Tag Archives: Claims Denial

Practical Strategies Webinar: Auto Insurance Law Impacting You and Your Clients

The Practical Strategies webinar aired on April 30, 2013.

This webinar will update you on how lawyers and health care providers are coping with the evolving challenges of working in the constantly changing auto insurance system. You will learn strategies that will benefit you and your clients, including:

  • Establishing “incurred expense” and “economic loss” in attendant care claims.
  • Recent developments in catastrophic impairment.
  • Common pitfalls in clinical note taking and report writing.
  • Preparing for giving evidence in the Courtroom.



Lawyers Take up Injured Veterans’ Fight for Benefits

From today’s Toronto Star:

Moved by the stories of Canada’s wounded soldiers who’ve come home only to be forced to fight the federal government for benefits, Ontario’s trial lawyers say they’ll represent injured veterans for free.

And in Ottawa, sources tell the Star that the Liberals will present legislation Tuesday that, if passed, would elevate the Office of the Veterans’ Ombudsman so that it reports to Parliament, and not the minister of national defence, as is currently the case.

A recent Star series entitled Our Wounded Warriors exposed the fight Canada’s 1,500 injured soldiers — many disabled and traumatized after serving in Afghanistan — face when they return home.

The 1,100-member Ontario Trial Lawyers Association told the Star it is astounded by the “hurdles, the runarounds and the hardships” Canada’s veterans face when they try to collect federal military service and disability benefits.

“These veterans fight for our country and they really should not have to fight for these benefits,” said lawyer Patrick Brown, chair of the new initiative called Trial Lawyers for Veterans.

“If we can help out, we will,” said Brown. “The commitment from our volunteers is to offer free services. It is all pro bono.”

After suffering devastating injuries from roadside or suicide bombers, missile attacks, vehicle rollovers or gunshot wounds, the veterans are often stunned when they find themselves battling Ottawa for money, for a job and for respect.

The Star series, plus a suggestion from lawyer and mediator Paul Torrie, prompted the executive of the association to ask its members if they would consider helping the injured soldiers. Trial lawyers specialize in disability claims, injuries and fatalities.

Association president Dale Orlando said the response from the province’s lawyers was “remarkable.”

“We had all read the stories in the Star, so we had a little bit of background, and we did a little bit of investigating and we did find that Canadian veterans — to whom we all owe a debt of gratitude — were having to navigate a maze of government red tape in order to receive compensation,” Orlando said.

“We heard some horror stories about the roadblocks they were facing.

“We thought, that is what we do in our day-to-day jobs — fight for victims so they do receive fair compensation. There was a natural fit for our organization.”

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Essential Tips for Consumers renewing their Car/Auto Insurance in Ontario.

After September 1, 2010, car insurance companies and brokers across Ontario will be presenting consumers with new choices for their auto insurance renewals.  A daunting process is ahead.  The insurance system in Ontario is one of the most complicated systems in North America.

Even though car insurance is a major budgetary item for many families, many consumers are unfamiliar with the coverage they actually have.  After September 1, consumers will be given a number of choices as to amount of benefits they wish to purchase. By giving such a choice, the intent was to give them a break on premiums being paid.

The new basic auto policy being sold contains far less benefits than what existed before September 1.  With benefits being drastically reduced, one would of course expect to see some significant reductions in how much one has to pay in premiums.

Therefore it is absolutely critical that each consumer ask their insurance company and brokers what are they buying and at what price.  Like shopping in a supermarket, each item ought to have a price tag. Continue reading

Insurers Must Advise Insured Persons of Rights When Refusing Benefits

When an insurance company denies accident benefits to an insured person, the insurer must advise the insured person of his or her right to dispute the denial and of the most important points in the process.    A recent court decision has confirmed that if an insurer falls short of this requirement, it will not be able to rely on the limitation period that begins with that denial.

In Yifru v. Certas Direct Insurance Company, Certas Insurance denied Ms. Yifru’s claim for non-earner benefits on June 23, 2003.   Certas advised Ms. Yifru that she could dispute the decision by applying for mediation within two years of the denial.  However, it did not advise her that she had any further options if she and Certas failed to settle her claim at mediation.

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Caring Family Members Will Feel the Sting of the New Law: Changes to Auto Insurance Effective September 1, 2010

[This is the fourth part of a series by Patrick Brown on upcoming changes to Ontario’s Auto Insurance Laws]

Starting September 1, 2010, many family members who provide basic care needs to their injured family members will be cut out from receiving any compensation for these essential services.  The new law eliminates any benefits going to a family member who help the disabled family member unless they show they suffered an “economic loss” because of it.

This will have a devastating impact on families who chose to have family members look after their severely injured loved ones.  The new law was passed at the request of the insurance industry.  It will force families to use outside agencies.  Right now for instances, if a family member is hit by a car and suffers serious injury to the extent they can no longer dress, bathe or feed themselves, a benefit is available up to either 3,000 or 6,000 per month so that other families members can help.  Under the new system, this funding will stop unless mom, dad or sibling can show they lost money somehow [i.e. they have to quit work or miss work without pay]. The only way to access the benefit is to have a third party care agency come in and provide the services. Continue reading

Is an Insurer’s Examiner an “Expert”?

“When is an expert not treated as an expert?”  That was the question Ontario Superior Court judge Thomas Lederer asked in the case of Babakar v. Brown .

The Babakars were involved in a motor vehicle collision and were insured by State Farm.  They applied to State Farm for accident benefits.  At some point, State Farm required the Babakars to attend insurer examinations under section 42 of the Statutory Accident Benefits Schedule with psychologist Dr. Hoath, orthopaedic surgeon Dr. Kadish, and physiotherapist Mr. Diaz.  Based on the reports of Dr. Hoath, Dr. Kadish and Mr. Diaz, State Farm terminated the Babakars’ accident benefits.

at the examination for discovery of State Farm’s representative, the Babakars’ lawyer askedState Farm to make the following inquiries of Dr. Hoath, Dr. Kadish, and Mr. Diaz:

1.                  To ask Dr. Hoath whether pre-accident or other historical records were needed and if he ever made a request to State Farm for the records.

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Insurance Company Terminates Benefits After Seeing Facebook Posts

Nathalie Blanchard was diagnosed with depression about a year and a half ago.  Since then Ms. Blanchard, 29, has been on leave from her job at IBM.

During that time Manulife, her insurance company, paid her monthly short-term disability benefits.

According to Ms. Blanchard, her doctor advised her to socialize, take vacations and have fun as a way of improving her condition. She did – and posted photos of herself at a party, a Chippendales show, and on a sun holiday.  Ms. Blanchard also says that she told Manulife that she was going to be taking the trip.

In what has become a widely-discussed case, Manulife terminated Ms. Blanchard’s benefits this fall.  When Ms. Blanchard called Manulife to find out why, she says she was told “I’m available to work, because of Facebook.”

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Insurer Slammed for Denying Benefits 21 Times in 3 years

The  Ontario Superior Court of Justice slammed Echelon General Insurance Company for unreasonably denying benefits to Janey McQueen, 21 times in a three-year period.  Judge Raymond Harris concluded that Echelon insurance denied Ms. McQueen funding for necessary treatment and ignored evidence that supported her claim for other benefits.

Unreasonable Denials of Benefits has Consequences for Echelon Insurance

Echelon Insurance’s unjustified denials of Janey McQueen’s claims had costly consequences

Judge Harris found that Echelon created an adversarial relationship that caused Ms. McQueen mental distress.  He ordered the insurance company to pay the benefits and to pay an additional $25,000 in damages to Ms. McQueen for her mental distress.