,000 plus $25,000 loss of income = $75,000

These are very simple mathematical equations. The problem is these equations are too simple and don’t take in to consideration the whole story.

What accident victims don’t know is that often insurer are entitled to credits or set offs when calculating damages to make sure that the Plaintiff is not over paid for their injuries.

There are many examples when an insurance company is entitled to a set off. What is a set off?

Essentially, it’s a credit in favour of the insurance company. Take the example of a person who was involved in a catastrophic car accident. Prior to the car accident, they were earning $40,000/year. They will never be able to work again on account of a traumatic brain injury.

They are receiving an income replacement benefit in the amount of $400/week from their accident benefit insurer. The total amount of income replacement benefits equal $20,800/year.

If the tort insurer pays 100% of the $40,000 income loss; then the accident victim ends up with $60,800/year ($40,000 + $20,800). That would mean that the accident victim is in a better income position post accident than pre-accident. While this is great to see; unfortunately, this is NOT how the law or the Insurance Act works. In this example, the tort insurer is entitled to a credit; commonly known as a “set off” to make sure this type of over payment doesn’t happen. That set off would be for $20,800 for the income replacement benefits already paid out. Therefore, in order to make the accident victim whole, the tort insurer will pay the difference, that being $40,000-$20,800 = $19,200.

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If insurers paid out maximum compensation on each and every claim, there wouldn’t be any need for personal injury lawyers or paralegals who focus on benefit accident claims.

Why does an injured accident victim or disability claimant need a lawyer, if the insurer is paying them out the full value of their claim up front; without any hassle?

But, if an insurer paid out the maximum value of each and every claim which came across their table, chances are they wouldn’t be as profitable as they are; or profitable at all.

As much as we are made to believe that insurers are there to look out for our best interests and pay out when they are supposed to; at the end of the day; insurance companies exist to MAKE MONEY.

Many Canadian insurance companies trade on the Toronto Stock Exchange (TSX). Here are a few examples along with their stock symbols, along with current share values as of the time of preparing this Toronto Injury Lawyer Blog Post on July 7, 2015:

Intact Financial Corp: IFC $90.57

Sun Life Financial: SLF $41.80

Manulife Financial: MLF $23.03

Co-Operators General Insurance: CCS-PS $23.79

Those are just a few of the examples of insurance companies which do business in Canada, who trade of the Toronto Stock Exchange.

Those stock symbols and share prices are VERY important. If those share prices drop significantly, millions, if not billions of dollars will be lost value and options for shareholders around the world.

If one of these insurers paid out ALL claims, regardless of merit of an entire year, chances are those stock values would dip dramatically.

So, when accident victims or disability claimants wonder why so many claims are denied at first instance, or why insurers refused to believe what their doctors have to say about their injuries, there is a financial reason for this.

The more money an insurer pays out to your for your claim, the less money they get to report in profits for their share holders.There are certainly a variety of their factors involved in insurer profits, but this is one of the most tangible concepts for accident victims and disability claimants to understand.

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Our law firm does NOT handle any WSIB matters. Imagine that…a personal injury law firm refusing work!

But that’s right; our law firm doesn’t touch WSIB work. There are a lot of reasons we don’t practice in this area. Aside from the WSIB being an archaic, overly complicated system; the reality is that it does not adequately compensate injured workers. The awards are rather pitiful, hard for workers to get, and their system of unbiased assessments is “impartial assessors” is a farce. There are a number of economic reasons why our law firm doesn’t do WSIB work, but that’s pretty much all you need to know about WSIB.

You will be hard pressed to find a reputable lawyer in Ontario who does exclusively WSIB work, but there are a handful of them around if you’re lucky enough to find one and have them take on your case at a reasonable rate.

There are times when WSIB and civil tort law intertwine. When this happens, we are there to help people make the right decisions so that their cases get off on the right foot.

For starters, you CANNOT receive bot WSIB benefits and SUE. You can’t have both. You either get one, or the other. This is very important for any accident victim to know.

There are instances where injured workers CANNOT sue. If they’ve been hurt or injured on the job site, there are instances where the injured party MUST pursue a WSIB claim. In such instances, it’s important to find out if your employer is a Schedule 1 or Schedule 2 employer. The difference is that is that you CANNOT sue a Schedule 1 employer; while you can sue a Schedule 2 employer. How do you find out if you’re dealing with a Schedule 1 or a Schedule 2 employer? That’s easy. All it takes is a call to the WSIB at 1-800-387-0750. Just ask the person who picks up the phone. It’s an easy search for their staff to make.

Banks, Veterinarians, Law Firms and some other employers are NOT require to have any form of WSIB coverage. So, it’s open season to sue these employers for their wrong doing.

At the end of the day, it’s important to keep in mind that WSIB acts as a shield for employers. They pay in to an insurance plan known as WSIB, and it’s there to protect them in the event of a worker getting injured.

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Intact Insurance has some great television commercials where an terrible accident happens (like a car driving in to a swimming pool); followed by a scene involving an insurance policy holder calling the insurer over the phone. The next scene is that of a well lit and pleasant call centre whereby an insurance agent from Intact proceeds to collect that person’s information and open up a claim in 5 minutes or less. Pretty impressive! The ad is meant to show the ease and speed in which Intact can open a file and process your claim.

Because that’s exactly what all Ontarians are looking for when choosing an insurance company. We’re not looking for low rates, or good customer service. We’re looking for speedy claims opening procedures. They’re fast, so we know they’re good.

The commercials are pleasant and well executed. They are.

A casual observation from this injury lawyer: the television commercials don’t show any personal injuries, and physical injuries. The only damage is comical or cartoonish.

One ad has the car driving in to the swimming pool, another ad has a car driving in to a mail box. Nobody is hurt. It all looks like an honest mistake where everyone is calm, able to smile, and having a relatively good time. Of course, all of this is intentional to keep the air of the ads light; rather than be downers and show catastrophically injured accident victims and crying family members waiting attentively by a hospital bedside attending to their seriously injured loved ones.

Here is the reality of most claims:

1) If it’s a car crash, there are likely injures. In many cases, there are serious injuries. Sometimes the injuries are so serious that the accident victim can’t talk.

2) The claimant isn’t all bubbly and happy when making the call, no matter how pleasant the agent is on the other line. The claimant is upset, mad, stressed, nervous, anxious, or pi$$ed off for lack of a better term that they were involved in a serious accident and now have to make a claim.

3) The claimant might not speak the best English; making reporting the claim difficult. Language can always be a barrier to getting these things sorted out.

4) The person on the other line might not be as bubbly, welcoming and friendly as they appear in the commercials

Here’s something which you probably didn’t pay attention to in these commercials. The person who was working in the call centre for the insurer was sitting at a desk, in front of a computer and inputting information in to their system. They may be taking notes of the conversation, OR the conversation may be recorded for “customer service purposes“. The claimant who initiated the telephone conversation isn’t taking any notes, nor are they depicted as sitting at a computer an inputting information in to a computer system.

Don’t overlook this tiny detail. It’s important. Want to know why? Read on and find out.

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The governing Liberals announced Ontario’s budget on April 23, 2015. Finance Minister Charles Sousa, backed by Premier Kathleen Wynne were in fine form that day. When one thinks of the term “budget“, we would think of all things financial, including taxes, public spending on healthcare, infrastructure, and education. And to be fair, healthcare, infrastructure and education were all addressed in the 2015 budget.

But what often gets swept under the rug without any debate, deliberation or consultation with stake holders is CAR INSURANCE.

Why is this such an important topic? Well, for starters, if you want to drive a car in Ontario, you need to have car insurance. It’s the law. Check the Compulsory Automobile Insurance Act. That’s right. Ontario has a specific act regarding operating a motor vehicle WITH car insurance.

So, if Ontarians are required to operate a motor vehicle with car insurance, then it’s going to be important to all motorists in the province. This amounts to a lot of people. And if all of these people need to have car insurance, then the product they’re required to purchase better be a good product, and protect their rights in the event of property or physical damage.

For insurance companies, car insurance is important because it’s a way for them to make money. What the legislation says regarding what insurers are required, and not provided to require under these policies of insurance goes straight to their bottom lines. The more they can charge by providing the least amount of benefits will increase their profits and make their shareholders happy.

For politicians car insurance is important because if rates are too high, then voters are unhappy. So, the aim of politicians when tinkering with car insurance is to get the cost of car insurance down. But how do they do that? The government doesn’t set car insurance rates. But they do however legislate what benefits are required to be provided in said policies and how benefits work; which ought to have some form of correlation with the price of car insurance (among other factors such as driving record, age, where you reside, driving experience, and the type of vehicle your drive).

So how has car insurance in Ontario been affected since the new budget was announced? Keep reading and I will share that with you.

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The time immediately following your car accident can me the most difficult time; and the most important time in terms of getting your case on to the right start.

There is a LOT of work to do immediately following your car accident. Lawyers know this. Insurance adjusters know this. Unfortunately, the general public doesn’t know this.

I can say with utmost certainty, that the amount of work required on behalf of accident victims and their families has gone up exponentially with the introduction of no-fault accident benefits in Ontario. This no fault accident benefit scheme was supposed to protect consumers (that means every day Ontario drivers like you and me).

In the beginning, I’m sure that it did. The system was not as complicated, not as adversarial, and did not have a myriad of forms or medical experts who focus on only in accident benefit claims. Nowadays, the system has more forms than you could ever possibly imagine; concentrated clinics and health care professionals who only handle treatment for car accident cases; along with a backlog of over 60,000 mediation and arbitration cases dealing specifically with accident benefits before the Financial Services Commission of Ontario (FSCO).

By completing one form incorrectly, you may be jeopardizing your case from the start. How so? Take the example of electing or FAILING TO ELECT for the proper benefit following your car accident. If you elect an Income Replacement Benefit, but you weren’t making any income before your accident, you may have been better off electing the Non-Earner Benefit. How do you make an Election? You have to complete the OCF-10 Election Form. If you aren’t a lawyer or somebody who works in the car insurance industry, you likely don’t have the foggiest idea about the variety of benefits available, how to claim those benefits, and what on earth to do with all of these forms. This is why the start of the case is such an important and difficult time. Getting your case off on the wrong foot can forever jeopardize an otherwise meritorious claim.

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Our lawyers represent clients from all across Ontario.

From Southwest Ontario, Toronto, all the way to the Northern most part of this great province.

I will be in Thunder Bay this month, and next month helping out innocent accident victims. People want to know what sort of differences we see in our cases from more urban settings such as London, Hamilton or Toronto, compared to more remote settings in the Northern Parts of Ontario.

I can tell you that it doesn’t matter where you are; we see plenty of odd and strange stuff. Having said that, the odd and strange things we see in Northern Ontario are unique to Northern Ontario. Don’t believe me? Try these cases out for size!
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