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Buying insurance is more complicated than buying a loaf of bread or a new pair of shoes. For starters, neither bread nor shoes are meant to last a lifetime, nor do they come with a fine print policy or instruction manual explaining what they’re all about. There’s no fine print when it comes to bread or shoes (other than perhaps the list of ingredients contained in the bread).

What you see with bread or shoes, is what you get.

The same can’t be said for purchasing insurance. There are thousands of twists, turns, bobs and weaves contained in each different policy of insurance; regardless of what the insurance is being purchased for. Often what you think you’re purchasing isn’t exactly so; or the insurance product doesn’t work the way you expect it to to work.

Case in point, let’s take the example of long term disability insurance. Here are some common misconceptions:

  1. My long term disability benefits will cover 100% of my income: WRONG! Most policies only cover around 60-80%. Some lesser policies only cover 50% of your pre-disability income.
  2. My long term disability benefits will last for the rest of my life: WRONG! Most policies terminate benefits at the age of 65, despite the fact you may have intended to work until the age of 70. Other less policies only cover benefits for a maximum duration of 5 years, or up to the age of 65; whichever period comes first.
  3. I don’t have to pay any tax on my long term disability benefits. WRONG! Whether or not you pay income tax on your long term disability benefits depends on the wording contained in your policy. Rule of thumb: If your employer pays your premiums, then your long term disability benefits are taxable. Rule of thumb #2: If you lump out your long term disability claim with your insurer; only past benefits are taxable. Future benefits are not.
  4. My long term disability benefits are paid in addition to my CPP Disability benefits and other collateral disability benefits so that I can double dip and make just as much money disabled (or more) than I made while I worked. WRONG! Nearly every Long Term Disability policy our lawyer have seen contains a set of provision whereby to long term disability insurer is entitled to a dollar for dollar set off for any disability income you are receiving; thereby reducing the amount of long term disability benefits owing to you.

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Mediation is mandatory in any civil case commenced in Toronto, Ottawa or Windsor. There are mandatory mediation requirements under the Rules of Civil Procedure.

Mediation is also mandatory in car accident cases, but not many save for lawyers and insurance adjusters know that it is.

Buried deep inside the Insurance Act is a provision dealing specifically with mediation for car accident cases:

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Life isn’t fair. Here’s a example of why life isn’t fair.

You are in the wrong place at the wrong time, and you get stabbed, shot, punched, assaulted etc. by a stranger or acquaintance.

You are the victim of a violent crime. A crime which you did not initiate or provoke. You were simply in the wrong place at the wrong time.

As a result of the violent crime, you sustain life long physical and emotional injuries which will have significant consequences over many aspects of your life: ability to earn an income; housekeeping, handy person; participation in recreational activities; on going treatment requirements; nightmares; inability to trust people; anxiety; depression; rage; PTSD etc.

It’s only fair that you seek compensation for your injuries. That’s what the law is there for. To make you (or to attempt to make you whole) for the injuries you have sustained.

Here is the problem at law. There is no insurance for a criminal action. So if a stranger on the street assaults you, there is no insurance to protect against getting assaulted in a violent crime. You can purchase other insurance (like disability insurance), in the event you become disabled as a result of an assault or another traumatic event. But, there is no insurance in place to recover damages directly from the bad guy tort feasor.

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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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People want to know:

“Should I talk with my insurance company about my personal injury or long term disability case“.

The answer to this question may surprise you.

You may hear some personal injury lawyers tell you that under NO CIRCUMSTANCES should an injured accident victim or disability claimant ever speak with an insurance adjuster about their case.

There is nothing wrong with this school of thought. What you don’t say, cannot hurt you. What you don’t say also can’t be recorded and used against you down the road to defeat your claim and credibility. Silence is golden.

But what happens in the situation where you can’t lawyer up in a timely manner? What happens if the insurance company calls you and has a few very simple and basic questions to ask of you which you can certainly answer (address, location of accident, date of birth, what hospital you are currently staying at, whether or not you’re employed or retired). Keep it very simple and basic. You should not share any further details with the insurer without a lawyer, as you will read below.

Your claim, personal injury or long term disability has to get opened so that the benefits can begin to flow. The longer you wait, the longer it will take for the insurer to open their file, assign an adjuster, and hopefully pay for the attendant care, med/rehab and income replacement benefits you need. If you wait to retain a lawyer, this may delay you getting the benefits you need. There is nothing wrong with you calling the insurance company to simply open up a claim and get things started. But when doing so, be cautious of the amount of information which you disclose. Keep things simple and short.

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Winter is coming.

The North winds are blowing.

We the North.

Snow. Sleet. Ice and everything in between.

Some smile at the prospect of negative temperatures. They love the winter!

Others cringe. Count me in on team cringe. I would much rather have nice and pleasant warm weather any day over the ice, cold and darkness that winter brings. I think it’s the darkness and cold that gets me down the most.

Some people have a hard time transitioning from warm weather where one can get away wearing flip flops everyday, to cold weather where winter boots and indoor shoes are more appropriate. Flip flops certainly require less effort to take on and off, and you can wear them inside; so I kind of get it. But, when one makes the conscious decision to ignore the elements; one must live with the consequences….

You would have no idea the number of winter slip and fall cases our personal injury lawyers have seen on account of people who wear flip flops, Crocs, or other non winter footwear outside on icy or snowy surfaces. It’s mind blowing!

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Fibromyalgia is a serious disorder characterized by widespread pain, fatigue, depression, memory loss and other symptoms which vary from person to person.

Some doctors believe in fibromyalgia.

Some doctors don’t.

The same way that some doctors believe that fibromyalgia exists and is a very real and debilitating condition; and other doctors don’t; some insurance companies accept that fibromyalgia is very real and can have a significant impact on a person’s livelihood and ability to engage in day to day activities.

Some insurance companies don’t accept that fibromyalgia is real. They will want to create a narrative that fibromyalgia is a figment of your imagination. They will hope to establish that because you cannot see fibromyalgia on any sort of objective test like an x-ray, CT Scan or MRI Report that it’s simply not there. They will also try to create the narrative that you can fight through or work through whatever pain or ailment it is that you’re experiencing.

This is a false narrative. There are hundreds of thousands of people across Canada who suffer from fibromylagia, and there are countless doctors across the country who treat people for fibromyalgia. Don’t let your insurance company beat you down and crush your hope; because this is exactly what they’re trying to accomplish.

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If you are reading this entry in the Toronto Injury Lawyer Blog, then likely a loved one, family member, dear friend or acquaintance has passed away as a result of the negligence of another party.

We are sorry for your loss.

Thoughts, prayers and well wishes from others are great, but sometimes they aren’t enough. You need action. And that’s where my law firm comes in.

Goldfinger Injury Lawyers has a proven track record of results in getting families the compensation they deserve following the untimely death of a family member as a result of the negligence of another party. Full disclaimer here: past results are not indicative of future awards. We have to include that disclaimer because we’re lawyers.

Many of the fatality claims that we see come as a result of a motor vehicle accident (car vs. car, car vs. truck, bike vs. car; pedestrian vs. car; motorcycle, etc.). Thousands of pounds of steel, metal, aluminium in the form of a motor vehicle travelling carelessly at high speeds will cause devastating and fatal injury.

Here is where things can get confusing for the general public.

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Sand castles are built of sand.

Log cabins are build of wood.

Large office towers and built of concrete, steel and glass.

And personal injury and long term disability cases are built of medical records!

The evidence of any personal injury case establishes the foundation upon which cases are built. The stronger the evidentiary foundation, the stronger the case. And the opposite is of course true.  No evidence, or a lack of evidence will translate in to a weaker case.

The basic evidentiary building block in a personal injury or long term disability case are medical records. These records can be from a hospital, rehab facility, doctors office, specialists’ office, nurse practitioner, rehab clinic, or an OHIP Summary.

Without compelling medical evidence to support the injury or disability, establishing damages (the injury) will be difficult for the Plaintiff and his/her personal injury lawyer to do.

It’s simply not enough for an injured or disabled Plaintiff to get up on the stand and state that they were and remain injured due to the negligence of the Defendant.

Of course a Plaintiff is going to say such a thing. They have everything to gain because they are the lead party in the action. The Plaintiff has a lot of skin in the game.

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Long Term Disability insurance is based on the basic premise that you are too disabled to work, and that you are insured for a percentage of your pre-disability income. This percentage can vary anywhere from as low as 50% to as high as 80%, depending on the wording of the policy along with the riders contained in the policy.

You know what your pre-disability income was. But your long term disability insurer does not.

Chances are, your long term disability insurer has never heard of you, met you, or hasn’t the faintest idea what you do for a living until you’ve applied for long term disability insurance.

Once you’ve applied, the only way the insurance company has a chance to get to know you is on paper; based on the forms you’ve submitted to them in support of your application for long term disability insurance.

A very important form is the Employer’s Statement, or Employer’s Declaration.

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