Posted by Rikin Morzaria on September 7, 2011 under Accident Benefits, Automobile Insurance, Case Law, Claims Denial, Insurance Companies
On February 26, 2000, Michael Downer pulled into a Scarborough gas station in his Jeep. He left the engine on the Jeep running while he sat in the driver’s seat and separated money from his wallet to pay for gas. When Mr. Downer looked up from his wallet, he saw 3 or four young men around his jeep. The men began hitting Mr. Downer while pulling him out of the vehicle. Mr. Downer put the Jeep into reverse to get away from the men. One of the men tried to force the gear into park while Mr. Downer reversed out of the gas station and then drove off. A short time later, he became aware that he had suffered injuries in the incident.
Mr. Downer’s insurance company brought a motion to dismiss Mr. Downer’s claim for benefits on the basis that he had not suffered his injuries in an accident.
Was the carjacking an accident?
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Posted by Patrick Brown on August 3, 2010 under Accident Benefits, Automobile Insurance, Claims Denial, Disability Benefits, Insurance Companies, News, Our Firm
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. Read more of this article »
Tags: Accident Benefits, auto insurance renewal, Automobile Insurance, Claims Denial, Community, Disability Benefits, help to renew auto insurance, how to renew my auto insurance, Insurance Companies, personal injury claims, renewing auto insurance ontario, Safety, settlements, Statutory Accident Benefits, tips on auto insurance
Posted by Rikin Morzaria on May 31, 2010 under Accident Benefits, Case Law, Claims Denial
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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Posted by Patrick Brown on May 10, 2010 under Accident Benefits, Automobile Insurance, Claims Denial, Disability Benefits, Insurance Companies, News
[This is the fifth of a five part series by Patrick Brown on upcoming changes to auto insurance]
Injured accident victims will have a significant amount of their benefits reduced due to assessment costs. Despite the dramatic slashing of benefits reported in my previous blogs, consumers will also face further reductions based on the fact that the cost of assessments will come out of the amount of benefits available.
For example, if a consumer is injured in a car accident and the injuries are not considered to be catastrophic, they presently have $100,000 in benefits for medical and rehabilitation treatment. Any assessment costs to obtain the benefit are over and above the $100,000.
Under the new standard policy without buy ups, the consumer will only have $50,000 available in benefit dollars. That $50,000 includes assessments costs. Therefore, if $5,000 is paid for an assessment to obtain the benefit, then the amount available to the injured person is reduced down to $45,000. Read more of this article »
Posted by Patrick Brown on April 27, 2010 under Accident Benefits, Automobile Insurance, Claims Denial, Disability Benefits, Insurance Companies, News
[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. Read more of this article »
Tags: Accident Benefits, Automobile Insurance, Claims Denial, Disability Benefits, help for family members, injured victims, insurance, Insurance Companies, med, ontario auto insurance changes, personal injury claims, settlements, spinal cord injuries, Statutory Accident Benefits, what are the new auto changes
Posted by Patrick Brown on April 15, 2010 under Accident Benefits, Automobile Insurance, Claims Denial, Insurance Companies, News, Our Firm
This is the third of a series by Patrick Brown on the upcoming changes to auto insurance in Ontario.
After September 1, 2010, if you are hurt in a car accident and are deemed to suffer a “minor injury”, do not expect to get much help. Although the legislative intent was to simplify the system, reduce extraordinary assessment and administrative expense and reduce the number of smaller claims, this new category of injury may have a significant impact on injuries that may be anything but “minor”.
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Posted by Rikin Morzaria on January 10, 2010 under Case Law, Claims Denial, Disability Benefits, Insurance Companies
The case of Fernandes v. RBC Life Insurance Company is a reminder of the need to be completely honest and thorough when completing applications for insurance coverage. Where an insured is anything less than completely honest, the consequences can be severe.
Avelino Fernandes worked as a rough carpenter. Mr. Fernandes bought a policy of long-term disability insurance with RBC Life Insurance Company in November 2000. In approximately January 2001, he became disabled from acute meningitis and was unable to return to his work as a rough carpenter. He applied for disability benefits and RBC denied his claim. RBC stated that Mr. Fernandes’ policy of insurance was void because he had made misrepresentations and failed to disclose important medical information on his application. Mr. Fernandes sued RBC for payment of his benefits. At trial, Madame Justice Susan Chapnik found that the application required Mr. Fernandes to disclose the identity of his attending physician, his consulation with that physician four or five months before the date of the application for lumbar pain, and his attendances and treatment from an orthopaedic surgeon on several occasions from 1998 to 2000. Justice Chapnik concluded that Mr. Fernandes failed to disclose and, in some instances, misrepresented facts relating to each of those matters. He dismissed Mr. Fernandes’ claim against RBC.
Mr. Fernandes appealed to the Ontario Court of Appeal. Read more of this article »
Posted by Rikin Morzaria on January 7, 2010 under Accident Benefits, Case Law, Claims Denial, Insurance Companies
“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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Posted by Rikin Morzaria on December 1, 2009 under Claims Denial, Insurance Companies, News
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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Posted by Rikin Morzaria on November 14, 2009 under Case Law, Claims Denial, Insurance Companies
A recent decision out of British Columbia reminds us all to pay close attention to the limitation period for suing an insurance company for denying disability benefits.
Sander v. Sun Life involved a dispute between Kenneth Sander, a dentist, and his insurance Company, Sun Life Assurance Company of Canada. In early 1998, Dr. Sander was diagnosed with cataracts in both eyes. The cataracts interfered with Dr. Sander’s ability to carry on his dentistry practice. In July 1998, Dr. Sander filed a claim for disability benefits with Sun Life. Sun Life approved Dr. Sander’s claim and started paying benefits to him. in September 2000, Sun Life wrote to Dr. Sander to tell him that Sun Life expected him to undergo surgery to correct cataracts. If he did not, Sun Life said that it would extend benefit payments for the time that Dr. Sander would have been expected to be disabled if he had proceeded with the surgery, and then it would close his claims file. In February 2001, a judge decided that Dr. Sander’s refusal to undergo cataract surgery was unreasonable under the terms of the policy. In June 2001, Sun Life wrote to Dr. Sander to advise that Sun Life was terminating Dr. Sander’s disability benefits.
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