Can Insurance Claim Be Denied Because of A Failure To Disclose Medical Condition?

In order to get the benefits under the insurance policy, the insured enters into a contractual relationship with the insurance company which requires both parties to approach every single action under the contract in good faith. This particular concept encompasses the beginning of the entire relationship when the insured is going to take out the policy and also later on when the insurance company agrees to go ahead and pay out the coverage for a claim. There is a requirement in order to act in good faith and the insured needs to disclose any and every relevant fact to the insurance company as the former applies for said insurance coverage. This entails full and thorough disclosure of all existing and pre-existing medical conditions. Read More

Dealing With Long Term Disability Or Critical Illness Claims In Ontario

There are quite a few different ways that an accident can result in. As unfortunate as it may be, long term disabilities as well as critical illnesses are most definitely a possibility. These are both part of the so called “living policies” which are significantly different from death benefits or any kind of life insurance policies. This is due to the fact that the one who is insured is actually still alive. He is the direct beneficiary and he is able to recover the benefits under the agreement. Read More

An Overview Of The Personal Injury Deriving From Motorcycle Accidents In Ontario

As soon as the summer kicks in and we start to approach the hot months, it’s safe to say that people in Ontario hop on their bikes and motorcycles and turn this into the preferred method of transportation. And, quite frankly, you can’t really blame them – the open air is definitely persuasive. However, the more people get on the road, the more accidents start to happen and that’s most definitely unfortunate. That’s why this blog intends to familiarize bikers with the things they need to be aware of.

Insurance Matters

Now, the first thing that you need to know is that if you have decided to ride your bike, you should have proper insurance. This is determined and duly laid out in the Highway Traffic Act as well as in the Compulsory Automobile Insurance Act. It doesn’t matter that you aren’t in a car – your bike should have coverage as well. If you aren’t abiding by this then you are just asking for trouble. It’s also worth noting that getting the compensation in cases of accidents can be daunting, even if you have the right insurance, let alone if you don’t. However, if you have a reliable injury lawyer on your side, things will get much easier.

Helmets – that’s right – you should wear those

How many times have you seen a biker without a helmet? Okay, it’s true that motorcycle riders are almost always equipped with the helmet but the same goes for those who ride a bike. Not only that, the law specifically says that the helmet itself needs to be tightly and securely fastened under your chin.

Sure, it may not seem fair but it is what it is. You will definitely feel the importance of the helmet in case something happens, which we thoroughly hope it won’t. Now, the truth is that you need to follow helmet safety instructions because they are prerequisite for compensation. Of course, the court isn’t going to deny you compensation because you failed to equip your helmet, but that’s something that could play against you.

Safety of Passengers

One of the things that you need to consider, especially as a motorcycle rider, is that you aren’t allowed to carry passengers less than sixteen years of age. This applies unless the passenger has a helmet which is in full compliance with the regulations and he has a chin strap that’s put in place conveniently. With all this in mind, these are just some of the things that you should take into account. Keep in mind that failing to comply with all these is going to get you a fine – that’s for sure.

And in case, you or a loved one has been injured in a motorcycle accident, it is important to consult a qualified and licensed personal injury lawyer. They will be able to guide you about the best way to seek and win compensation.

How Does An Injury Lawyer Assess Damages In Catastrophic Accidents?

Catastrophic injury claims are particularly devastating in Kitchener. From the perspective of an injury lawyer, this is the most difficult type of case that they deal with. The ring to the word catastrophic itself is determining when it comes to it. However, when it comes to the law, this term has a specific meaning, as it is defined in the Insurance Act which is in full force in Ontario.

With this in mind, if you are subjected to compensation for catastrophic damages under the act, you will be eligible for an amount which is greater than the usual. Of course, this sounds a bit abstract, so let’s go ahead and take a more particular and precise look:

1. $1,000,000 in medical as well as thorough rehabilitative benefits – under the Minor Injury Guideline you would be only entitled to $50,000.

2. Up to $1,000,000 in care benefits for attendants, instead of the inconsiderable $36,000 under the aforementioned guidelines.

3. Furthermore, you can claim up to $100/week for housekeeping as well $250/week for a caregiver as well as $50 more for each dependent. Guess how much the guidelines specified above allow for this? Zero!

As you can see, the difference is more than just significant. If your accident is characterized as a “catastrophic” then you would be able to claim a substantial amount of money. However, how to understand whether that’s the case or not? Well, the law is precise.

In order for your accident to be classified as catastrophic, a licensed and practicing doctor has to submit a form OCF-19. This is the shorter name for the Application for Determination of Catastrophic Impairment. There are quite a lot of different criteria which have to be met under the 4th Edition of the AMA Guidelines.

However, one thing that you should consider is that this is a complex and difficult process mainly because the specifications are particularly challenging. A lot of doctors do not feel comfortable filling out the OCF-19 because they are unfamiliar with the language to a certain extend. Furthermore, it is also worth noting that in order to fill it out, the patient needs to have undergone significant and particularly comprehensive medical and more precisely – orthopedic examination.

The best thing that you could do is to go ahead and have an injury lawyer, as well as doctor on your side for this one. It might be an investment, but refer to the numbers outlined above to see whether or not it’s worth it. This form could be the reason for half a million dollars on top of your compensation.

This is precisely, why it is important to hire an injury lawyer to represent your case instead of trying to do it on your own. Most people lose out on the much needed compensation because they decide to represent themselves. Don’t make that mistake but hire a good lawyer.

How Should You Deal With The Insurance Adjuster If The Compensation Is Denied?

Now, as soon as you file your claim for compensation with the insurance company, it’s going to be distributed towards a certain adjuster who’s going to handle the investigation of your claim and the further adjustment of the amount. However, there are a few things that you need to know about those special agents.

The fact is that it’s in their best interest to make sure that you don’t get a lot of money. The more they manage to cut back off your compensation, the more profit they will be able to report and hence the larger bonuses they get. That’s right – this is how it works. Insurance companies do not have it at their best interest to pay the full amount of your compensation, even if you are legally entitled to it. This is due to the fact that this way they wouldn’t be able to report any kind of profit to their shareholders. So, naturally, they would try to cut it back or even deny it. So, how to proceed if you’ve been denied insurance that you are actually entitled to?

The first thing that you can do is hire a professional personal injury lawyer in Milton or Kitchener and have him look into the case. As a matter of fact, this is something that you should have done already. However, a lawyer could help you undertake the right trail of action. They have the skill and knowledge about how to deal and handle similar cases and have already won millions as compensation for various other companies and victims.

Furthermore, you can always threaten a lawsuit. If you are entitled to the compensation and you know it, then so does the insurance adjuster. Having two different opinions on a straightforward matter of the kind is impossible. With this in mind, as soon as you file your claim in court and the adjuster gets notified about it, you will see how his overall attitude is going to change immediately. This is due to the fact that they have absolutely no interest in pursuing the matter to court. Sure, it’s going to take a while prior to reaching a ruling but once you get there, it’s definitely not going to be in their favor and the amount of money they would have to pay would have doubled because of attorney’s fees, interest rates as well as higher compensation award.

These are just a few things that you can do in order to get a proper compensation offer from your adjuster and avoid getting ripped off. Even though it’s just business for them, you shouldn’t let insurance companies bully you into situations that are outside of the lawful frames. Make sure that you stand up for your rights and get the necessary help to do so effectively. This way you will get compensated.

How To Proceed In Complicated Product Liability Cases

So you’ve just bought your new car for which you’ve spent thousands of dollars on. It’s a brand new model, straight from the dealership. However, you take it out for a spin and your break malfunctions leading to a terrible accident. It’s clearly the manufacturer’s fault but what can you do in this case? Luckily for you, this is the perfect representation of a product liability case, which is one of the most lucrative fields of expertise in the entire law. However, filing a claim of the kind requires thorough knowledge of different laws as well as a lot of experience on handling the case itself because it would commonly include a jury which you’d have to convince.

Filing Product Liability Claims

It’s worth noting that as per the current legislation on the territory of the province of Ontario, you can file product liability claims under two separate premises – Contractual and Common law.

Filing a claim in Milton under the grounds provided to you by the Contractual law could be incredibly beneficial. The main reason for which is that you are essentially implying a breach of contract which could lead to some serious compensations. Apart from all of the injuries, you’d also be capable of getting thoroughly compensated for the vehicle itself. This is due to the fact that aside from the regular duty required by the common law, there is also an additional duty of care implied by the sales-purchase contract.

Hidden Defects

This means that the seller is legally obligated to disclose all sorts of information regarding particular defects in the object of the sale. Hidden defects, as in this case, are also grounds for compensatory claims, regardless of whether the seller knew about them or no. In the first case, the claim is going to be dully civil while in the second, depending on the particular situation it could even get to criminal prosecution. However, the case in point which is subjected to personal injury law is a part of the civil law and there aren’t going to be any criminal charges. This is due to the fact that product liability cases seek monetary compensation and not to legally punish the perpetrator through a penalty, provided by the criminal legislation.

It’s also worth noting that unlike seeking reparations under common law provisions, doing so by claiming responsibility set forth through the contractual law, you can exceed the boundaries offered by common law. In any case, the claims which are filed for product liability are going to be extremely high, especially if they involve a fatality. The main reason for this is that they are usually targeted towards influential companies with billions of dollars in capital.

However, there are plenty of personal injury lawyers that have won millions of dollars as compensation for victims of product liability cases and they will be able to help you.

How Does An Insurance Adjuster Work?

Now, if you’ve been involved in some sort of accident, there is a high chance that you are going to have to deal with an insurance company. Regardless of the case, in the majority of situations the opposite party is likely to have some sort of insurance coverage that will kick in if you decide to sue. On the other hand, if you’ve sustained the injury without the involvement of another person, your own insurance is going to kick in.

With this in mind, it is highly beneficial for you to understand the way that the insurance adjusters work. This is a helpful insight which would enable you to take certain advantages when it’s possible. Let’s go ahead and take a look.

What’s The Motivation of the Insurance Adjuster?

Now, there are two things which are going to get the cash flowing for the insurance adjuster. The first one is to pay you as little as it’s possible and the second one is to avoid going to a lawsuit. Even though it may sound a bit troublesome, that’s the reality – insurance companies are in the business of making money and if they paid off every single claim in full they would have went out of business long time ago. There’s nothing personal – it’s just business. The more they manage to cut off your insurance compensation, the more profit they can report to the shareholders. It’s as simple as that.

On the other hand, they don’t want to go to trial. The reason is quite common – they don’t have the upper hand while at court. The jury and the judge are quite unpredictable which puts the insurance company at a risky position. Furthermore, if they lose the claim, they would have to pay the entire amount of the compensation, the court taxes, the accumulated interest as well as the fees for your lawyer – this could far exceed the amount of the compensation itself.

Damages Taken Into Account

There are a few different categories of damages that the adjuster is going to collect data for and calculate for your compensation:

·         Pain and suffering

·         Damages for emotional distress

·         Actual loss from lost income

·         Actual expenses for medical costs

These are the categories which you need to build upon. So, in order to force his hands, there are a few things you can do.

First, you need to decline low ball offers as they are widely inappropriate and disproportional. Second, you need to show that you aren’t afraid of the court. And third, which is just as important – provide him with the necessary assistance along the way in terms of documents, evidence and calculations. Additionally, everything can smoothen out when you hire the services of an injury lawyer in Kitchener to ensure that they put forth your rights and negotiate it better with the insurance adjuster. This will help you get maximum compensation instead of being intimidated by the insurance company.

When Injuries and Liability Aren’t Enough: The Importance Of Causation

Personal injury law is particularly interesting and quite complicated. The first thing that you need to know is that there are three solid merits that your case is going to need in order to be successful – damages, liability and causation. Let’s break this down a notch.

·         Damages

Obviously, the first thing that your case is going to need is damages. They could be both pecuniary and non-pecuniary. That is to say that you could have sustained physical damages which are valued with documentation such as medical bills, for instance. Furthermore you could have sustained emotional damages in the form of pain and suffering which are assessed by the court in every different case.

·         Liability

This is the legal responsibility of a party to recover the damages. When someone has negligently caused another person wrong, he’s obligated to repair it in the amount stipulated by the legal provisions.

·         Causation

This is the third and amongst the most important requisites for your case. The causation is a legal institute which requires the damages to be direct result of the accident for which the accused is liable for. It might sound a bit complicated but it really isn’t. For instance, if your neighbor’s dog bites you and you sustain physical injuries in relation, the latter are in direct causation with the accident for which the accused is liable for.

So, if that’s the case, how can things get complicated? Well, that’s why we said that personal injury law is particularly complicated. Imagine this – you’ve been involved in a car accident. As a result, you’ve broken your leg and you sustained considerable damages that you are now filing for. However, a few months later, you begin to feel dizziness, nausea, migraines and a wide range of symptoms which might be indicative of a brain injury. Are they in direct causation with the car accident? Even if they are, it’s going to be significantly harder to prove this.

Another example with the Emotional damages is also appropriate here to demonstrate the complications that may arise. Let’s imagine you’ve been attacked by your neighbor’s vicious dog. It has caused you severe physical injuries that you file for. However, after a week, you start having nightmares, troubled sleeping, raised anxiety levels and many other emotional damages. Once again, it’s highly likely that they are caused by the stress induced by the accident but it’s going to be significantly harder for you to prove this.

In any case, all of the premises have to be existent and to be established in order for your case to be successful. These are not subjected to the slightest speculation and lacking each one of them is going to have a detrimental impact on your entire case. Most of the injury lawyers have experienced a host of different reasons for injuries that surfaced after the accident. They understand how to develop and present a case and still win compensation for their clients. That is why it is important to hire their services when you have been injured.