FAQs when filing for Long Term Disability (LTD) Claim Settlement

When filing a Long Term Disability (LTD) claim, you are going to trigger a complicated process which includes quite a lot of procedures. One of them includes the insurance adjuster to start asking questions in order to allegedly asses your claim and determine its credibility. With this in mind, let’s take a look at some of the most commonly asked questions and the way you should handle them.

Should I answer all the questions that the insurance adjuster asks?

Insurance adjusters have the sole intention of making you jump through tons of hoops before they give you the compensation that you are legally entitled to. That’s how it works. If insurance companies paid out every compensation no questions asked they’d run out of business days after opening. So, yes, you should answer all the questions and you should present all the required paperwork unless you want your claim to get dismissed for non-compliance.

Should I appeal if my claim gets denied?

As far as the history of our law firm goes, we’ve never seen a claim that gets denied on the first instance to get approved after an appeal unless there have been some game-changing circumstances in the health of the claimant. So, in case you get denied in the first instance you should turn to a lawyer right away and stop messing around. The last thing you want is to establish a chain of overturning decisions as that’s what the insurance company wants and that’s what you are going to get if you act rash.

How much is my case actually worth?

We can tell you the total value of your Long Term Disability claim only when all of your expenses have been paid. Without this information, it’s absolutely impossible to provide the client with an accurate estimation. Even though we have years of professional experience in handling cases of the kind successfully, every single long term disability claim is particularly subjective and individual. All the patients respond differently to the same kind of treatments and therefore the intensity can’t be assessed in advance.

How can a Judge help me?

The only thing that a court can do for your case is to order your insurance company to pay you right away. Of course, going to trial is always related to a certain amount of risk as you’d have to thoroughly consider the fact that the decision is within the hands of the judge or the jury and you can only control the outcome as much as the opposite side.

In any case, a Long Term Disability claim is related with quite a lot of variables and consulting with a professional lawyer is definitely one of the first things you should consider. Talk with an experienced lawyer today and let them judge the merits of your case as that would give you a ballpark amount of compensation that you are justified in asking for.

Assessing the Damages In Catastrophic Injury Claims

As you may guess by the sound of it, catastrophic injury claims are definitely the most serious claims that any personal injury lawyer is going to have to deal with throughout his career. As far as the characteristic “catastrophic” goes, it has a special meaning when it is regarded from a legal stand point. The lawyers refer to it as a term from an act which means that it’s of particularly special significance defined by the Insurance Act. If you manage to meet the requirements set forth in the description of the “catastrophic” term, you are going to be eligible for a greater amount of benefits. These include:

·         $1,000,000 in benefits for rehabilitation instead of just $50,000 or $3,500 as specified in the Minor Injury Guideline.

·         As much as $1,000,000 in benefits for attendant care as opposed to the $36,000 allowed for non-catastrophic claims

·         $100 per week for home maintenance and housekeeping as opposed to none for non-catastrophic claims

·         $250 per week for claims for caregiver as well as $50 for every single dependant as opposed to none for none-catastrophic injuries.

As you can see, the differences are absolutely dramatic and tremendous when it comes to it. However, as we mentioned above, you have to meet the description of “catastrophic” in order to be eligible for them. How do you do that?

In the first place, a licensed doctor has to fill out and submit the OCF-19 form. It bears the name Application for Determination of Catastrophic Impairment. Now, the entire procedure is extremely complicated and quite frankly, a lot of doctors wouldn’t be able to complete it, simply because they are widely uncomfortable with the terminology which is used in the OCF-19. So, if you are to go through it, you should most certainly arm yourself with quite a lot of patience as it’s going to take months to set up an appointment with a catastrophic determination professional and even more time to get the report done. Once the report is through and you submit it to your insurance company, it’s likely for them to take their sweet time for another month in order to go through the report and digest the information. Keep in mind that these reports often consist of 200 and more pages.

What is more, you can rest assured that the insurance company is almost always going to disagree with the report. Why? Well, because it is their job to do so. Of course, this shouldn’t discourage you and you should, by all means, pursuit the entire amount of your compensation, especially if you’ve been involved in a catastrophic car accident. However, the procedure could be rather tough.  However, it is good to have a legal expert handling your claim because they understand all aspects of the tort laws. Thus, work with an experienced lawyer that can evaluate your case and offer to work on contingency basis.

How To Proceed With A Claim After A Slip And Fall Accident?

Slip and fall cases are particularly common in Canada, and especially in Ontario. The reason for this is quite simple – winters are long and cold and walkways aren’t as clear as they need to be. This tends to create a lot of slip & fall potential and sometimes, inevitably, you are going to fall for it. Even though people tend to underestimate these types of accidents considerably, they are capable of inflicting tremendous damages. From broken spines to critical brain injuries, slip & falls are to be taken as seriously as any other accident in the field of personal injury law. With this in mind, we would like to provide you with a few helpful tips on how to proceed, from a legal stand point, so that you have the strongest case against the municipal institution responsible for that particular walk way.

1.    Get medical attention as soon as possible.

Now, the first thing that you need to do is to get medical attention. Safety must always come first, regardless of the situations and the potential legal consequences. However, once you do get the attention you need, make sure that you keep the paper trail of the pain. Appearing in court or in front of the insurer and stating that it was painful isn’t going to cut it – you should know that.

2.    Take pictures of the area of the accident.

This is another important thing to consider. The first thing that the insurance company is going to ask is where did the accident occur? If you are unable to definitively answer this, then your case is gone from the get-go. With this being said, taking pictures should be your priority number two.

3.    Secure witnesses.

Even though it may sound a bit strange to ask someone to remember the accident – it’s most certainly incredibly helpful. See if there is an eye witness to your accident and if there is – make sure to get his contact information. Let him know what it is all about and kindly ask for his assistance.

4.    Wear appropriate footwear.

The court is going to be a bit refrained from awarding you the compensation you claim if you were wearing flip flops during the accident. Wearing appropriate winter boots and falling regardless attests that the walk way was in truly terrible condition, which is something that’s going to play in your favor heavily. Furthermore, this is one of the tips that you would want to take into account when it comes to staying safe during cold winter conditions.

In any case, these should give you the merits for a solid case. Make sure to get these done and you are likely to get what you set out to in the first place. It is good to discuss the details with the lawyer and they take a note of it immediately. As time passes, you tend to forget the details and that is why taking action quickly is important.

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.

How Returning To Work after an Accident Affects Your LTD Claim

If you’ve been involved in an accident in Ontario, regardless of whether it’s a car accident or you’ve been subjected to professional malpractice, you are entitled to follow a Long Term Disability claim. One of the most common questions which the majority of victims are usually going to ask is whether or not they should return to work after a fall, motorcycle or car accident. The answer is, unfortunately, not as definitive as you would like it to be. There are two common pictures that have to be painted here. In both cases your insurer denies payment of the claim and you have to go through trial to get your compensatory money.

Claim Denied By Insurance Company

In the first scenario, after your insurer denies your claim, you decide that it’s high time you start working again. The first thing that you need to do is to consult your physician. You have to make sure that you are in proper working condition and you are capable of executing your professional obligations without this impairing or damaging you any further. This is the best case scenario. Right off the bat, you are going to be receiving 100% of your regular profits instead of the 70% eventual LTD benefit that you are entitled to. Furthermore, your claim becomes easily quantified and your lawyer could get a quicker settlement agreement on the table. The insurer might also be more inclined to go for the settlement, now that the case has gotten much more comprehensive and easy to handle. It’s the best opportunity that you’d have to leave this particularly dark chapter of your life behind and move on with your day-to-day affairs.

Unable To Work

The second scenario is a bit more interesting. We’d like to call it the failed attempt at getting back to work. While it might seem a bit grim at first, this is by far the best thing that could happen to your lawyer. He’s now capable of making the case in front of the court that you had the absolute desire to get back to work in order to start earning and providing for your family, but your medical condition doesn’t allow it because of the accident. This is going to tip the scales in your direction considerably and it’s at this point that the majority of insurers are going to bend their knees and settle for as much as you want below the estimation of the verdict. This is due to the fact that they are well aware that they are likely to lose the case in court and they don’t want to risk having to pay considerable legal fees and court taxes. That is why it is important to talk with the lawyer about the pros and cons of the claim before filing for it.

Are Medical Malpractice Claims Based on Misdiagnosis of Neck and Lumbar Pains?

Unfortunately, neck and back pain is amongst the most common reasons for which Canadians would seek medical treatment. Some of the studies show that 66% of the population experienced neck and back pain and this goes as far back as 1998. 80% of the adults experience back pain throughout their life.

The majority of the doctors aren’t really able to determine the exact cause for the pain. It’s usually self limiting which means that in the majority of cases it’s going to resolve itself. The most common treatment includes pain medication and then the patient would be sent to go home and get back if the pain gets worse. In the majority of the situations this is an appropriate approach.

However, the problem with this particular treatment is that neck or back pain could be symptomatic of other conditions and illnesses. With this in mind, if the doctor fails to take this into consideration, this could lead to potentially serious and devastating consequences.

The importance of a differential diagnosis

With this in mind, a differential diagnosis is a procedure which aims to identify any kind of serious or potentially life threatening conditions which could be ruled out or ruled in. The physician is going to go through the list and reach a final diagnosis based on the ones that are already ruled out and ruled in. There is, however, a specific process of elimination that has to be adhered to. The doctor has to create a list of all the potential injuries and conditions that could be causing these symptoms. They are all tested until the doctor comes with a final diagnosis by eliminating those who are irrelevant. The most commonly missed diagnosis when neck and back pain is involved is the CES or cauda equina syndrome. This is a potentially debilitating condition which is capable of causing paralysis when the nerve roots are compressed within the spinal cord. This is an emergency condition which requires urgent surgery in order for the doctors to prevent permanent disability.

Of course, there are other potential causes which are also frequently missed. These include fractured vertebrae, renal disease as well as some particular forms of lymphoma as well as bone cancer. With this in mind, it’s important to note that according to the CMPA the mistakes which lead to missed diagnosis can usually be traced back to the doctor’s inability to identify particular signs and relate them to the condition.

For instance, the presence of fever is symptomatic of infections. If it’s accompanied with neck and back pain this could be a sign of different spinal infections such as a spinal epidural abscess. Another thing that has to be taken into consideration is sudden or quick loss of weight. These two symptoms in combination could be indicative of a tumor or of a lymphoma. This is the main reason for which the SMPA has warned physicians to follow up on abnormal findings such as elevated white blood cell counts.

The truth is that a misdiagnosis of neck and back pain could potentially have devastating consequences. An example is given with a patient who came in with problems of the kind and got discharged with pain medication. He returned to the department two more times, reporting an increase in the pain. He also developed a fever and the numbness spread to his legs. Approximately 48 hours afterwards the patient was diagnosed with a spinal epidural abscess that became quadriplegic later on.

Protection against such medical malpractice

The first thing that you need to take into consideration is that you shouldn’t assume anything. You should make sure that the entire situation is carefully examined and that you are given the full physical as well as neurological examination. It’s going to take no more than 5 to 10 minutes and it’s going to cover your entire body. Make sure that you also pay attention to changes in your symptoms and if there is even the slightest alteration you should consider getting medical attention right away.

Understand the Aftermath of Public Transit Accidents

Bus Accident law is generally going to fall within the common carrier law because a large portion of the buses offer transportation services mainly as part of their own enterprise and business to ordinary people. The common carrier is regulated as an individual or a business which is going to be offering transportation services to people as well as items for a particular fee. The common carriers could also be private companies or public entities. The province of Ontario is being regulated by the Federal Government which sets forth provisions that steer the common carriers which transport regular passengers.

Ticket is important

Public transit accidents are usually going to involve one or more people who have been using the services of the public transit and they have dully and proven incurred damages as a result of a particular misconduct of the driver. There are, however, a few differentiated specifications in this particular regard that have to be taken into thorough consideration while filing a compensation claim with grounds of the kind. You would have to account for the fact that the majority of common carriers, inclusive of public transit services are going to bear a particularly higher duty of care because they would usually offer services in return for a fee. This means that they would have to adhere to the highest degree of care as well as vigilance in order to ensure the safety of everyone who is on board. Basically the ticket for the public transit that you buy is substantially your most stable ground for filing a compensatory claim.

Filing notice of intent

There is also a time term to be concerned with. Under the current legislation which is set forth in the province of Ontario, you have to file a notice of intent to sue within the next 10 days after the accident has happened. This is a mandatory requisite and failing to do so would deprive you of your rights to sue. However, after you’ve done this, the legislation allows additional two years to file your case after which you wouldn’t have these rights any more. The solution is incredibly fair.

Claim against Municipality

Furthermore, in the event in which the transit service provider is owned by a public entity, you have to file your claim against the municipality. If that’s the case, after filing the notice of intent, you would have to wait for another 60 days during which you wouldn’t be able to file your claim. This is done so that the authorities can conduct an extensive investigation of the matter. However, this particular solution is rather questionable as it skews the favors towards public entities because the waiting period in the situation of privately owned companies is practically non-existent. You might need to discuss the details with the personal injury lawyer in Milton to understand the clauses and other aspects of your specific case to get all the information.

Steps Of Insurance Investigation For A Personal Injury Claim

Now, even though the majority of the accidents and the personal injury claims as a result are going to be a matter of insurance, most of these would never even reach the courtroom. But it’s still important to understand that an investigation is going to be carried out. There are some things that have to be considered and even though Ontario is governed by the “no fault” rule pursuant to the Rules of Fault Determination in the Insurance Act, an investigation and assigning of fault would be carried out. However, it would be done by the insurance company. This is done so that it could be thoroughly reflected in the amounts of the monthly premiums.

Rules of Fault Determination

The process of the entire investigation is consisted of quite a few steps along the way. However, it’s important for the insurer that it’s completely factual and true in order for it to reflect properly on your insurance record and on your premiums.

The first thing that’s going to happen is that the insurer is going to open a file for your case and all of the pertaining documents are going to be collected within it. This is logical as all of the paperwork has to be handled correctly. After that the insurer is going to get the information out of the insured – his explanation of the case and the circumstances around it.

The next thing that the company is going to do is to contact the police department or the local department of motor vehicles and get the official records of the accident. They are then attached to the file as part of the documentation. Responding to the particular claims comes afterwards. Of course, this step is strongly optional as claims might not have been filed.

Afterwards the insurance company is going to try and understand everything that they are dealing with by investigating the injured parties. Of course, getting the medical records of the injured is also crucial and essential for the insurance company as it’s going to potentially determine the amount of the owed compensation. Your personal injury lawyer is going to work to ensure that you get maximum amount of compensation.

After this is through, the insurer is going to determine the particular value of the accident and of your injury and he’s going to make you a settlement offer which you aren’t obligated to accept. You can, however, accept it and file a civil lawsuit towards the “at fault” party if you feel like the compensation isn’t enough. However, you also have the claim to dispute the offer and request an adequate one from the insurer himself. In any case, you want to make sure that the entire record is factual and true as this is going to reflect on the overall offer that the insurer is going to make you.

Do Pedestrian Accidents Call For A Civil Lawsuit?

Pedestrian accidents are incredibly dangerous and they are almost always going to lead to tremendous complications. The main types of injuries which are going to occur are almost always going to be of orthopedic nature because of the essence of the accident itself. However, there are quite a few things to be considered when handling the compensation for this type of accidents. It’s worth noting that a civil lawsuit is optional but not mandatory and in the majority of cases the entire situation is going to be resolved in an out-of-the-court settlement. However, your personal injury lawyer in Kitchener can try to ensure that you get the compensation amount that covers your medical treatment and other requirements.

If we dig a little deeper in this particular settlement, we are going to find out that this is a legally binding solution which has the same enforceable power as the ruling of the court of the civil lawsuit. The enforce ability of a document means that it could be imposed onto to the liable party in the events in which he has followed through his legal obligations while the other party has failed to deliver. This is when the document becomes enforceable unless there are some other conditions included within it. Up until this moment, depending on the additional conditions, of course, the obligation under the document can’t be forced onto the one who’s responsible for it. However, when this event occurs, a public or private enforcer could start pursuing him with formal legal actions in order to deliver the necessary result.

Seeking settlement

This is, however, just one part of the overall reason for which the majority of injured people in pedestrian accidents prefer to go for a settlement. The truth is that a civil lawsuit is going to take time and the outcome can never be certain. This is due to the fact that the judge has the final word and if you fail to prove all of the circumstances and the opposite party has solid defense, you might fail in getting the protection that you are entitled to. Going to trial is always risky and that’s why the majority of personal injury attorneys are likely to advise you to settle, especially if you have solid grounds and the upper hand in the negotiations.

Expensive trials

Furthermore, it’s also worth noting that a civil lawsuit is going to be incredibly expensive. While you would likely have to pay the attorney his fee, it’s going to be reduced because a settlement requires less work. Apart from that, you would also save yourself the expenses which are due to the court. Filing a claim is going to require you to pay a significant amount of court taxes and even though you are going to get them back when you win, funding the entire thing could be quite challenging. You can discuss the details with the injury lawyer in Kitchener and get the facts straight.

Are Orthopedic Injuries Qualified For Compensation Under Tort Laws?

Orthopedic injuries are a basis of personal injury law. The truth is that, unlike criminal law which aims to seek criminal prosecution and punishment of the one who committed the crime, personal injury law’s aim is to reimburse the victim in full. This is the core difference between both practice areas and it’s one that has to be considered thoroughly as it poses fundamental differentiations.

Strong reason to file a case

However, when it comes to orthopedic injuries, it’s important to point out that this is the cornerstone of personal injury law. They are at the bottom of every single accident and, even though some would claim that pain and suffering could be the basis of a personal injury claim – it would be associated with an orthopedic injury. With this in mind, it’s also worth noting that there are quite a few different types as an orthopedic injury would stand for a broken bone, ripped tendon and everything in between – the area is quite extensive but it’s more of a medical conversation.

In any case, the orthopedic injuries are viewed differently from the various types of personal injury areas. For instance, an orthopedic injury in a dog bite claim would be governed by the Dog Owner’s Liability Act. This means that all of the responsibility deriving from the infliction of said injury would derive from this particular piece of legislation.

Apart from that, we have orthopedic injuries which are resulting from car accidents, which are likely to be the most common type of accidents that are concerning personal injury law. This is solely because of the fact that they are so many of them happening on a per annum basis.

Now, it’s also worth mentioning that pain and suffering is a different type of claim and even though it’s always accompanied by a claim for orthopedic injuries, sometimes it might not derive from them. For instance, a car accident could leave you unharmed in any way but you may have experienced severe stress which could have caused emotional trauma which is also subjected to compensation on behalf of the person who’s at fault.

Insurance covers expenses

Of course, the majority of the expenses which are associated with orthopedic injuries would be covered by the insurance company. However, the possibility for a civil lawsuit is always there and you could sue the other party if you believe that your damages exceed the amount that has been forwarded by the insurance company. However, you need to know that the court procedure is expensive, time-consuming and would require a lot of effort. Furthermore, you need to know that it’s not a done deal and the case could always go the other way around if you don’t manage to prove your point.

If you are suffering with chronic pain or other effects of orthopedic injuries, it is time to seek an experienced personal injury lawyer in Ontario that can help you get justice.