What is the procedure of an accident benefit lawsuit?

Acquire knowledge of the six main stages of an accident benefit claim In 2016, the procedure in AB lawsuits fundamentally changed when the Licensing and Appeal Tribunal (“LAT”) took over jurisdiction over ABs from the Financial Services Commission of Ontario (“FSCO”). Below is our summary of an informative continuing legal education paper entitled “Latest Word on Procedure, Process and Best Practices in Accident Benefit Litigation” (2019) by lawyers Sven Mascarenhas and Catherine Wilde from the 2nd Motor Vehicle Litigation Summit. Claims Stage Initially, the insured applies to the insurer for one or more benefits, the insured and insurer exchange information,…

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What are Long-Term Disability Benefits?

Most common questions and their answers What are long-term disability benefits? Long-term disability benefits provide financial assistance to covered employees or self-employed individuals whose disability prevents them from working. Although there are some general aspects of these benefits, outlined below, the details are always set out in the employee’s insurance policy. Who is eligible for long-term disability benefits? A person is eligible to receive long-term disability benefits if they: are covered under a disability insurance policy; were actively employed when they became unable to work due to disability; have a medical condition that makes them unable to perform the regular…

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The Income Replacement Benefit

Most common questions and their answers Video Description: If you were injured in a motor vehicle accident and were employed or self-employed at the time, you may be entitled to the income replacement benefit. This is an accident benefit that is available to you if your injury from the accident prevents you from being able to work or work to the same extent. To make a claim for the income replacement benefit, the first step is to notify your insurance company within seven days of the accident or as soon as practicable afterwards. The insurance company will send you the…

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What is Occupier’s Liability?

Find out about the action in negligence against owners and occupiers of real property by persons and some recent examples (in grey) 1- General background Occupiers’ liability is the area of law about the duty of care owed by the owners and occupiers of real property (i.e. land) to those who enter their property. This area of law is set out in the Occupier’s Liability Act (“OLA”), R.S.O. 1990, c. O.2, as well as the common law (i.e. case law). An “occupier” of real property is either a) someone who is in physical possession of the premises or b) someone…

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I am a Motor Vehicle Accident tort claimant. How can I meet the statutory threshold?

Why it is important for claimants to be accurate in communicating about their injuries The owner or any occupant of a motor vehicle, or anyone present at a MVA, is not liable in an action in Ontario for damages for income loss, nonpecuniary loss and health care expenses unless, as a result of the use or operation of the automobile, the victim died or sustained a permanent serious disfigurement or a permanent serious impairment of an important physical, mental or psychological function.[1] The threshold issue is whether the plaintiff meets one of these exceptions. Analysis of whether an injury is…

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What are Short-Term Disability Insurance Benefits?

Most common questions and their answers 1- What are short term disability insurance benefits? Short-term disability insurance benefits are an income replacement for employees while away from work for a brief period and unable to perform their employment duties due to a disability or illness. A “disability” is a physical or mental condition that prevents the employee from working. 2- Who qualifies for short-term disability benefits? If a person is employed and they have short-term disability benefits coverage at the time they become disabled, then they qualify to receive short-term disability benefits. 3- How can I find out if I…

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Accident benefits for the catastrophically impaired

Acquire knowledge of the highest category of accident benefits Often, in auto insurance cases, either the insured/injured person, their lawyer, a doctor or the insurer raises the issue of whether the injury is catastrophic. In Ontario, the maximum amount of accident benefits is provided for persons who are designated as having a catastrophic impairment. Types of impairments that qualify as catastrophic (or “CAT”) are specified in s. 3(1) of the SABS – subject to the qualifications, as applicable, in subsections (2) to (5) – and include impairments sustained as a result of an accident that occurred on or after June…

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I am a family member of a tort victim or plaintiff. What are my options?

Learn about FLA claims When a person sustains a tort (e.g. negligence, a MVA, a slip and fall), the consequences of the injury can extend to their family members. Ontario law provides a remedy for when this occurs. The source for this claim is the Family Law Act, R.S.O. 1990, c. F.3 (hereafter “FLA”), most of which is concerned with family law issues such as support and equalization of net family properties, but that, in Part V, provides for a claim for damages to dependents of injured persons. According to s. 61(1) of the FLA, a family member of a…

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Can someone be civilly liable for intentional misconduct?

Find out about some of the “intentional” torts In a previous post, we explored the concept of negligence – civil wrongdoing, for which there is not necessarily an intention to do wrong on the part of the defendant, that causes damage. But tort law, the area of law about compensation for civil wrongdoing, also contains another major category of individually named or nominate torts (aka intentional torts) which do provide compensation based on proof of civil wrongdoing intended by the defendant. Many of the activities that are addressed by the intentional torts are also criminalized. For example, there is a…

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Attendant Care Benefits

Most common questions and their answers What are attendant care (“AC”) benefits? Attendant care benefits cover the expenses of hiring an aide or attendant to help an insured person with their day-to-day functions after they have been injured in a MVA An attendant care expense must be “reasonable” and “necessary” in order to be able to successfully claim a benefit for it (Statutory Accident Benefit Schedule or (SABS), s. 19(1)) Who pays for attendant care benefits? Your insurance company What are the types of injuries to which attendant care benefits pertain? An injury must meet two requirements to qualify for…

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