Occupational injuries and LTD.

LONG TERM DISABILITY AND WSIBOntario Accident Insurance Claims

Many employers provide group benefits packages to their employees, including long-term disability (LTD) benefits. In addition, some employers also have an additional LTD policy to cover workplace injuries and illnesses caused at/by the workplace, called an occupational long-term disability policy. Some Ontario industries (eg. construction) are required by law to participate in a provincial workers’ compensation plan, such as WSIB. Some other companies have an occupational long-term policy in place to cover workplace illnesses and injuries that would be covered under the provincial workers’ compensation plan, if they had one. Mental and physical illnesses and injuries that are specifically related to the workplace are covered by occupational policies.

There are many differences between a group LTD policy and an occupational policy. For example, the definition of disability under an occupational policy differs from a group LTD policy. Under an occupational policy, you must be unable to work due to an illness or injury arising out of and because of your employment. Under some occupational policies, you must be unable to do any occupation within the company you work for, that you are or may be qualified for that would be at a minimum of the same pay-rate as your pre-disability income. With group LTD policies, however, you may be unable to work due to an illness or injury sustained outside of the workplace.

To be eligible for benefits under a group policy, you are required to provide evidence that you became totally disabled due to an occupational illness or injury while covered under the group policy, You must show that your disability continued past the waiting period stated in the group policy and you have sought appropriate treatment.

The payout under an occupational policy is generally a higher percentage of your monthly income than through a group policy. To be eligible for benefits under this policy, you must prove that you became totally disabled due to an occupational illness while covered under the group policy. As with a group policy, you have to show that your disability continued past the waiting period and you are seeking appropriate treatment.

LTD benefits

Although the two types of policies have differences, they also share some similarities. Both types of policies require that you be an active employee when your disability started. You must meet specific criteria as stated in both types of policies in order to qualify for disability benefits. As well, both policies usually have two different definitions of disability one involving your ability to continue working in your own occupation and the other being your ability to work in any occupation, even if you were to be provided education or training in another occupation. With both types of policies, other types of benefits – such as Canada Pension Plan Disability Benefits – can be used to reduce your LTD benefit amounts. LTD policies have a waiting period before benefits are paid out, and benefits can end for a variety of reasons, such as not following the recommended treatments, returning to work and are therefore gainfully employed, or turning 65.

If you were injured at work or developed an illness, such as anxiety or depression, and you decide to submit a claim, you will need to show when the illness/injury began or happened and how it relates to your workplace. It is best to include as much detail as possible, and attach an incident report (if there is one) and any other written evidence, doctor’s notes or reports regarding your illness or injury and treatments, prognosis and progression. The more information you provide, the better able your insurer will be able to assess what benefits you are entitled to.

The simplest of things can quickly turn into a farming accident.

Farming Accident Insurance Claims

Unfortunately a farming accident can happen any time. The spring weather is finally here and across the outer regions of Ottawa and into Kemptville, Cornwall, Arnprior and the Valley, farmers are beginning to prepare for their spring planting season. 

Living in the city, we often forget that these farms are where our food comes from and that these farmers work long hours in, sometimes, dangerous situations.

Machinery is the major cause of accidents and injuries in farm workers with 70 per cent of fatalities being attributed to machine rollovers, run overs, entanglement in moving machinery parts or other machinery-related causes, (Canada Safety Council). Proper training, education and preventative maintenance are very important to maintain a safe working environment.

Farming accident and safety

The best tool for any farmer who operates machinery is the owner’s manual. Machines are designed with safety in mind and are often used without error with properly maintained and operated.

An inspection of the machinery at the start of the work day can sometimes expose serious safety issues. Leaking air or hydraulic lines, missing machine guards or obstructed stop switches can have dire consequences. Safe operation should include a daily walk around the machinery. Here are some safety tips for farm operators.

* Wear personal protective equipmenton the job. Goggles, safety shoes and leather gloves are all potentially lifesaving.

* Avoid wearing any loose-fitting clothing, jewelry, hairstyles or anything that could get caught on moving parts.

* Stay away from moving parts at all times. If there’s something caught in a moving part, make sure to turn off the machine and remove the keys from the ignition before performing maintenance.

* When parking a machine on a slope, make sure to block it. The majority of all run over accidents between 2002-2012 were caused by unmanned machines.

* Exercise caution and judgment when operating a machine close to the edge of a ditch, slope or field. This is the most frequent cause of machine rollovers.

* Perform preventative maintenance regularly, making sure that machinery is properly lubricated, adjusted and does not have parts that are in need of adjustment or repair.

Farming can be a dangerous industry, but education and a mind for safety can greatly reduce accidents and injuries.

If you or someone you love has been injured in a farming accident, call us today. We understand, we care and we are here to help.

WSIB claims and cancer ?

WSIB claims

Extension of presumption for entitlement for cancers in firefighters.

What do WSIB claims and cancer have in common ? Ontario has made it easier for firefighters to get the help and care they need by extending the presumption for entitlement to benefits to cervical, ovarian and penile cancers.

“Firefighters are vital to keeping our communities safe from life-threatening dangers. Every day, they risk their health and their lives to protect us and our communities. In return, we must protect them. That’s why the government has made it easier for firefighters and fire investigators to qualify for workplace safety and insurance benefits,” Kevin Flynn, Minister of Labour.

By adding the three cancers to the list of cancers presumed to be related to their work, firefighters and fire investigators will have greater access to healthcare and compensation. With the expanded presumption, once a firefighter is diagnosed with cervical, ovarian or penile cancer, the claims process for WSIB claims benefits will be expedited, and firefighters will not be required to prove a causal link between these cancers and a workplace exposure.

“If a firefighter is diagnosed with cervical, ovarian or penile cancer, the worker’s Workplace Safety and Insurance Board ( WSIB) claims for benefits and services will be presumed to be work-related. This will give firefighters faster access to compensation and other benefits, ultimately supporting positive recovery outcomes,” Ron Kelusky, Chief Prevention Officer

Claims related to cervical, ovarian and penile cancers will be retroactive to January 1, 1960. This will apply to full-time, part-time and volunteer firefighters, firefighters employed by band councils and fire investigators.

Quick Facts

* In 2007, the Workplace Safety and Insurance Act (WSIA) was amended to create a statutory presumption for firefighters and fire investigators to get compensation for heart injuries and certain cancers without having to prove they are work-related.

* In 2014, the Ontario government amended the Firefighter Regulation under the Workplace Safety and Insurance Act to add six cancers to the list of diseases that are work-related: multiple myeloma, testicular, breast, prostate, lung and skin cancer.

* This amended regulation makes Ontario among the leaders in this area and Ontario’s firefighters among the best protected in Canada.

* There are about 450 fire departments in Ontario made up of about 11,000 full-time firefighters, 19,000 volunteer firefighters and 200 part-time firefighters

If you, or someone you love, has been injured at work or has a work-related diagnosis of disease, give us a call. We can help you make sure that you receive the benefits that you deserve.

Clarifying what it means to be Additional Insured.

Additional Insured coverage

What does it mean to be additional insured ? The law, like most things, can sometimes be ambiguous.  Where some laws are straight forward and easily understood, others leave a great deal of room for interpretation.  In the latter case, it is often left to the courts to interpret the law and set precedent.  This has certainly been the case for Additional Insureds. 

Additional Insured coverage occurs when one company engages in a business relationship with another company.  Such relationships, while often beneficial, can sometime create the risk of lawsuits.  An example of this would be a landlord hiring a contractor to shovel the snow from the walkways in the winter.   Should a tenant of the building slip and fall on ice, that tenant could sue both the landlord and the contractor for damages. 

As an Additional Insured, the contractor could request protection under the landlord’s general liability policy, but since the law has not been clear, these requests for defense have often been denied by insurance companies.  The rationale being that there was a lack of clarity.  The insurance company would say that contractor should have independent liability insurance of their own and, when cases like this came to court, the rulings on Additional Insureds have not been consistent. 

A recent case, The Corporation of the City of Markham. v. Intact Insurance Company has done a lot to provide some clarity around Additional Insureds.  In this slip-and-fall-case, the City of Markham and a contractor hired to keep the sidewalks clear of snow, both requested defense from the Intact Insurance Company.   Intact took the position that Markham was not entitled to a defence and was not an additional insured for the purposes of this claim as it had failed to call out the contractor on the date of the incident. The Judge ruled that “The mere possibility that a claim falls within the policy triggers the duty to defend”, and that since the Plaintiff had alleged negligence on behalf of both the city and the contractor and that the city was a named additional insured, Intact could not opt out of defending the city. The judge further ruled that the city was entitled to appoint and instruct a counsel of its choice at Intact’s expense, as well as the past costs of defending the main action.

The court was very clear in the insurance company’s responsibility to provide a defense. Meaning that Intact Insurance would need to pay for separate counsel if the City of Markham did not believe that the one lawyer could effectively represent both parties. 

Much of the confusion stems from a series of cases that were decided differently, in particular, the case of Atlific Hotels and Resorts Ltd. v. Aviva Insurance Company of Canada, 2009.  At the time, a guest of the Deerhurst Resort slipped on an icy pathway and the Aviva insurance company refused to provide a defense to Deerhurst as an additional insured.  The judge found that since there were different categories of negligence in this action and that only of the categories, snow and ice removal, fell within the coverage, the insurer only had to provide the contractor with a claim. However, the court ruled that Aviva had to provide the defence in part to Deerhurst, but it was appealed soon after because the parties felt the decision lacked clarity.  The cases ended up being resolved before the appeal was heard and the clarity never came to be. Since the decision was not in line with previous decisions, there was confusion as to how to apply the law. 

Although the Markahm v. Intact decision has shed some light on how insurance companies must interpret the additional insured’s clauses of their liability policies, we will have to wait for a new Ontario Court of Appeal decision to provide clearer instructions and guidance in this area of litigation law.



What you need to know about a workplace injury.

Workplace Injury

A workplace injury can happen anywhere. A workplace injury can also go far beyond the industrial and construction site accidents that we hear about in the news. Workers are often injured in offices, retail stores, restaurants and many other industries. In fact, the Association of Worker’s Compensation Boards of Canada reported in 2015 that there were 281 fatalities in Ontario: that’s one about every 31 hours. Non-fatal injuries amounted to 51,570: that’s one every 10 minutes.

Employees injured on the job and their families have a lot to cope with including a wide range of expenses and losses. If you suffer a workplace injury, you or your family are entitled to benefits or compensation to recover these losses. · Loss of Earnings · Compensation for Non-Economic Loss · Loss of Retirement Income · Compensation for Future Economic Loss · Health Care Benefits · Health Care Equipment and Supplies

Most workers are able to claim benefits for their losses either through workers’ compensation or by suing their employer for damages.

Filing a workers’ compensation claim after a workplace injury

The Workplace Safety and Insurance Board is an independent agency of the Ministry of Labour in Ontario responsible for providing workers’ compensation to Ontario workers who become injured on the job

This is a “no-fault” system which means you can get workplace insurance benefits without proving that your employer was to blame for your injury or disease. Even if you think that the accident at work was your own fault, you are still entitled to benefits and services from the WSIB. Work-related injuries include those sustained while running errands off the premises or while travelling for work. It does not cover break periods or travelling / commuting back and forth to work.

To qualify for a workplace injury insurance benefits, you must meet the requirements set out in the Ontario law that governs workplace insurance. It is really important to file the claim as soon after you are injured as possible. Employees who wait too long have a harder time gaining full compensation. As always, report early, take a lot of pictures, write down the details and get the names and numbers of any witnesses.

If you are covered by the WSIA (Workplace Safety and Insurance Act) , you cannot sue your employer in court for your injuries

Suing your employer or a third party for a work place injury

If you believe that your employer was to blame for your injury or disease, and you are not covered by the WSIA,  you can sue for damages. It is important you inform yourself of your options and of which category you fall into before you file for workers’ compensation.”

If your workplace was unsafe, the equipment was unsafe, or your employer was unintentionally reckless, you can sue . You could also sue a third party, for example a cleaner, visitor or contractor to your work place if they have unintentionally done something that contributed to your injury.

Injuries at work can be complicated. Whether filing a workers’ compensation claim or suing your employer, you should take the time to first consult with a lawyer. Consultations are free. Call us today.

Should you settle your personal injury lawsuit out of court?

Settling Personal Injury Lawsuit Out of Court

If you have been injured in an accident and are considering a personal injury lawsuit you may be somewhat familiar with the process – accident, evidence, lawyers, court rooms, trial and compensation. But what about settlement? Most accident victims don’t consider settlement, yet the majority personal injury cases do not go to trial. Most are, in fact, settled out of court.

Ottawa personal injury lawyer referrals

Our personal injury lawyers in Ottawa will work closely with you to ensure maximum compensation.

A settlement happens when both parties involved in the suit come to an agreement. The victim is offered compensation and the trial process can be avoided.

Knowing the ins and outs of the settlement process will help to decide if it is an option to consider. Either way, the decision always remains with the victim as to whether or not they will choose to settle. There are many reasons why it may be an option depending on the circumstances of case.

Trials are very time consuming. Appearing in court means time off work, travel expenses and hours of preparation. Some personal injury cases can take years to settle.

Trials are very unpredictable. Working with an experienced personal injury lawyer, and assessing the circumstances, evidence and witnesses, a good lawyer can usually tell how things will go in a settlement. When the case goes to trial, the outcome is in the hands of the judge and jury.

Trials are expensive and they take a long time, which means higher fees for lawyers, expert witnesses and specialists. A settlement reduces the amount of all of these expenses.

Settlement hearings are private, whereas, a trial is open and can be very stressful. Appearing in front of strangers, answering personal questions and sharing the details of your injury can be a huge strain for some.

Some may see accepting a settlement as taking the easy way out, but depending on the circumstances, it may be the best course of action. If you are considering legal action in a personal injury case, call us for a free consultation.  Our personal injury lawyers will work with you to help you get the best outcome possible and maximum compensation, whether through settlement by going to court. 

Signs and Symptoms of PTSD : Post Traumatic Stress Disorder

Post Traumatic Stress Disorder

A very normal response to a tragic and abnormal event, Post Traumatic Stress Disorder (PTSD) is a common form of mental illness brought on by exposure to serious trauma and events. People who suffer from this disorder are not always soldiers returning from the war front as we once thought. In fact, car accidents, cycling accidents and violent assaults are some of leading causes of PTSD.

When do PTSD symptoms appear? 

While it is normal to be upset and anxious after a traumatic event, symptoms usually disappear within a few weeks. When they fade or get worse over time, PTSD may be the cause.

Signs and Symptoms of PTSD

There are several signs and symptoms of Post Traumatic Stress Disorder that are fairly easy to detect. Regular flashbacks of the tragedy, nightmares, constant anxiety and fear are all typical hallmarks. In addition, several risk factors increase the likelihood that someone will develop PTSD following an accident or tragedy. If the accident was particularity severe, if the victim was catastrophically injured or feels that their life was threatened by the accident or if the victim has had a previous traumatic experience or history of mental illness, there is a greater likelihood that the disorder will develop.

Lately, there seems to be an increased awareness of PTSD, but those who suffer still struggle when bringing claims related to non-physical injuries to court. Medical evidence is always key to proving your condition. If you have suffered a trauma and are experiencing symptoms of post traumatic stress disorder, you should seek medical attention as quickly as possible to reduce the symptoms and allow you to cope better. It will also be helpful keep records of everything that you have experienced in the aftermath of the traumatic incident.

The success of a personal injury claim for PTSD always depends on the nature of the injury as well as the medical diagnosis and the evidence. An experienced personal injury lawyer can help you make the claim with making claims and get you compensation for your treatment, loss of income, pain and suffering and other damages.

Disability Insurance and disability claims. The long and the short of it.

Disability Insurance – The Long and Short of It

Life happens and it’s never predictable, making it difficult to plan for the trials and tragedies that come our way. Sadly, good health and well-being are not guaranteed. This is where disability insurance comes in. Accidents happen and poor health finds us. Thankfully, we can purchase insurance to protect ourselves long- or short-term.

What does disability insurance cover?

In the unfortunate circumstance that we are temporarily unable to work, short-term disability insurance will replace wages as a temporary provision until we are able to return to work and resume our responsibilities. When an illness or injury prevents us from returning to work altogether, long-term disability insurance comes into effectas a permanent income replacement.

Short-term disability insurance replaces wages when we are temporarily unable to work due to injury or illness. Long-term disability insurance provides financial coverage long-term. It affords a more permanent income replacement when a medical condition prevents you from working altogether.

For the most part, disability claims are not dependent on a strict set of criteria and when an injury or illness prevents us from doing our jobs to earn wages, we look to long-term disability insurance.

In a perfect world, this would be a seamless process, but sometimes insurance companies try to find loopholes and attemp to reassign people to another job within the scope of their training and education.

Since every insurance policy is different and some exclude different types of injuries, it is always wise to read a policy carefully before investing in and accepting its terms.

When do you start a disability insurance claim ?

When accidents and illness happen, it is wise to start a claim straight away. Sometimes it can take time to resolve the details while insurers work to determine what the injured are entitled to. There are cases where a disability can be more complex and the injured party will have to make a case about the severity of the disability and its impact on the his/her life.

If you are ill or injured, make sure that you keep records of all of your medical visits and follow the doctor’s orders.

Sadly, there are times when long-term disability benefits are denied by the insurance company. In these cases, it is advisable to seek the help of a lawyer who can help you navigate the claim and help you to get what you deserve to help you rebuild your life.

Accident while travelling? Prepare yourself before you leave.

Accident while travelling? 

Avoiding an accident while travelling is so important. Another blast of winter weather has hit the capital enticing more and more people to travel south to escape the cold and snow. A word of caution to those travelers, take a good look at your travel insurance policy. Know your own health conditions and

Accident while travelling ? Get the right travel insurance.be clear about the details of your trip.

Each winter thousands of Canadians travel south for a little of sun and fun. Unfortunately, many of them will be injured while on vacation. Their injuries can range from minor cuts and bruises to quadriplegia and worse. Sadly, for these travelers and their families, obtaining full and fair compensation can be difficult.

As Canadians, we tend to make assumptions about health care coverage. We buy a travel insurance package and think that, like OHIP, all we have to do is present our card in case of emergency, no exceptions, no upfront costs. Unfortunately, this notion has cost Canadian travelers a lot of money and heartache. Resulting in an accident while travelling not being covered. 

By definition, traveler’s insurance protects you in case of unexpected medical emergencies and related expenses that may happen while you are travelling outside of your home province or country.

Risk takers and binge drinkers beware. Traveler’s insurance may not cover accidents that happen as a result of participation in extreme activities. Skydiving, bungee jumping and cliff diving may not be covered under your policy. In addition, accidents that happen when travelers are overly intoxicated may not be covered.

Traveler’s insurance may  not cover pre-existing medical conditions and pregnancy-related conditions may get limited coverage, this may include apremature delivery.

Travel insurance is not the same as liability insurance

Traveler’s insurance is not liability insurance. If you damage someone’s property while away on vacation and they sue you for damages, traveler’s insurance will not cover you. Separate policies need to be considered for liability.

Cross you Test and dot your Is because if you are found to have given false information on your insurance application, your claim can be denied.

Lanark accident results in compensation for soft tissue injury.

Soft tissue injury compensation- Lanark accident

Soft tissue injury

Accident Scenario:

Our client suffered a serious soft tissue injury. We worked closely with “CW” to ensure she received maximum compensation for her soft tissue injury.  CW was a 38-year-old married woman with two teenage children from Lanark, Ontario. One day, her husband was driving their vehicle when a vehicle travelling in opposite direction swerved into their lane causing a collision.

Injuries Resulting From Accident:

CW suffered soft tissues injuries to her lower back, hip, shoulder and neck. Prior to the collision CW suffered from a pre-existing back injury that prevented her from working for periods of time in the past. Unfortunately, because of her accident, her symptoms of back pain did not resolve and became worse. She continued to experience numbness and tingling in her arms and legs. In addition she was diagnosed with anxiety and depression that was causally related to the motor vehicle collision. CW was unable to return to work as Personal Support Worker.  Thankfully she was able to go back to work on a part time basis as a babysitter.

Compensation for soft tissue injury :

After private settlement conference, we were able to get the insurance company to settle. CW received $157,000 from the tort action and continues to receive monthly  Ontario Accident Benefits to cover her expenses.

Soft Tissue Injuries

Many people believe  that soft tissue injuries are less painful and less severe that other injuries such as fractures; however, a soft tissue injury can have much more long lasting effects. Some soft tissue injuries can be life-altering and can leave individuals with the inability to return to life as they once knew it.  After an accident, it may take  days for the soft tissue damage to appear. Often times, our clients come to us and have symptoms but need to wait to see the full extent of their injuries. Often times, the soft tissue injury isn’t diagnosed until after  x-rays,  CT scans or MRIs have been performed. From there, often times physiotherapy, massage therapy, chiropractic therapy are often recommended. Our Ottawa injury lawyers know that it is important not to rush a settlement in a personal injury case where soft tissue injuries are involved. It’s important to have a full diagnosis so that the life long impact of the soft tissue injury can be determined and properly compensated.

If you are suffering from a soft tissue injury, it’s important that you receive proper medical treatments and that you hire an experienced Ottawa personal injury lawyer to ensure that your soft tissue injury is properly compensated.