Understanding the Insurance Claims Process

Isaac Zisckind, Diamond and Diamond Personal Injury Lawyers, discusses the importance of navigating and understanding the nuances of the auto insurance claims process.

Getting injured in a car accident can be a very traumatic experience. Dealing with the sudden pain, or even pain that only begins to affect you a few days later can debilitate your way of life and affect your loved ones. In many car accident cases, pain does not start right at the time of collision, but only later, when one overcomes the initial shock and adrenaline.

Most of us will hopefully never encounter a situation where we are in need of assistance because of an injury sustained in an automobile accident. However it is important that we educate ourselves with how insurance companies operate in Canada, as the claims process can be quite complex.

This article will outline the essential things you need to know about the automobile insurance scheme in Canada, and what an injured victim may be entitled to in compensation. When you are reading this, bear in mind that this is not legal advice, simply information to help you understand and discuss.

WHAT IS NO-FAULT INSURANCE?

Must of us have heard the phrase “no fault insurance”, especially if you drive an automobile in Ontario. After 1990, the Ontario government introduced the no fault scheme relating to automobile accidents. The purpose of the scheme was to limit the at-fault driver’s liability in a collision while trying to ensure compensation for the injured victims. What does that mean to us? It means that you do not immediately sue the at-fault driver for compensation.

When a person is involved in an auto collision, no matter who is at fault, any of the parties directly injured can and should apply to their own insurance company first for benefits. That’s right! Even if the accident is completely your fault, you can apply for benefits from your own insurance company.

WHAT BENEFITS ARE AVAILABLE FROM YOUR INSURANCE COMPANY?

Income Replacement Benefits

If you are injured in an auto accident and as a result, unable to resume employment afterwards, income replacement benefits are available to you. If you were not employed at the time of the accident, but employed in the previous 26 of the 52 weeks before the accident, you may still be eligible for income replacement benefits.

Care Giver Benefits

If at the time of the accident, you were the primary caregiver to a dependant in need of care and not receiving pay for those services, you may be eligible for care-giver benefits. These benefits can help you pay the expense of someone else to assist in care-giving.

Non-Earner Benefits

If you do not qualify for income replacement benefits or care giver benefits you may be eligible for non-earner benefits. Students are an example of a person that may qualify for these benefits.

Medical, Housekeeping and Attendant care Benefits

There are a variety of services available to an injured person by their insurance company to aid in rehabilitation. Medical benefits that an injured person may be eligible for can include services such as physiotherapy, psychological counseling, transportation, and access to assistive devices.

How will you complete your daily household chores? If you need assistance in housekeeping and home maintenance, you may be eligible for housekeeping benefits as well.

If you require ongoing care as a result of the accident, such as assistance in grooming, dressing and laundering, you may also be eligible for attendant care benefits. 

HOW DO I APPLY FOR BENEFITS?

If you are injured in an automobile accident you can call you insurance company and they will send you an application package.

SO THEN WHY DO I NEED A LAWYER?

You might be thinking to yourself, why do I need a personal injury lawyer?

The answer is actually quite simple.

Firstly, insurance companies can deny your claim for benefits for a variety of reasons. They do not always understand your pain and suffering, nor do they always assess your needs appropriately. Disputed claims between an injured person and their insurance company are brought to the Financial Services Commission of Ontario (FSCO), where similar to the court process, you must argue for your benefits in front of an arbitrator. This can be a time consuming, confusing process that entails a lot of legal procedure.  If you need to go to arbitration, you need someone with experience and expertise to represent your best interests. 

Secondly, your insurance company will only cover certain benefits and only up to certain amounts prescribed by law.  If your injuries are severe enough, it is possible to issue a claim against the at-fault driver in the Superior Court of Justice for compensation that you own insurance company cannot cover. For example, an injured person can claim for general damages, loss of past and future income, medical rehabilitation and other expenses against an at-fault driver. Paralegals are not allowed to bring a claim to the superior court of justice, so be careful who you talk to! A lawyer will represent you in court so that you receive the proper compensation for your injuries and the best possible outcome?

SO WHEN DO I TALK TO A PERSONAL INJURY LAWYER?

It is recommended that you speak with a personal injury lawyer as soon as possible after the automobile or car accident. They will help you fill out the proper forms so that you start the claims process on the right foot. The lawyer will also give you an opinion on your claim and all legal options available. Remember, many lawyers, including Diamond and Diamond Personal Injury Lawyers, that represent accident victims do not make any money unless you win or settle. Contact us today.