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Determining how much your case is worth in a Long Term Disability Case can be a bit of a weird science. But, there is a method to what many perceive as madness.

Plaintiff side personal injury lawyers would LOVE for your number to be accepted by the long term disability insurer.

Wouldn’t it be great if coming up to a number in a long term disability case was as easy as imagining the highest number in your head, spitting it out, and then the case is settled.

This would be your personal injury lawyer’s dream. The client gets what s/he wants. That number is very high. The lawyer feels great for having achieved such a significant recovery on behalf of his/her client.

Long term disability cases are not cases for pain and suffering. Nobody from the long term disability insurer committed an actionable wrong which led directly to your disability. Meaning, no one from the long term disability insurer ran you over with their car resulting in your disability (unless this actually really happened). For the most part, the disability has little to do with the action(s) of the insurer, and vice versa. While the decision of the insurer to deny, or terminate benefits will likely cause emotional stress and financial duress; it has little to do with the onset of the actual disability giving rise to the claim in the first place.

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After a serious accident or collision, the injured party will require treatment.

Sometimes the treatment is covered by OHIP. Seeing your family doctor, getting surgery, assistance through LHIN, seeing a specialist, publicly funded physiotherapy; these are all examples of treatment which is covered under the OHIP system. That means that regardless of who was at fault for the accident, that you don’t need to pay for the treatment. This type of treatment is of particular important for all manners of accident and injury cases. If you hold a valid Health Card, there is no excuse for not at the very least, seeing your doctor. It’s free.

Sometimes treatment is NOT covered under the publicly funded OHIP system. Seeing a psychologist, a physiotherapist, occupational therapist, chiropractor, speech language pathologist, massage therapist; these are examples of treatment which is NOT commonly covered by OHIP.

To get these forms of treatment which are not covered, accident victims have a few options to access treatment.

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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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Some of the most devastating and gruesome injuries which our personal injury lawyers see occur as a result of fire. Fires in homes. Fires in apartments. Fires in condominiums. Fires in commercial units. Fires cause devastation to person and property. They also kill.

Often in fire injury and fire loss claims, damages are almost secondary for the lawyers. All of the lawyers for both Plaintiff and Defence recognize the loss suffered by the burn victim. The lawyers may argue about the extent of the damages and the impact and duration of those damages. But reasonable lawyers will recognize that serious burns cause serious injuries which have life long physical and psychological consequences.

Where things can tricky is when it comes to who will pay for those damages.

All lawyers are taught that it’s very important to sue a party with deep pockets; meaning that you have to make sure that you can sue a party who can pay a judgment or payout on a settlement.

If you sue a party with no assets, you have nothing to collect upon. The judgment which a Plaintiff is awarded is without any material value because you cannot collect from an impecunious party. Think of it like you can’t get blood from a stone.

The same adage applies to fire loss claims. Generally in personal injury cases, lawyers see insurance companies defend their insureds, and payout damages on a judment or settlement.

The same cannot be said in burn cases and fire loss cases.

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If you have been denied long term disability benefits, you are likely wondering what your next steps are. The purpose of this week’s installment of the Toronto Injury Lawyer Blog is to give you some tips on what those next steps are towards getting the long term disability benefits which you deserve.

Long Term Disability Benefits are very topical for this week’s blog post given that yesterday was Bell Let’s Talk Day to raise awareness for mental health. The thing about mental health is that it’s invisible. When you break a leg, you’re put in to a cast and the whole world can see that you’re injured and not able to walk properly.

In contrast, mental health is invisible to the naked eye. Everyday people walk around with mental health issues which the outside world isn’t aware of, or doesn’t understand.

This dovetails nicely with long term disability claims not only because mental health can have long term consequences on one’s ability to work; but also because the vast majority of our long term disability clients suffer from mental health issues. It’s because mental health issues are invisible, and can be subjective in nature; which gives long term disability insurers an easy out to write them off as “made up“, “exaggerated“, or which won’t impact your ability to work. Mental health issues won’t show up on an x-ray, CT Scan or MRI. That gives a long term disability insurer a reason to say that the mental health issues which you are struggling with are simply a fabrication of your mind or that mental health isn’t a big deal and that you should be able to work.

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We must admit, long term disability cases can be very strange. Liability and calculating damages is not straight forward like in a dog bite or car accident case. The reason for that is long term disability cases are contractual in nature. That means that they are based upon, and defined by your long term disability contract.

This long term disability contract can be under a group benefits plan, or an individual policy of insurance.

Either way, chances are you haven’t taken the time to read the entirely of your long term disability contract because the majority of people (who aren’t lawyers or insurance professionals) simply don’t. Why curl up with a good book when you can read over your long term disability contract right?

Determining liability in a dog bite case is easy. Bad dog bites innocent passerby and causes damages. Liability has been established and now we can move along to damages.

Calculating damages in a dog bite case is easy as well. What are the injuries; look up similar fact case law and damage awards and then process those figures. Factor in the person’s age, education, employment, and how the injuries impact their daily lives along with any past/future care needs.

It’s not so easy when it comes to long term disability claims. Every contract is different, every disability is different as well. There are lots of terms and conditions contained in the long term disability policies our lawyers have seen which are real head scratchers for our clients.

Here are a few of those clauses which tend to confuse long term disability claimants.

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A lot of the clients at Goldfinger Injury Lawyers suffer from Chronic Pain, Fibromyalgia and Depression. It’s not easy because nobody seems to understand these conditions. More on that later.

We have expertise in handling chronic pain, fibromyalgia and depression cases which present in a variety of forms such as car accident cases, accident benefit claims, short term disability cases, long term disability cases, Canada Pension Plan Disability Appeals, dog bite cases, slip and fall cases, assault cases and bike accident cases just to name a few.

There are a few things which chronic pain, fibromyalgia and depression have in common.

For starters, they are are invisible to the naked eye. Your chronic pain, fibromyalgia or depression does not show up on any x-ray, CT Scan or MRI. There are no objective diagnostic tests which show that you have chronic pain, fibromyalgia or depression.

Normally, your family doctor or treating specialist (like a rheumatologist, psychiatrist, physiatrist or psychologist) will make a diagnosis of chronic pain, fibromyalgia and depression (depending on their specialty).

But for every specialist who will attest that you cannot function or cannot work on account of your chronic pain, fibromyalgia and depression; there will be another specialist who will say the opposite. Usually that specialist is retained by, or contracted by the insurance company in the context of an accident benefit, long term disability benefit or tort claim. Because they have been retained by the insurance company; and the insurance company is paying the cost of the assessment; you must take their findings with a grain of salt.

But despite this, too many negative reports against the Plaintiff/Claimant will create a compelling chain of denials making it harder and harder for a Plaintiff/Claimant to get the results/benefits which s/he deserves.

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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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It’s that time of year. Slip and Fall season is upon us in Ontario.

Before we get in too deep on this edition of the Toronto Injury Lawyer Blog, all of us here at Goldfinger Injury Lawyers would like to thank our readership for their support over this past year. We appreciate your positive and constructive feedback. In 2020, we hope to bring you more interesting to read legal content so that you can better understand the world of personal injury and disability law in Ontario. If there are any topics which you would like covered that we have yet to touch upon, send us an email to info@goldfingerlaw.com with subject title “Blog” and we will do our best to accommodate your request. You can always dig in to our archives on the Toronto Injury Lawyer Blog page.

This week’s topic will cover slip and trip and falls. We always notice a spike in these sort of calls around this time of year. This year is no exception with the steady freeze, thaw, freeze, thaw weather we’ve had across the province, it’s kept everyone on their toes so to speak.

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Personal Injury Lawyers across Ontario are all talking about the dramatic changes to the Rules of Civil Procedure which take place on January 1, 2020.

The most notable change is that being made to Simplified Procedure.

The amount you can claim for Simplified Procedure claims will double from $100,000 to $200,000, exclusive of interest.

This is significant for personal injury lawyers because damages for pain and suffering claims across Canada are capped at around $388,604 depending on who you ask. We found our best reference guide here with an actuarial/accounting company who focuses their time on personal injury claims. This cap on general damages goes up (or down) each month with the cost of inflation.

The cap on general damages is also significant when taking in to consideration the deductible for car accident cases in Ontario. As of the time of preparing this edition of the Toronto Injury Lawyer Blog, the deductible for general damages in motor vehicle accident claims sits at $38,818.97 and is set to increase on January 1, 2020.

When you take in to consideration the cap on general damages in Canada, along with the deductible for pain and suffering in car accident cases in Ontario, many personal injury lawyer across Ontario will look to take advantage of bringing claims under the New Simplified Procedure Rules.

The New Simplified Procedure puts a cap on cost recovery at $50,000; along with a cap on disbursement recovery at $25,000.

What’s important to note here is that the recoveries are limited at these amounts. But there is nothing preventing another party from spending well over these amounts. That means that a deep pocketed insurer can spend $500,000 on a case limited to just $200,000 under the Simplified Rules, and only recover $50,000 in costs and $25,000 in disbursements. It wouldn’t surprise any of the personal injury lawyers at our office if any insurer spend 10x of the value of the case in order to prove a point. There is NOTHING preventing a party from over spending on a case. What doesn’t make good business sense has never stopped an insurer from attempting to prove a point. How this plays out we have yet to see.

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