As we wind down 2010,  the Ottawa Personal Injury Lawyers at our law firm wanted to share some of the “low lights” of our dealings with insurance companies on behalf of our clients in 2010.   Here are our top four this year.

• The insurance company cut off benefits saying claimant had not pursued a specific treatment AFTER the insurance company denied that the treatment was reasonable and necessary.  The treatment was recommended in an assessment by the insurance company, the treatment provider filed the forms with the insurance company, the insurance company denied the treatment and then cut off benefits!

• The insurance company refused to pay benefits to a claimant saying that the claimant had not undergone a insurer’s assessment,  when the insurance company had repeatedly failed to give the claimant notice of any assessment telling her where and when to show up. The insurance company kept scheduling appointments with the assessors and then forgot to send the notice to our client.

• The insurance company told a man who now uses a wheelchair for mobility that they did not have to ensure he had an accessible washroom because he lived in a rental home.  (Renters don’t have to go, I guess?)

• The insurance company refused to fix a teenager’s teeth which were broken in an accident saying they had no proof of the damage despite being provided with before and after photos. Imagine having your graduations photos taken with broken front teeth.  Not nice.

The accident lawyers at our firm are either working on or have resolved each of these issues for our clients.  If you had an accident and didn’t have a lawyer, would you know how to fix these issues?  (Hint:  rational discussion usually does not work.)

Adjuster “Misses” $45k in Benefits Owed to Mom of 9

OTTAWA PERSONAL INJURY LAWYER – Our Ontario personal injury accident benefit lawyer and paralegals at Ottawa law firm Auger Hollingsworth audit every motor vehicle accident claim we receive to ensure that our new clients have received all past accident benefits to which they are entitled.

We examine the medical rehabilitation benefits, housekeeping benefits, visitors expenses, income replacement benefits, caregiver expenses and several other benefits that you are entitled to receive after a serious motor vehicle accident.

Where there is a shortfall, we demand immediate payment from the accident benefit adjuster.  We did this very thing for a mother of nine children in early November.  This week, we received notice that she would be paid $45,000 in arrears.  While every case is different, this is a great example of missed opportunities if you don’t have an experienced car accident lawyer.

If you have been injured in an Ottawa accident, don’t deal with the insurance company adjusters alone. First, get advice from an experienced personal injury lawyer. For more information, contact the Ottawa lawyers at Auger Hollingsworth by email info@ottawalawfirm.ca or by phone at (613) 860-4529.

Ottawa Lawyer: Don’t let your adjuster RIP YOU OFF!

Yet again this week our Ottawa personal injury lawyer received a telephone call from an Ottawa accident victim who told us that he cannot get more physiotherapy through his accident benefits because his adjuster has “closed his file”.

Meaning what, exactly?  She put it in a drawer?  She is storing it in another cabinet?  Remember, as long as you have not exhausted the policy limits, and as long as ten years have not expired and as long as you have not entered into a settlement agreement, your file cannot be closed.  It just doesn’t matter what the accident benefit adjuster says.

For accidents before September 1, 2010, most people have $100,000 in medical / rehabilitation benefits.  For accidents after September 1, 2010 the amount you have may be less ($50,000 or $3,500 depending on a variety of factors)  However, as long as it is reasonable and necessary, you can spend your total policy amount on physio, chiropractic, psychological services, occupational therapy services etc., etc.  within 10 years of the date of your accident.

Don’t let the adjuster short change you by using meaningless words like “closing your file.”   If you are not sure, take advantage of the free consultation offered by most Ottawa motor vehicle accident lawyers.

How Long Will it Take to Settle My Ontario Accident Case?

As personal injury lawyers who meet many accident clients, we know that if you have been in an Ontario motor vehicle accident, either as a driver, cyclist or pedestrian, you are probably wondering how long it will take for your case to result in compensation.  There is no one size fits all answer to that question,  but there are some factors that affect the timeline.

1)  What type of injury do you have?

Some injuries are more straightforward than others in terms of assessing what your claim is worth.  Many fractures or so-called “objective” injuries have a predictable course of recovery and their lasting effects are well known.  If you have an injury like that, it may be easier to resolve your case sooner because we can reasonably assess what your case is worth without waiting to see what happens to you.

In contrast, if you have a type of injury that is progressive, for example, where you may need surgery in the future or may not.  It will be more difficult to assess your damages (the amount of compensation) at an early stage.  There is a serious risk of under-compensation if you settle before this type of injury has stabilized.

2)  Have you returned to work?

If you have returned to work, or if you did not work before the accident, it may be easier to settle your case sooner because it is not necessary to predict what your ultimate loss of income will be.  For example, if you are still off work, but expect and hope to return to work sometime in the future it can be difficult to negotiate sufficient compensation for your lost future income.  Similarly, it will usually take the passage of significant time before your doctors will provide a sufficently conclusive opinion that you will not be returning to work.  Again, settling before you have that information risks under-compensation.

3) Are your injuries permanent?

In Ontario, you cannot sue for pain and suffering after a car accident unless your injuries are permanent.  For many types of injuries, it simply takes time before you will be able to show that your injuries will meet that part of the legal threshold.

4) Did you contact a lawyer early in the process?

If you have a lawyer involved soon after the accident, there may be an opportunity to settle with the insurance company directly.  This can be a much faster process than a lawsuit, although it is not appropriate or possible in some cases.

If you contact a lawyer too close before the limitation period expires (usually two years from the date of the accident), there will not likely be enough time to negotiate a resolution with the insurance company’s adjuster.  When that happens, a lawsuit will be required.  Where a lawsuit is started, cases rarely settle before examination for discovery which can when busy defence lawyers are on the other side of the case can be scheduled 8-10 months down the road.

You and The Insurance Adjuster-  Understanding the Adjuster’s Role in an Ontario Claim

Every month we receive telephone calls from Ontario accident victims who have been dealing directly with the insurance company in an effort to get fair compensation.  In many cases it is possible for a non-lawyer to handle his or her own claim and come out just fine, especially if the injuries are small and the loss is straightforward. 

However, the most serious mistake injured victims make is believing that the Ontario  insurance adjuster is on their side and is working for them.  This belief is just plain wrong and leads to many problems obtaining fair compensation for your case.

It is a fact that the insurance adjuster works for the insurance company.  That is true regardless of whether the adjuster is an employee of the insurance company or a so-called independent adjuster who has been contracted to look after your case.  It is also true if the adjuster is called a “claims representative” or a “customer service representative”.  The person sent by the insurance company to meet with you or who calls you on the telephone from the insurance company works exclusively for the insurance company.

The mandate of the insurance adjuster is to settle your claim as cheaply as possible.  The mandate is not to ensure that you receive all the compensation you deserve.

When the personal injury lawyers at Ottawa law firm Auger Hollingsworth explain this to injured victims and their families, they are often sceptical.  We are told:  “The insurance adjuster seemed so nice.”   “She came to the hospital with a cheque for our parking expenses.” “She sent flowers.”  All of this may be true.  It does not change what the adjuster is there to do.  In fact, the nicer the adjuster, the more likely you are to agree to whatever proposal she makes. 

Auger Hollingsworth is not saying all insurance adjusters are evil.  The vast majority of insurance adjusters are decent professionals who are just doing their job.  Our personal injury lawyers enjoy excellent professional relationships with most adjusters.  The fact remains, however, that their job is to settle your case, and all of the cases they are handling, for the least amount possible.

Would it make sense to have an Ottawa personal injury lawyer review your claim for compensation to see if you are on the right track?  The personal injury lawyers at Auger Hollingsworth offer no obligation free consultations to all injured victims whom we believe we can help.  To schedule a free consultation or to speak to a lawyer about your case, contact us today at info@ottawalawfirm.ca or by phone at (613) 233-4529.