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Our law firm gets a variety of calls from people who have had their Long Term Disability claims denied.

These people have A LOT of questions about how to best proceed with their Long Term Disability Claim after their claim has been denied. Some of the questions our lawyers hear are:

What do I do now that I’ve been denied?

How can I fight the insurance company? Can I do so on my own?

Do I need a lawyer?

How much will it cost to get lawyer?

How long will it take to get my LTD benefits re-instated or have my case settle?

Why is the insurance company being so hard on me?

Are they like this to everyone?

All of these questions are certainly valid; understandably so. This is probably your first time applying for LTD Benefits. And it’s also probably your first time getting denied as well.

Our lawyers would be pleased to answer all of these questions, if not more, via free phone consultation toll free at 1-877-730-1777 or via email at info@goldfingerlaw.com.

The topic we wish to address in today’s installment of the Toronto Injury Lawyer Blog is the questions whether or not to appeal your Long Term Disability Claim. Whether to appeal, or not to appeal is a tactical move that shouldn’t be taken lightly.

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Long Term Disability Plans are what they call in the insurance industry “living policies” or “living benefits“. You need to be alive in order to recover on going LTD Benefits.

In their most basic form, these LTD policies are there to protect an insured person in the event of serious disability which prevents that person from working at their own occupation, or at any gainful occupation.

If an insured person meets the test for disability, and they have filed all of the proper paper work, then in a perfect world; that person will receive long term disability benefits for the period for which they are disabled.

The amount of the monthly LTD benefit depends on your policy along with your pre-disability income. Some polices have a set monthly benefit amount like $1,000/month; regardless of income. Other policies base the monthly benefit amount on a percentage of your monthly pre-disability gross or net income, depending on the wording of your policy (ie 66.67% of your gross income averaged in the year before your disability).

All of these calculations sound simple enough. But have you ever read the fine print of these policies? Have you ever paid attention to how long some LTD policies can be?

The devil’s in the details, and the wording of these LTD policies can rise up and have a negative impact on your long term disability case.

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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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Many of our clients suffer from fibromyalgia, depression and chronic pain. These injuries arise and present themselves in a wide variety of ways. Each case is fact specific. We never know how these injuries will present themselves or manifest.

Our lawyers see fibromyaligia, depression and chronic pain in the context of car accidents, long term disability (LTD) claims, motorcycle accidents, slip and fall cases and assault claims.

Even though the starting of these points of these claims may be different, the end result is similar. An inability to work, function, or engage in your normal routine of daily living.

The struggle of having to explain to family, friends and loved ones the nature of your injury and how it impacts you life, when the injury is invisible is taxing. It would almost be easier if you had a broken leg. That way, everyone would see what’s wrong with you. Having to describe the pain and depression is difficult and hard for others to understand or sympathize with.

Insurers know this. That’s why in chronic pain, depression and fibromyalgia cases we see lawyers for insurance companies file Jury Notices right away. They know that they can play upon the subjective nature of chronic pain, fibromyalgia and depression in order to defeat your claim. Their goal is to have the jury disbelieve your version of the events along with your pain, such that your case will get dismissed.

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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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It’s not very often that judgments from the criminal court system impact personal injury and car accident cases.

It’s particularly rare when a criminal case which was decided in British Columbia, has such a far reaching effect that it impacts the way and timing in which personal injury cases are heard in Ontario.

But the case we are about to review is no ordinary case…..

Today’s installment of the Toronto Injury Blog will focus on a unique decision from the Supreme Court of Canada in R. v. Jordan [2016] SCJ No 27 (QL).

This was an appeal which went all the way up to the Supreme Court of Canada, from the BC Court of Appeal, and the BC Supreme Court.

The accused, Mr. Jordan, was charged with various charges in a dial a dope operation. He was charged in December 2008. His trial ended in February 2013. What’s a dial a dope operation? It doesn’t really matter for the context of this analysis.

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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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I would like to begin this Toronto Injury Lawyer Blog Post by discussing our law firm’s experience reporting a case of auto fraud to the Financial Services Commission of Ontario (FSCO). I will get in to what exactly the auto fraud was in a later post, as I simply don’t have the space this week to get in to the story.

FSCO is the government body which takes care of car accident and accident benefit fraud in Ontario. This was our first time reporting an incident.

When you wish to report a fraud, there is a Fraud Hotline, 1-855-5TIP-NOW or 1-855-584-7669. There is also an online form you can complete on the FSCO website. Accident Benefit and Car Accident Fraud has been made to be a big deal with all of the huffing and puffing which insurers do about this “epidemic“. You would think that reporting a fraud would be simple, and that the fraud team at FSCO would know what they’re dealing with, and get right on it seeing as it’s such a big deal.

I was passed on to four separate people at the FSCO Fraud Hotline (plus a hang up altogether)  before they even took down any of the fraud victim’s information to investigate the matter. It seemed like nobody knew what to do, nobody knew what to look for, and nobody wanted to deal with our report. I was being passed, from person to person without getting any answers. I had to advance a theory of the fraud which made them say “AH-HA! That’s it!” before they even understood the cause/root of the alleged fraud. It was like they hadn’t even dealt with car accidents or accident benefit cases before.

After much pressing and energy, the fraud has now been reported. What happens now is beyond our law firm’s control. Whether or not we get a progress report from FSCO regarding their investigation is uncertain. I’m doubtful they’ll get back to our office or to the fraud victims. Reporting car accident and accident benefit fraud should NOT be an exercise of jumping through hoops. It should be a clear and easy process with responsive, knowledgeable and accountable staff who get results. Results matter and I got the feeling in dealing with the FSCO fraud team that didn’t know what they were doing. Just our opinion based on our experience.

Now, on to the remainder of the Toronto Injury Lawyer Blog which focuses on Long Term Disability Claims and their tricky limitation periods…..

If there’s one thing which causes Plaintiff side injury lawyers to panic or lose sleep, it’s the fear of missing a limitation period. Conversely for defence counsel and their insurer clients, the prospect of getting a clear cut win on summary judgment motion because a Plaintiff missed their limitation period is exciting; along with a fast and cost effective way to close a file.

Determining when a limitation period begins to run has always been a challenge in certain types of cases. For motor vehicle accident claims, establishing the date of loss is rather simple. Most of the time, with certain exceptions, all the Court needs to do is look at the date of loss. But the same approach does not apply in the context of long term disability claims where there can be multiple denials, multiple levels of appeal, or the denial is not clear and unequivocal. There can be heated debate between Plaintiff and Defence Counsel as to when a limitation period should begin to run. Continue reading →

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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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Throughout the course of the year, the Toronto Personal Injury Lawyer Blog gets tonnes a questions from our loyal readership. We do our best to answer every question we can. Here are some of the best, and most commonly asked questions we have received. All of these questions have been answered by personal injury lawyer, Brian Goldfinger, directing lawyer of Goldfinger Injury Lawyers. We trust that this rapid fire Q&A session will answer some of your pressing questions when it comes to car accident, slip and fall, dog bite, motorcycle and long term disability claims/law.

Q: HOW MUCH DOES YOUR LAW FIRM CHARGE?

A: We don’t charge an upfront hourly rate. We take your case on a contingency fee basis. If our firm doesn’t recover any money for you in your case, that means that you don’t have to pay any legal fees.

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