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Litigating Long Term Disability Claims (LTD Claims) can be tricky, especially when the injury is an invisible one; such as chronic pain or a psychological injury.

Firstly, it’s important to note that Long Term Disability Claims aren’t your typical tort or pain and suffering claims. These are special sort of cases.

What this personal injury lawyer means by that; is that the insurance company didn’t intentionally hire a hit man to whack you over the head with a sledge hammer to cause your pain and suffering. While it may feel like the insurer is intentionally causing you harm, the reality is, that in a vast majority of cases; they didn’t do anything intentional to cause your disability. We acknowledge that there are small exceptions where the behaviour of insurers is so outrageous and so disrespectful that it adds to the harm ; or causes harm. BUT, the reality is, that in most cases, while the insurer may have contributed to your harm by their denial of your claim, in the vast majority of cases; they likely didn’t cause you to be disabled in the first instance. The classic example of this was as stated: they didn’t hire somebody to hit you with a baseball bat to cause you to go on disability. Your health can deteriorate over time for a wide variety of reasons. Stress and anxiety from a denied LTD claim? Sure. But there are likely a wide variety of factors which have led to you being disabled from working.

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Goldfinger Injury Lawyers has four offices. Our first office opened in Toronto. This was followed by our second office in Peterborough. Our lawyers have long driven up and down a beautiful stretch of highway known has Highway #115. This is an Ontario Provincial Highway that connects Peterborough to Toronto by Highway 401. Highway 115 begins near Newcastle, and then proceeds north and ends at Highway 7 in Peterborough.

In the summer months, many cottage goers in the Kawarthas zoom along picturesque Highway 115 driving by quaint farmer’s markets, ice cream stands, kitschy motels, burger stands; sprinkled in with a few Tim Horton’s type of restaurants. It’s a beautiful drive in the summer.

It’s also a glorious drive in the fall with the changing of the autumn leaves.

The winter is when this drive can get dangerous. Not unlike many smaller highways in Ontario, Highway 115 isn’t particularly wide. It has two lanes for northbound traffic, and two lanes for southbound traffic.  The highway isn’t particularly well lit. There are no lights in most sections of the highway which can create visibility problems. Highway 115 is straight for the most part, so drivers may have a tendency to be aggressive on the gas. Or, they may not even realize how fast they are travelling.

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As the title of this edition of the Toronto Injury Lawyer Blog suggests, Winter Time is Slip and Fall time. When the weather starts to get cold, damp, slippery and icy, our law firm sees a spike in slip and fall related calls (sweet rhyme!). Some of these slip and falls result in some very serious injury. Being hospitalized and breaking bones as a result of a slip and fall is not only painful and debilitating; but it can also be very depressing, humiliating and embarrassing.

The reality is that in Ontario, these serious slip and fall claims happen, and we need to best understand how to deal with them so that you get the compensation you deserve.

So, without further a due, below is a quick sampler of the Goldfinger Guide to Better Understanding Slip and Fall Cases in Ontario. We have prepared the Goldfinger Guide in such a way that it’s easy to read, easy to understand, and hopefully; enjoyable as well (as enjoyable as you can get when it comes to reading about slip and falls).

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After a serious car or motorcycle accident, chances are you will need a wide variety of treatment. Some of that treatment will be covered by Ontario’s OHIP Healtcare System. That means if you have a valid Ontario Health Card, it will be FREE.  Seeing a medical doctor (not a chiropractor or a psychologist), a hospital visit, and even treatment through the Community Care Access System (CCAC) is all covered. This is fantastic news for accident victims, especially when you compare healthcare in Canada vs. health care costs for our neighbours south of the border.

Some treatment isn’t covered by OHIP. Things like physiotherapy, massage, chiropractic care, occupational therapy, speech language pathology outside of the hospital, psychology treatment, social work, rehab coach etc. All of these things are NOT covered by OHIP (with some exceptions). If you’ve been involved in a serious motor vehicle accident, chances are you will need at least one, if not a few of the aforementioned treatments. Without OHIP or collateral benefits, you will have to pay for these treatments out of your own pocket. If you aren’t working following a serious car accident, you likely won’t have the money to spend out of pocket on these treatments unless you’re incredible well off.

Here is the “good news”. When I put “good news” in quotes, it’s because I’m explaining a text book; best case scenario…And we all know at law; these text book best case scenarios rarely happen. That’s why there are so many personal injury lawyers around.

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This Holiday break, my family didn’t go away on a nice vacation. We stayed in town. Our offices were open, and I worked. The cities I visited (Windsor, London, Leamington, Toronto, Peterborough) were all very quiet.  It seemed like everyone was away somewhere else. The busiest place I saw was Masonville Mall and the Cineplex at Masonville in London, ON. Both were jam packed at really odd hours which I found rather strange; but that’s a topic for a different day.

A few hot shot Bay Street type lawyers I know recommended that I listen to the Pod Cast “Serial“. They knew I did considerable driving to meet with clients and listening to the Serial Podcast would be a great way to make the time pass. I downloaded Season #1 of Serial and binge listened. What a fascinating (but troubling) series of events. If you haven’t yet listened to it, I highly recommend you get in to it. The production quality and research that went in to the Podcast is nothing short of exceptional. The producers are well deserving of all of the accolades they have received. They ought to start practicing law!

Having got hooked on Serial, I proceeded to get hooked on the recent documentary “Making a Murderer” on Netflix. The documentary, filmed over 10 years or so tells the story of Steven Avery and his nephew Bobby Dassey, who were accused and later convicted of murder along with other charges.

The documentary pokes large holes in the case of the prosecution and advances the theory that the police may have framed Mr. Avery and Mr. Dassey in order to secure the conviction.

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Happy New Year to all of the readers of the Toronto Injury Lawyer Blog! We hope that the upcoming new year brings you  health, happiness and prosperity. We also want to thank all of our readers for their excellent comments, likes and shares. 2015 was a banner year for Goldfinger Injury Lawyers and the Toronto Injury Lawyer Blog and we hope to build upon that success in 2016.

What’s new for 2016? Well, Ontario has a set of laws which have just kicked in pursuant to the aptly named “Making Ontario’s Roads Safer Act“. As an aside, Ontario along with other jurisdictions have a tendency of giving grandiose names to acts which make the public think that they are not only AMAZING, but also do what they say they do. The reality is that within these incredibly named acts, there are sometimes provisions which have little or nothing to do with the name of the Act as well. Sometimes, it’s a way for legislature to pass laws under the rug, without the public or media catching on. We often see this with car insurance and the Statutory Accident Benefits Schedule and the Insurance Act.

In any event, the Making Ontario’s Roads Safer Act is a fantastic name for a set of laws. Whether or not it will do what it purports to do is still up in the air.

Here’s what you need to know:

There are increased fines for violations at crosswalks, school crossings, and pedestrian crossings. Those fines are DOUBLED in Community Safety zones. Drivers will be fined $150-$500 along with 3 demerit points for such offences.

Staring January 1, 2016, drivers and CYCLISTS must STOP and yield the entire road to pedestrians at pedestrian crossovers, and at school crossings where  there is a crossing guard displaying a school crossing stop sign. These pedestrian crossovers are identified with specific signs, road markings and lights. The new rules do NOT apply to pedestrian crosswalks at intersections with stop signs or traffic signals, unless a school guard is present.

The Making Ontario’s Roads Safer Act also gives municipalities the power to install new types of pedestrian crossings on low speed, low volume roads in addition to existing crossovers (think more speed bump crossings in a sub-division).

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The Christmas lights have gone up. The festive parties are a plenty. The snow is….um…..non-existent with some of the highest temperatures Ontario has ever seen for December. In any event, it’s HOLIDAY time once again.

Around this time, and in to the New Year, our lawyers get some strange, and some not so strange calls. This means that there are some common injury patterns we see, and other patterns which aren’t so common. Without further a due, here are Goldfinger Injury Lawyers’s top tips on keeping things safe for the Holiday and New Year season.

DON’T DRINK AND DRIVE: Quite simply, alcohol and driving don’t mix. And that statement applies to any amount of alcohol consumed; even if it’s “just a couple of drinks” at a friend’s Holiday Gathering. We can tell you that R.I.D.E will be out in full force across Ontario; from London to Peterborough, to Toronto to Sudbury. Your local police force will be out there making sure people aren’t drinking and driving. If you play your cards right, you may even get a coupon from those friendly officers at R.I.D.E. I would also like to add that the term “driving” applies not only to cars, motorcycles or other vehicles. It also applies to bikes, E-Bikes, scooters. segways, etc. We get a lot of crazy calls of people riding anything with wheels (motorized or non-motorized) after having consumed a few too many drinks with catastrophic consequences. Drinking and driving is always a choice. Make the right one and arrive alive and in one piece. You’re not just putting your life at risk, but also the lives of other innocent people and their families at risk as well. No amount of money can ever properly compensate somebody for a loss of limb, a catastrophic brain injury, or the loss of a loved one. Continue reading →

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Not too long ago, the Toronto Injury Lawyer Blog focused on limitation periods in the context of Long Term Disability Claims, and how insurers will delay, delay, delay such that enough time has passed that they could ask the Court to dismiss your claim. Delay is the enemy of a Plaintiff and the friend of an insurer.

The longer a denied claim goes without litigation, the greater the chance that the delay argument will swing in the favour of the LTD insurer. It’s clear that time is NOT on the claimant’s side when it comes to filing an LTD claim, and then litigating it at Court.

One of the larger LTD Insurers, RBC Life Insurance Company recently brought their delay argument to the Ontario Court of Appeal in the hopes of having a claimant’s case dismissed completely.

The case is Dube v. RBC Life Insurance Company and the initial decision at the Superior Court level can be found in the above noted link.

In this case Mr. Dube was a full time employee of the Windsor Essex Housing Corporation. He began working there in around November 2008. He was entitled to benefits under a group disability policy with RBC. One of those benefits was Long Term Disability Benefits. These benefits were supposed to pay for a percentage of Mr. Dube’s salary, in the event of serious injury, illness and/or disability. Basically, if you’re too hurt to work, RBC will pay you a portion of your salary to help make ends meet. In theory, this sounds like a great thing. Almost too good to be true…

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It seems that every few months or so, the Toronto Injury Lawyer Blog is discussing the topics to changes in car insurance and accident benefit disputes in Ontario. Is it because we LOVE blogging about accident benefits? Not really. Accident benefits are quite frankly, an incredibly complicated and dense area of the law. The rules for accident benefits, in many respects, are made in favour of large insurance companies and designed to limit an injured claimant’s ability to recover an income. It’s not a committee of accident victims who sit around and make these laws, and tweek them ever so slightly. Rather, it’s deep pocketed insurers and so called “insurance experts” who do so at the behest of the large insurance lobby.

A few quick examples of some arbitrary decisions which accident benefit laws have imposed:

  • No monetary reimbursement for a trip to the doctor which is under 50km. Why 50km? Who picked the 50km distance? Your guess is as good as mine
  • A maximum recovery of just $3,500 for soft tissue injuries which are classified to fit under the Minor Injury Guideline. Why just $3,500? Because that’s what insurers and our government deems to be reasonable. Interesting enough, that $3,500 is less than you paying the full value of your car insurance premiums over a 3 year period in Toronto, London, Ottawa or another large city in Ontario.
  • A maximum recover of $50,000 for claims which aren’t catastrophic, but not Minor. Why a $50,000 limit? Beats me.
  • An income replacement benefit of a maximum of just $400/week under a standard Ontario Automobile Policy, which has NOT increased to reflect inflation over the past 15 years.
  • A deductible which will be increasing from $30,000 to $36,500 for pain and suffering claims. Why $36,500? Beats me.

As you can see, many of the monetary limits imposed in accident benefit law in Ontario are just numbers which seem to be picked out of a hat to favour insurers. Not once have I ever met an injured accident victim, or an ordinary person who believes that these limits are reasonable or helpful for claims.

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Our law firm handles a wide variety of Long Term Disability (LTD) Claims against pretty much every deep pocketed insurer you can think of: Manulife, SunLife, Great West Life, Desjardins, SSQ, RBC Insurance, Empire Life, Canada Life, Industrial Alliance, Equitable Life, Co-Operators, Standard Life (Now Manulife). If you can name them, we have probably sued them.

Although every LTD claim is different, and every insurer handles claims in their own way, our lawyers see many similarities for these denied claims. Because we have years of experience helping people get the benefits they deserve, we are able to share some of our wisdom with you, our readers of the Toronto Injury Lawyer Blog.

For today’s instalment, we would like you share with some of the top reasons why Long Term Disability Insurers deny claims.

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