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OCF-19 Catastrophic Claims

There are special legal connotations when injuries from a car accident are deemed to be “catastrophic“. This is a term of art; meaning the term “catastrophic” has a special legal meaning.

Catastrophic is defined under the insurance act as an injury which meets one of the following criteria:

  1. Paraplegia or Tetraplegia;
  2. Severe impairment of ambulatory mobility or use of an arm, or amputation;
  3. Loss of Vision of Both Eyes;
  4. Traumatic Brain Injury (applicant 18 years of age or older at the time of the accident);
  5. Traumatic Brain Injury (applicant under 18 years of age at the time of the accident);
  6. Physical Impairment or Combination of Physical Impairment which results in 55% or more of whole person (there are additional criteria which aren’t included in this instalment of the Toronto Injury Lawyer Blog);
  7. Mental or Behavioural Impairment, Excluding Traumatic Brain Injury, Combined with a Physical Impairment which results in 55 percent or more impairment of the whole person. (there are additional criteria which aren’t included in this instalment of the Toronto Injury Lawyer Blog); and/or
  8. A Class 4 impairment (marked impairment) in three or more areas of function that precludes useful functioning or a Class 5 impairment (extreme impairment) in one or more areas of functioning, due to mental or behavioural disorder (there are additional criteria which aren’t included in this instalment of the Toronto Injury Lawyer Blog).

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Slip and falls can happen anywhere, at anytime.

Unlike a car accident case, the police don’t come to the scene of a slip and fall to record what happened; or to ticket the at fault party.

That’s very important because in a car accident case, the information regarding liability (the who, where, what, when and why) is recorded by the police. This information is later used by the parties and the Court to place the particulars of the accident in to context. The accident report is relied upon and generally weighed upon by the Court to understand how, where and when the accident happened.

The same cannot be said for a slip and fall case. There is no accident report. There is no recording by independent third party witnesses. There is no accident reconstruction.

Somtimes where a slip and fall happens in a monitored private space (like a supermarket, or a shopping mall) an employee or security guard may record an incident report. Sometimes a video camera may capture the fall itself. But more often than not, this doesn’t happen. And when it does happen, these incident reports are taken by employees, agents, contractors or servants of the defendant property owner. They have an inherent bias towards their employer or contractor to absolve them of liability. Those incident reports won’t favour the accident victim. They will be prepared in such a way as to favour the property owner which isn’t good news for the injured Plaintiff.

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Everyone is entitled to their own opinion. These opinions differ from person to person….and that’s ok.

Opinions can be based on a lot of different things: fact, belief, values, upbringing, history, education, training, experience, a gut feeling; or based on absolutely nothing at all!

You don’t need evidence to craft an opinion. It’s yours and doesn’t need to be justified by evidence, facts or anything other than that’s how you feel. And the crazy thing is how you happen to feel changes from day to day. Just like your opinion on something can change day to day, or hour to hour. Opinions aren’t concrete. They are fluid and forever changing.

Take politics. Sometimes Canadians elect a Liberal Government. Sometimes Canadians elect a Conservative Government. Other times Canadians can’t decide and elect a minority government. During an election; Canadians voice their political opinions by casting a vote for their party of choice. The party which they vote for can change from election to election. The change of vote represents a change of political support or political opinion. Opinions are fluid and change.

Evidence is completely different.

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2020 has been a really difficult year for so many people across all walks of life; for so many different reasons.

Where does the hell storm of 2020 start for you? Here are a few line items in no particular order just to put 2020 in perspective:

  • Wildfires blaze out of control and destroy millions of acres of forests in Australia and California. Those California wild fires still blaze. Politicians battle each other whether or not climate change is real
  • Prince Harry and Meghan Markle announce they are “stepping away” from their Royal Duties
  • Iran launches ballistic missiles at two American military bases in Iraq
  • Ukranian flight crashes over Tehran, Iran, killing 176 passengers
  • An impeachment trial for US President Donald Trump. Trump is acquitted. Depending what side of the isle you’re on, this is either fantastic or a disaster. Regardless of your political stripe, it’s a black eye on American politics showing a nation divided
  • Kobe Bryant’s helicopter crashes killing Kobe, his daughter Gigi along with 7 others
  • The UK formally draws out of the European Union. Depending on which side of the political spectrum you’re on, this is either great news, or a catastrophe. Nonetheless, it shows a continent divided.
  • Stock markets crash globally, recording their largest losses on record
  • 2020 Tokyo Olympics postponed.
  • Death of George Floyd. Black Lives Matter protests across America show a country divided
  • Death of Ruth Bader Ginsberg
  • Death of Eddie Van Halen
  • Disneyland closes its doors. First time that’s happened since JFK was assassinated.
  • COVID brings the world to a standstill with over 1,000,000 deaths and global lockdowns.

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More and more; people are purchasing insurance or renewing their insurance policies over the phone. This can relate to car insurance, mortgage insurance, life insurance, disability insurance, critical illness insurance, health/medical insurance. It doesn’t matter what type of insurance it is; the reality is that we are placing more emphasis on purchasing these policies over the phone.

An important decision came across my desk when it comes to the purchase or renewal of insurance over the phone. It’s an important read for anyone. The decision is Estate of Donald Farb v. Manulife et. al., 2020 ONSC 3037; the entirety of which can be read by clicking the link here.

The decision was written by the Honourable Justice E. Belobaba who is one super duper smart Judge. Ready his decision doesn’t require a law degree to understand. It’s easy to read and makes sense to lawyers and non-lawyers alike.

So, if you’re buying insurance; no matter the type over the phone; here’s what you need to know from this decision:

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You know what people hate? Jury duty.

Civic duty? Yes.

Sense of national pride and feeling like you’re contributing to society? Sure.

But there are likely 1001 things you’d rather be doing other than sitting on a jury. Particularly for a personal injury case.

As stated previously in the Toronto Injury Lawyer Blog; most jurors want to sit on a high profile murder or drug case. Nobody every wants to sit jury duty for a personal injury case hearing all day how a Plaintiff’s neck; back and shoulders hurt them.

Insurance companies know this.

So as a reflex, they file Jury Notices simultaneously with their Statements of Defence knowing that an angry jury; a bored jury; or a day dreaming jury is going to relent the Plaintiff and it will reflect in their decision.

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Hey Ontario Government. Want to open up again for business? Want to be a Government that’s “For the People“?

Heed these words of first hand experience from one of your COVID-19 Testing Centres and learn.

For starters: I’m a personal injury lawyer. I’m lucky to have my own practice; call my own shots and set my own schedule. My “boss” are my clients. I don’t have to punch a clock or report to a manager if I have to take time off work. I have a team of lawyers and clerks to help serve our clients. That makes me very lucky. I appreciate that most people don’t have the same luxury or flexibility in setting their own schedules or getting help.

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Long Term Disability benefits flow for many disabled claimants with no issue.

The insurer may from time to time request a report from a family doctor, questionnaire, or request updated clinical notes and records. The insurer may also request that the claimant see their own “doctor” or “specialist” in order to assess their disability.

This is completely normal.

Unfortunately, when this happens, it opens the door for the insurer to interpret the medical data which they have received in such a way to justify a termination of long term disability benefits.

It can be really frustrating, depressing and hard when long term disability benefits get terminated. Like the electric company turning the power off; or like the water company shutting off the water making it difficult; if not impossible to live or to make ends meet.

If only there was a way to get those long term disability benefits reinstated. If only there was a way to get back on claim.

This instalment of the Toronto Injury Lawyer Blog will discuss a reinstatement of long term disability benefits and what factors need to be considered when a reinstatement option is offered.

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“In my view, the simplest answer to this issue is, “It’s 2020”. We no longer record evidence using quill and ink. In fact, we apparently do not even teach children to use cursive writing in all schools anymore. We now have the technological ability to communicate remotely effectively. Using it is more efficient and far less costly than personal attendance. We should not be going back.”

-The Honourable Justice F.L. Meyers

Arconti v. Smith, 2020 ONSC 2782

During the COVID pandemic, personal injury lawyers, insurance adjusters and defence lawyers have claimed to have adapted.

We claim to have embraced e-discoveries, video conferencing, virtual mediations and settlement conferences because we have to. If we don’t embrace the technology, then business doesn’t get done.

It means a Plaintiff’s case can’t be pushed forward.

It means that an insurance defence lawyer cannot bill.

It means that an insurance company cannot clear another file off their desk to set targets and make quarterly economic reports for their stakeholders.

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Many of our Long Term Disability clients want to know how long term disability cases settle. By this question, what they are really asking is how do they as the client, get paid.

Is it a lump sum payment?

Is it a monthly benefit that the client will receive for the rest of their life?

Are there additional damages for pain, suffering, punitive damages, or damages for mental distress?

Does the client have to pay any tax on the settlement amount? If so, then how much?

All of these are valid questions because there are so many ways which a long term disability settlement can be structured outside of Court.

For starters, in order to achieve any sort of award in a long term disability case, the Plaintiff needs to be disabled. This seems so simple, but for so many clients, it’s hard to understand.

Granted; each policy of insurance carries a different definition of disability. But at the end of the day, if the Plaintiff does not meet the definition of disability under the long term policy, there is a very good chance that the insurance company won’t want to pay out any award.

Under most policies, the definition of disability is loosely defined as over the first two years, the Plaintiff is so injured/sick that s/he cannot perform the regular duties of his/her “own occupation“. This first two years is commonly known as the “own occupation” or “own occ” period.

After the first two years, the definition of disability generally changes to the Plaintiff cannot perform the regular duties of “any occupation” commensurate with their education, training and experience. The availability of work is irrelevant. It doesn’t matter that there aren’t any jobs out there for you. If you can do any job for which you have the education, training and experience, then you won’t meet the test for disability. This is commonly known as the “any occupation” period.

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