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We receive many calls every week from people who have been denied their Long Term Disability Benefits, by private disability insurers such as Great West Life, SunLife, Manulife, Standard Life, Industrial Alliance, SSQ, Co-Operators, Empire Life, RBC Insurance and others.

People want to know what to do after they’ve been denied.

Denial, or termination letters are often lengthy detailed letters which include the provisions of your LTD policy, the definition of the term “disability” based on the policy, excepts from medical records or medical reports, along with the insurer’s reasoning to deny or terminate benefits.

After these long winded reasons are provided, the insurer will also then include ways that you can appeal their decision. Statements like you have 90 days from the date of this letter to appeal this decision through our Appeals/Investigation Committee are common. People call our law firm in an absolute PANIC stating that they’re under the gun and that their opportunity to appeal the claim is fast approaching.

What I tell these people is NOT TO WORRY, and NOT TO PANIC. These internal reviews or internal appeals are often a waste of time and energy. Here’s why Continue reading →

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This week I had the pleasure chatting with a kind Detective from the Toronto Police Service in the lobby of the Criminal Injuries Compensation Board. The CICB is where victims of crime can go to get compensation for their injuries resulting from a crime. So, if you’ve been shot or stabbed, you may claim compensation from the CICB. Our office can assist you with the hearing. Hearings take place in a majority of these case. That means you need to go to Court.

If you were to sue the wrong doer, chances are you wouldn’t be able to recover very much money because most wrong doers are judgment proof (unless the wrong doer is a known multimillionaire). That means that they have no quantifiable assets. A stack of money under a pillow doesn’t count. The CICB awards victims of crimes with real money for their injuries, making these cases worth pursuing from a financial perspective.

Back to the story of the Detective and I. Has a nice ring to it, don’t you think?

We were sharing war stories, chatting about the hit TV Show “The Wire“, along with some of the crazy situations we’ve both encountered.

It was an absolute pleasure hearing the perspective from a Detective. Did you know that it’s the police officers who prepare the warrants and all of the legal paperwork which is later relied on by the Crown to prosecute a case? Unlike in the United States where the Attorney General and their lawyers and law clerks prepare this sort of paper work; here it’s the officers themselves who do it.

These officers have no substantive legal training. They’re trained to be cops, not lawyers/paper pushers. Yet, their paper work is legal, and it’s scrutinized by Defence Lawyers and Judges alike. Their paperwork is so important to advancing the Crown’s position. Seems like an unfair fight having paper work prepared by a police officer torn to shreds by an experienced Defence Lawyer along with their legal team. But I’m no expert when it comes to criminal law. Personal Injury Law is what we do best.
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Pre-Trial is one of the last steps in a personal injury case before it actually goes to trial.

The Pre-Trial, aside from the actual trial itself, is the most important step of your case which requires judicial intervention. That means that the Court is actively involved in this part of your case, unlike other parts of your case.

An examination for discovery does NOT require Judge. A mediation does NOT require a Judge. An independent medical-legal examination does NOT require a Judge.

But a Pre-Trial requires a Judge. Without a Judge, a Pre-Trial can’t happen. (save in Toronto/Ottawa and Windsor where Masters can conduct Pre-Trials in Simplified Procedure cases).

So, you might be wondering. What exactly is a Pre-Trial?
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You know which stories made HUGE headlines in 2013 and which continue the trend in 2014?

Municipal Politics!

In Peterborough, Mayor Daryl Bennett was suspended from the Peterborough Lakefield Police Services Board for conduct unbecoming a Board Member. He was accused of all sorts of shenanigans involving hiring and the funding for the police. He was suspended even before he had a hearing, which I found rather odd.

In London, Mayor Joe Fontana was charged with FRAUD by the RCMP! This had to do with allegedly using City funds for his son’s wedding. Yikes! In addition, a number of municipal Councillors held an alleged covert backdoor meeting at a bar called Billy T’s which cost City of London tax payers around $100,000 in legal fees.

And who can forget Toronto Mayor Rob Ford who was all over the news with his crack scandal, Sandro Lissi trial, drug tape, and now the Steak Queen Patois drunken rant. Amazing stuff!

To say that it wasn’t a good year for local mayors is an under statement. Or, perhaps it was a great year for them?!?

When you think of a mayor, you want to think that person is honest, intelligent, hard working and credible. You want to think that they’re in municipal politics for all the right reasons: to help people and help the city/municipality with its daily affairs. Above all, you want that person to be trustworthy.
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In around August 2013, the personal injury bar, along with the sports world was shocked that the NFL and its former players had reached a $765 million dollar settlement in a concussions class action law suit brought against the league.

The former players argued that the NFL knew or ought to have known of the dangers of concussion and hid these dangers from their players; often not providing them proper treatment and expecting them to play through the brain injury. The dangerous playing conditions and expectations put on these players led to significant long term cognitive and psychological damages. Just do a Google search for Junior Seau or Jovan Belcher and you’ll see what I mean.

Seems like a very plausible argument on the part of the players. But, then again, I’m a plaintiff personal injury lawyer so I tend to side on the part of the little guy accident victim.
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We received quite the response from a recent Toronto Injury Lawyer Blog post dealing with trends in long term disability claims. The response was so overwhelming, we thought that we would futher explore those new trends in long term disability law and policies, along with other things which you ought to know when advancing your claim.

The first thing which you should know about making a long term disability claim is that with the exception of a bad faith claim, a claim for mental distress, along with a punitive/aggravated damages; these claims are essentially claims for your BENEFITS. The amount of what those benefits are is defined by your policy of insurance. This means that if your policy sets out that your monthly disability benefit amount of 66.67% of your pre-disability net income (which amounts to lets say $2,100/month), then your monthly disability benefit is $2,100/month.
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When we think of injury or disability, the first thing which comes to mind are objective injuries. These are the sort of injuries which are obvious to the naked eye.

Often, a picture of a person in a cast, a person in a wheelchair, or using a crutch comes to mind. We think of broken bones, lost limbs, blood and gore.

What we don’t think about are the injuries we cannot see.

We don’t think about depression, anxiety, chronic pain, loss of memory, fatigue or any of a number of other countless symptoms which are subjective.

The distinction between what is a subjective injury, and what’s an objective injury is crucial to understanding many long term disability claims. Why is this distinction important?
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The calls and queries continue to roll in following the ice storm. The anger and frustration around the GTA has been quite remarkable. People are upset for a variety of reasons: lack of power; lack of information; duplication of information; useless information; lack of timely repairs; a certain deputy mayor going to Florida and the list goes on.

A colleague of mine forwarded me his thoughts on the ice storm. His thoughts were spot on, and thought provoking. He’s allowed me to share these thoughts with you. I’m sure that you’ll find them interesting. Here you go:
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The first wave of calls have come in following Toronto’s Ice Storm of 2013. Lots of angry and frustrated people out there. But who can blame them?

The ice storm has been called the most devastating storm to hit the City of Toronto and the surronding area in decades. Some call it the worst storm EVER.

Our thoughts go out to the thousands of families who remain without heat or power around the GTA. Our Toronto Office at Yonge and Sheppard was without power for 3 days. Business came to a stand still. But having not power at our law firm pales in compairison to all those without heat or power in their homes for the holidays.

This is where COMMUNITY comes in to play. Be a good neighbour and check up on the elderly, disabled, or those who live alone. Don’t leave fires unattended. Don’t use a generator inside of your house. Make sure that the batteries in your carbon monoxide detector are working. 9V battery? put your tongue to it. If your tongue burns; then your battery is good. No burning? Then no power. That’s some caveman advice for you.

One of the biggest misconceptions during the storm were the reporting numbers of the amount of people left in the dark. The Hydro Authorities and Municipalities identified the number of “customers” without power. The term “customers” does NOT mean people. This means buildings, houses, businesses etc. Reporters in the media didn’t seem to understand that customers didn’t mean people. So, when they heard customers, they confused that number with people.

Toronto Hydro estimated that each customer represented around 2.5 people or so. Accordingly, 1 customer = 2.5 people according to their estimates. So, when Toronto Hydro indentified that approximately 315,000 “customers” were without power at one point in time; that meant that 787,500 people were without power (or MORE according to their estimates). This distinction between “customers” and people is SIGNIFICANT as the multiple increased by 2.5x.
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Without any consultation, communication, notice or debate, your very own Ontario Government has changed how the laws surrounding no fault accident benefits work yet again! No formal announcment was made. Simply a release of the legislation.

In a normal democracy, when laws or amendments to laws are passed, they are first debated, studied, and put to a panel of experts and to the public to get their feedback. The voting public is put on notice of the proposed law or changes and a debate/discussion ensues. It’s all nice and out in the open for people to debate and to better understand.

Things aren’t supposed to be slipped under the carpet without you knowing. Heck: even the Harper Conservatives abide by these simple principals. It’s just good public relations.

But NOT your Ontario Government. Particularly when it comes to car insurance. Ontario’s government (no matter who’s in power) always likes to sneak things in when we don’t expect it. No vote. No debate. No discussion. Just put it in there just like how it’s was done in Communist Russia, and in today’s China and North Korea.

Today, the Ontario Government RELEASED Ontario Regulation 347/13. It comes in to force on February 1, 2014 and will be printied in the January 2014 Ontario Gazette. That means that only personal injury lawyers and people in the insurance industry know about the changes right now. It will become more common knowledge come the new year after it’s published in the Ontario Gazette.

You’ve never head of the Ontario Gazette? Don’t worry about it. Neither had I until I went to law school. I suppose it’s an elitist publiciation which nobody except lawyers, law students and policiticans read. So, there’s a very good chance that if you don’t read this Toronto Injury Lawyer Blog Post, you won’t know or understand how car accident law has changed yet again.

Why should you care about O. Reg 347/13? Read on and find out!
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