About: Roger Foisy

Navigating the aftermath of a motor vehicle accident can be daunting, especially when it comes to dealing with insurance claims and potential settlements. Among the various options presented to you, a ‘full and final settlement’ of your accident benefits claim is a proposal sometimes offered by your insurer after you appeal the denial of various accident benefits to the Licence Appeal Tribunal (LAT).

What does it mean to accept a full and final settlement of your accident benefits claim? How does it impact your rights as a claimant, and how can it influence your future, particularly if your injuries have long-lasting effects?

By examining what a full and final settlement is, the risks of accepting it, and how a lawyer helps you accurately assess the value of your case, you will be better prepared to navigate the complexities of your claim and protect yourself in the future.

What is a Full and Final Settlement?

A full and final settlement is an agreement you reach with your insurance provider after a motor vehicle accident. This agreement is a specified amount of money, mutually agreed upon to cover all claims for benefits – past, present, and future – that arise from the accident, as against the accident benefits insurer. These claims can encompass a variety of accident benefits from medical and rehabilitation, attendant care, housekeeping (if your injuries have been deemed Catastrophic or if optional benefits have been purchased under the policy), income replacement benefits, non-earner benefits, or caregiver benefits.

Generally, the settlement is given to you, the claimant, as a lump-sum payment and requires consent from both you and the insurer. The primary purpose of this arrangement is to provide you with closure and support while also limiting the future financial risk for your insurance provider.

Why You Should Not Agree to a Full and Final Settlement

While it may initially appear beneficial to agree to a full and final settlement of your claim with your insurance provider, it is crucial to consider the long-term implications of such a decision. When you find yourself at a LAT hearing and are offered a settlement, for instance, the future impact of your injuries might be unclear. In such a state of uncertainty, signing off on a full and final settlement implies accepting a definite sum to support your injury, eliminating any chance for further assistance down the line.

Additionally, the severity of your injuries can often be underestimated. In most cases, the full extent of damage from an accident, including the treatment you may need, such as surgery, attendant care, income replacement and other support, can take several months or even years to materialize. There is also the possibility of complications during recovery, which would require additional financial aid. It is important to envision potential future scenarios, so consider the following before agreeing to a settlement:

Will you have a permanent disability in the future?

Will you be able to perform your job effectively after your settlement?

Have you had surgery, or will you need it in the future because of your injury? If so, what are the potential risks of the surgery?

Will you need to see a therapist to deal with the mental impact and events of the accident?

What rehabilitation costs may arise in the future?

A full settlement also limits your right to pursue a determination of catastrophic impairment. This opportunity is forfeited once you’ve settled your entire accident benefits claim with your insurance provider.

Lastly, remember that while dealing with the LAT, you may find your insurer offering a full settlement for your claim even though your appeal pertains to only a portion of the claim, such as medical rehabilitation benefits or income replacement benefits. Be wary of such instances and remember, it’s crucial to think long-term when it comes to settling your claim. While a full and final settlement of your entire claim may seem appealing in the short-term, especially if you are in desperate need of treatment and/or financial support, doing so may be detrimental to your long-term health and finances if you have not considered the questions above.

How to Know What Your Case is Worth

Knowing the value of your case is critical in ensuring you receive a fair settlement. A qualified and knowledgeable lawyer, backed with experience, will provide the essential support needed to navigate your claim. A personal injury lawyer from our team will effectively assess the quality of an offer and will guide and inform you when a settlement does not align with your current and (potential) future needs.

Are you looking for a lawyer to assist you with your LAT appeal? Contact us for a free consultation. Foisy & Associates is a team with extensive experience in handling complex personal injury and accident benefit cases and are lawyers for the people who fight to receive maximum dollars for their clients.

Roger R. Foisy, Harpreet S. Sidhu, Daniel Berman, and Rutumi Tank are Ontario Personal Injury Lawyers with extensive experience in motor vehicle accident cases before the LAT and courts. They are strongly supported by Rusald Laloshi, a senior paralegal who has also represented many clients before the LAT. If you have been injured in a motor vehicle accident, please get in touch with us for immediate support and a free consultation.

Accessing records from the Ontario Provincial Police (OPP) or municipal police can provide crucial information for personal injury victims, particularly in motor vehicle accident cases. In Ontario, individuals have the right to request records containing their personal information, including 911 calls, from the OPP or municipal police services. However, navigating the process and understanding your rights is essential.

This post explores accessing records that contain your personal information, considerations of exemptions and personal privacy, and highlights a recent decision that illustrates the challenges and victories in obtaining this vital information.

Understanding Your Rights: Access to 911 Calls

When you have been involved in a motor vehicle accident, it is essential to understand your rights regarding access to your personal information.

In Ontario, you have the right to request records that contain your personal information from the OPP or any municipal police service. This can be a valuable resource for obtaining crucial information related to your incident. Whether you request this information yourself or through a lawyer, the process typically involves submitting a formal request form and paying a required fee.

The information you can access includes incident and investigation reports, witness statements, Crown or police briefs, records of arrest, officers’ notes, and police-related 911 calls. These records often provide valuable insights into the accident’s circumstances, aiding in understanding what transpired and supporting your case when legal action is pursued.

Exemptions and Personal Privacy

While you have the right to request access to your personal information, it is important to be aware of the exemptions outlined in the Freedom of Information and Protection of Privacy Act. These exemptions may allow the police to deny your request for specific reasons.

There are mandatory and discretionary exemptions; for example, if disclosing certain information infringes upon someone else’s privacy rights, your request may be denied.

This can create challenges when you require access to information that you did not personally provide. For instance, in a recent case we handled, we were initially denied access to 911 calls relating to our client’s incident as they were made by a third party. This highlights the potential hurdles you may encounter when seeking information that involves the actions or privacy of others.

Appealing a Denial to Access Information

Foisy & Associates recently achieved a victory in overturning the Ministry of the Solicitor General (Ministry) ‘s decision to deny access to 911 calls pertaining to our client’s motor vehicle accident. Our initial request for the 911 calls aimed to better understand our client’s injuries and state of mind immediately following the collision.

The Ministry first denied our request, citing the third-party nature of the witness’ call and the Freedom of Information and Protection of Privacy Act. However, we emphasized that our client’s interest lay solely in the information provided by the caller, not their identity or contact details. Given our client’s head injury and loss of consciousness, accessing the 911 calls would give vital insight into their well-being in the critical moments after the accident. Despite our clarification, the Ministry denied access once again.

Undeterred, we appealed the decision to the Information and Privacy Commissioner of Ontario. In a favourable outcome, it was determined that the Ministry must disclose the requested 911 calls. Since neither call contained personal information or identified the callers and considering our client’s memory loss due to their sustained injury, the calls were deemed relevant to our client’s collision. We were given access to the records.

For more information about this reported decision, please visit the reported decision’s page.

You Can Fight to Receive Information

If you have been denied information by the Ministry, it is important to know that not all hope is lost. With valid reasoning, appealing to the Information and Privacy Commissioner of Ontario may allow you access to these records.

Obtaining access to records with your personal information can be a pivotal step in gathering critical evidence to support your personal injury or long-term disability claim. As you move forward, it is crucial to have a legal team by your side that is committed to fighting for your rights and pushing for the results you deserve.

If you or someone you love has been denied benefits by your automobile insurance or long-term disability provider, we encourage you to contact us for a free consultation. Roger R. Foisy & Associates is a team with extensive experience in handling complex personal injury and long-term disability cases, and are lawyers for the people who fight to receive maximum dollars for their clients.

Roger R. Foisy, Harpreet S. Sidhu, Daniel Berman are Ontario Personal Injury Lawyers with extensive experience in motor vehicle accident cases. They are strongly supported by Rusald Laloshi, a senior paralegal who has also represented many clients before the LAT. If you have been injured in a motor vehicle accident, please get in touch with us for immediate support and a free consultation.

When it comes to a Licence Appeal Tribunal (LAT) hearing, preparation is key. At Foisy & Associates, we take several crucial steps to ensure our clients are well-equipped for their hearing. While the process may differ from case to case, we follow a general approach that empowers our clients to feel confident and ready for the tribunal.

A LAT hearing can be daunting, but our legal team is here to help. Learn about the steps we take to support our clients in feeling ready for their hearing.

1. Understanding the process:
   We start by explaining the LAT hearing process to our clients, including its purpose, structure, and potential outcomes. This helps you know what to expect and feel more at ease during the hearing.
2. Review the case:
   Each case is reviewed with our client, going over the facts, evidence, and legal arguments. Reviewing helps clients understand the strengths and weaknesses of their case. We also discuss any potential challenges that may arise during the hearing.
3. Prepare documents:
   We ensure that all relevant documents and evidence are organized and submitted to the Tribunal promptly. Documents submitted include medical records, expert reports, a Witness Will Say, and any other pertinent documents.
4. Develop a strategy:
   Together with our clients, we develop a clear and concise strategy for presenting their cases. This may involve deciding which arguments to emphasize, what evidence to present, and how to best address any weaknesses in the case.
5. Practice testimony:
   We help our clients prepare for giving testimony during the hearing. We understand this is a very stressful part of the case, so we focus our time on answering potential questions, guiding clients on how to present themselves confidently, and advising them on handling cross-examination.
6. Familiarize with the hearing room:
   We help our clients understand what a virtual hearing will comprise of, and all the participants involved on any given day of testimony. This allows our clients to feel more comfortable and reduce anxiety on the day of the hearing.
7. Address logistical details:
   We make sure to keep our clients informed about the schedule of the LAT hearing, which includes the specific date and time of witness testimony. Additionally, we also provide any necessary guidelines or procedures that our clients need to follow during the hearing.
8. Emotional support:
   The LAT hearing can be an emotionally challenging experience. Our team can arrange for emotional support and reassurance, helping our clients maintain a positive attitude and confidence throughout the process.
9. Post-hearing follow-up:
   After the LAT hearing, we will debrief with our clients, discussing how the evidence unfolded, potential next steps, anticipated waiting times for the decision rendering, and addressing any concerns or questions our clients may have.

At Foisy & Associates, we understand the challenges that come with preparing for a Licence Appeal Tribunal hearing. However, by following the steps outlined above and working with our experienced legal team, our clients can feel confident and well-prepared for their hearing. We are dedicated to providing personalized attention and support to each of our clients to ensure they receive the best possible outcome for their case.

If you or someone you love has been denied accident benefits by your automobile insurance provider, we encourage you to contact us for a free consultation. Foisy & Associates is a team with extensive experience in handling complex personal injury and long-term disability cases, and are lawyers for the people who fight to receive maximum dollars for their clients.

Roger R. Foisy, Harpreet S. Sidhu, Daniel Berman, and Rutumi Tank are Ontario Personal Injury Lawyers with extensive experience in motor vehicle accident cases. They are strongly supported by Rusald Laloshi, a senior paralegal who has also represented many clients before the LAT. If you have been injured in a motor vehicle accident, please get in touch with us for immediate support and a free consultation.

When an automobile accident occurs, the consequences can be life altering. For some, the injuries sustained can lead to a determination of catastrophic impairment. Understanding what catastrophic impairment is, how it’s defined in Ontario, and who makes a determination will allow you to be better prepared in the situation where you have suffered a permanent injury and believe you are catastrophically impaired.

Catastrophic impairment is a legal definition constructed by the Statutory Accident Benefits Schedule (SABS) to govern accident benefits claims. In Ontario, individuals who are considered catastrophically impaired are entitled to more substantial accident benefits than someone who experiences non-catastrophic or minor injuries.

Types of Injury Impairment

The SABS sets out three categories of injuries to determine how much money will be available to an individual after being injured in an automobile accident. Each person’s situation may differ depending on the type of benefits they have chosen, as optional benefits may entitle a person to further coverage.

Minor Injury Guideline

An individual will be classified under the Minor Injury Guideline (MIG) if they experience whiplash-related injuries, muscle strains or strains, contusions, or lacerations. An individual who falls under the MIG is entitled to $3,500 for their medical rehabilitation needs.

Non-Catastrophic Injuries

An individual who does not fall into the MIG will be classified as non-catastrophic. This typically provides up to $65,000 of medical rehabilitation and attendant care funding for up to five years from the date of the accident. For minors who have suffered injuries relating to a motor vehicle accident the duration of these benefits is funded for no more than 10 years for a minor who was 15 to 17 years old at the time of the accident; or until the minor turns 25 years old, if the minor was less than 15 years old at the time of the accident.

Catastrophic Injury

If a person has sustained more serious injuries than indicated in the MIG or non-catastrophic designations, they may meet the description of catastrophic impairment. To be found catastrophically impaired, a person must meet certain criteria as set out in the SABS.

A person who has suffered catastrophic impairment is entitled to a minimum of one million dollars over their lifetime for medical, rehabilitation, and attendant care benefits.

Catastrophic Impairment Criteria in Ontario

When determining catastrophic impairment designation, the SABS looks at impairments rather than the injury itself. The current (post-June 2016) legislation describes the following as “catastrophic impairments”:

1. Paraplegia or tetraplegia that meets the following criteria:
   1. The insured person’s neurological recovery is such that the person’s permanent grade on the ASIA Impairment Scale can be determined.
   2. The insured person’s permanent grade on the ASIA Impairment Scale is or will be,
      1. A, B or C, or
      2. D, and
         1. the insured person’s score on the Spinal Cord Independence Measure is 0 to 5,
         2. the insured person requires urological surgical diversion, an implanted device, or intermittent or constant catheterization to manage a residual neurological impairment, or
         3. the insured person has impaired voluntary control over anorectal function that requires a bowel routine, a surgical diversion, or an implanted device.
2. Severe impairment of ambulatory mobility or use of an arm, or amputation that meets one of the following criteria:
   1. Trans-tibial or higher amputation of a leg.
   2. Amputation of an arm or another impairment causing the total and permanent loss of use of an arm.
   3. Severe and permanent alteration of prior structure and function involving one or both legs as a result of which the insured person’s score on the Spinal Cord Independence Measure is 0 to 5.
3. Loss of vision in both eyes that meets the following criteria:
   1. Even with the use of corrective lenses or medication,
      1. visual acuity in both eyes is 20/200 (6/60) or less as measured by the Snellen Chart or an equivalent chart, or
      2. the greatest diameter of the field of vision in both eyes is 20 degrees or less.
   2. The loss of vision is not attributable to non-organic causes.
4. If the insured person was 18 years of age or older at the time of the accident, a traumatic brain injury that meets the following criteria:
   1. The injury shows positive findings on a computerized axial tomography scan, magnetic resonance imaging, or any other medically recognized brain diagnostic technology indicating intracranial pathology that is a result of the accident, including but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift or pneumocephaly.
   2. When assessed in accordance with the Glasgow Outcome Scale, and the Extended Glasgow Outcome Scale the injury results in a rating of,
      1. Vegetative State (VS or VS*), one month or more after the accident,
      2. Upper Severe Disability (Upper SD or Upper SD*) or Lower Severe Disability (Lower SD or Lower SD*), six months or more after the accident, or
      3. Lower Moderate Disability (Lower MD or Lower MD*), one year or more after the accident.
5. If the insured person was under 18 years of age at the time of the accident, a traumatic brain injury that meets one of the following criteria:
   1. The insured person is accepted for admission, on an in-patient basis, to a public hospital named in a Guideline with positive findings on a computerized axial tomography scan, a magnetic resonance imaging, or any other medically recognized brain diagnostic technology indicating intracranial pathology that is a result of the accident, including, but not limited to, intracranial contusions or haemorrhages, diffuse axonal injury, cerebral edema, midline shift, or pneumocephaly.
   2. The insured person is accepted for admission, on an in-patient basis, to a program of neurological rehabilitation in a paediatric rehabilitation facility that is a member of the Ontario Association of Children’s Rehabilitation Services.
   3. One month or more after the accident, the insured person’s level of neurological function does not exceed category 2 (Vegetative) on the King’s Outcome Scale for Childhood Head Injury.
   4. Six months or more after the accident, the insured person’s level of neurological function does not exceed category 3 (Severe disability) on the King’s Outcome Scale for Childhood Head Injury.
   5. Nine months or more after the accident, the insured person’s level of function remains seriously impaired such that the insured person is not age-appropriately independent and requires in-person supervision or assistance for physical, cognitive, or behavioural impairments for the majority of the insured person’s waking day.
6. A physical impairment or combination of physical impairments that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, results in 55 percent or more physical impairment of the whole person.
7. A mental or behavioural impairment, excluding traumatic brain injury, determined in accordance with the rating methodology in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, that, when the impairment score is combined with a physical impairment and combining requirements in the guide, results in 55 percent or more impairment of the whole person.
8. An impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, results in a class 4 impairment (marked impairment) in three or more areas of function that precludes useful functioning or a class 5 impairment (extreme impairment) in one or more areas of function that precludes useful functioning, due to mental or behavioural disorder.

Determination of Catastrophic Impairment

A determination of catastrophic impairment is usually made by your insurance company at the recommendations of medical professionals. Some injuries, such as paraplegia, total loss of vision in both eyes, and complete loss of use of lower or upper extremities, are automatically deemed as catastrophic.

In most cases the injured person, or their representatives, will obtain medical opinions from experts to support the conclusion that they have reached a permanent impairment that is classified as catastrophic under the law. If the insurer disagrees with the experts, they are entitled to a second opinion and catastrophic impairment assessments from their own experts.

In cases where an insurance company and injured person do not achieve the same conclusion (i.e. one party maintains catastrophic impairment and the other disagrees), the matter will be brought before the Licence Appeal Tribunal. In this situation an adjudicator will allow both parties to present their evidence, and will make a final determination regarding the injured person’s impairment.

Obtaining a determination can be a long, drawn-out process. It is recommended that you work with a personal injury lawyer with experience in catastrophic impairment determinations and who has had experience with appearing before the Licence Appeal Tribunal. A lawyer who can effectively advocate for you and your rights can help guarantee that you are treated fairly and that you receive the appropriate determination.

If you or someone you love has been denied catastrophic impairment by your automobile insurance provider, we encourage you to contact us for a free consultation. Roger R. Foisy & Associates is a team with extensive experience in handling complex personal injury and long-term disability cases, and are lawyers for the people who fight to receive maximum dollars for their clients.

For more information on catastrophic impairment, please visit our Frequently Asked Questions page.

Roger R. Foisy, Harpreet S. Sidhu, and Daniel Berman are Ontario Personal Injury Lawyers with extensive experience in motor vehicle accident cases. They are strongly supported by Rusald Laloshi, a senior paralegal who has also represented many clients before the LAT. If you have been injured in a motor vehicle accident, please get in touch with us for immediate support and a free consultation.

Expert witnesses are essential to appealing a case before the License Appeal Tribunal (LAT), but they can have severe implications for your disbursements if you are not careful.

You may recall from earlier blogs that disbursements are third-party expenses you will pay following the successful resolution of your case. Disbursements are in addition to legal fees, which lawyers charge for the legal services they provide to you for a claim. Disbursements will include the cost of retaining an expert witness.

Expert witnesses specialize in their given field and will give their opinion before a court or a tribunal. A medical expert who testifies in the LAT process provides a medical opinion about an applicant’s injuries concerning a treatment plan, attendant care benefits, income replacement benefits, and even catastrophic impairment determination.

While having such expert witnesses helps bolster your case before the LAT, they can present substantial accounts for their work.  Depending on the lawyer you choose, your expert fees can increase over time. Working with a lawyer who pays your expert fees quickly ensures you are not unnecessarily increasing your disbursement account—from interest on overdue accounts—which will be deducted directly from any future settlement of your accident benefits.

Table of Contents

• What do expert witnesses and third-party medical experts do for a case?
• How much do expert fees cost?
• Is the applicant the one who pays?
• Why are certain expert fees substantially higher than others?
• What happens to my expert fees if the LAT denies my appeal?
• What does Roger R. Foisy & Associates do to help?

What do expert witnesses and third-party medical experts do for a case?

When you participate in a LAT hearing, three types of witnesses participate:

• Lay witnesses, like family members and coworkers, know firsthand how an applicant’s function has been affected by the motor vehicle accident
• Treating witnesses, like family doctors, psychologists, and occupational therapists
• And Expert witnesses, who are retained by both you, the applicant, and the insurance company, the respondent

An expert witness is a person permitted to provide their expert opinion because of their unique knowledge and proficiency in a related field to the case – in LAT cases; these are often medical experts.

Expert witnesses are generally asked to answer a mix of legal and medical questions regarding your case. For example, experts may be asked to comment on a legal test or definition that an applicant has to meet to qualify for a particular benefit or to respond to whether an applicant’s requested treatment plan is considered reasonable and necessary for their injuries.

At Roger R. Foisy & Associates, we regularly use experts to comment on whether our client meets a medical-legal definition that renders them catastrophically impaired.

How much do expert fees cost?

The use of experts in a LAT appeal is an important consideration. For one, they can help you prove that a pre-existing condition did not cause your injury; or help to support the need for specific treatment and rehabilitation.

When your legal and medical team believes that your injuries from your motor vehicle accident have rendered you catastrophically impaired, insurance companies will cover up to $2,000 for a single medical expert assessment.

You will often need several expert assessments completed for a catastrophic impairment determination. Suppose you require six different assessments, which could include assessments from a neurologist, an orthopaedic surgeon, an odontologist, a psychiatrist and occupational therapists. In that case, the insurance company could pay up to $12,000 ($2,000 each) for those assessments. However, these expert assessments usually cost more – closer to  $5,000-7,000 each. Applicants must realize they become responsible for the fees outside the insurance company’s payments.

If each assessor charges $7,000 and insurance covers only $2,000 of those fees, the applicant becomes responsible for the remaining $5,000 from each assessment. In our example, that would amount to $30,000 outstanding, owed by you!

Remember, though, this is only for a report regarding the determination of catastrophic impairment. Experts who testify in a LAT appeal hearing charge additional fees. Experts generally charge 1-2 hours to meet with your lawyer, 2-3 hours of individual preparation and usually testify before the LAT for half a day (3-4 hours). Depending on an expert’s hourly rate, a client can expect an expert fee to be as low as $1,200 to as high as $10,000 for testifying.

Is the applicant the one who pays?

When appealing to the LAT, we highly recommend that the applicant works with a law firm that will pay their expert fees within 30-90 days upon receipt of an expert’s invoice to avoid accruing unnecessary interest. These expert fees will become a part of the disbursements your lawyer will charge you for their services after the resolution of your case, be it a settlement or a hearing.

Why are certain expert fees substantially higher than others?

Expert fees are usually charged to a law firm upon completing the expert’s service (i.e., a medical opinion report or testimony before a tribunal). If a law firm does not have enough funds to pay the invoice immediately, the expert or law firm may often connect with a litigation loan company that will ensure their fee is paid immediately. That loan company will often act as a creditor charging interest on the invoice paid to the expert on your behalf. Upon resolving your matter, you will now be required to pay the loan company for the cost of the expert report and the interest accrued during this time. This amount becomes a disbursement which will be deducted from the overall monies you can expect to receive from any decision or settlement of your case.

In cases where litigation loan companies are not involved, experts will often charge a more significant fee if they know a law firm will take longer to pay its invoice while it waits to settle. In these situations, these increased fees also become part of your disbursements.

What happens to my expert fees if the LAT denies my appeal?

In this situation, your law firm will still use the expert information in your case outside of the LAT forum, against the person who was at fault in your vehicle accident, as the information obtained will help to win your case.

When your case is settled, the costs for these third-party expert witness fees will be claimed as a disbursement in that case and become payable from your settlement or judgment.

What does Roger R. Foisy & Associates do to help?

Roger R. Foisy & Associates does not use litigation loan companies to pay for experts. They pay each expert within a 30-90 day period from the receipt of the expert report. This ensures that the expert does not have to incorporate additional costs into the invoice. It is well understood that in the personal injury field of practice, experts who are expected to wait to be paid for their services often charge more for their legal opinions. If it takes anywhere from six months to three additional years to settle a case from the delivery of the expert opinion, how much extra will an expert be charging while they wait to be paid for their expert services?

Our law firm team members are trained to ensure that when you only obtain the services of third-party experts you require to prove your claim, you will not pay for more expert assistance than you need. Our lawyers use strategy and consider the many factors of your case to decide when and whom we obtain as third-party experts. We do not treat you as part of a transaction but prioritize working on your case as effectively as possible.

We pledge that the job is done right, and our project management processes save you money in the long term. Our methods to keep you from paying extensive and unnecessary expert fees can help you save tens of thousands of dollars in disbursements.

Are you looking for a lawyer to assist you with your LAT appeal? Contact us for a free consultation. Roger R. Foisy & Associates is a team with extensive experience in handling complex personal injury and accident benefit cases and are lawyers for the people who fight to receive maximum dollars for their clients.

Roger R. Foisy, Harpreet S. Sidhu, and Daniel Berman are Ontario Personal Injury Lawyers with extensive experience in motor vehicle accident cases before the LAT and courts. They are strongly supported by Rusald Laloshi, a senior paralegal who has also represented many clients before the LAT. If you have been injured in a motor vehicle accident, please get in touch with us for immediate support and a free consultation.

If you need to go through the Licence Appeal Tribunal (LAT), it is essential to have a representative who can effectively advocate for you and protect your rights and interests. Without legal representation, you may be at a disadvantage and may struggle to present your case effectively. Although it is possible to represent yourself before the LAT, it is usually in your best interests to seek legal counsel to ensure that you are treated fairly and your rights are protected.

What is the Licence Appeal Tribunal?

The LAT is a quasi-judicial agency that reviews applications and resolves disputes related to compensation claims and licensing activities. It is composed of two divisions: the General Service division and the Automotive Accident Benefits Service (AABS). These divisions provide adjudicators who review appeals and try to resolve disputes between claimants and insurance providers.

For more information about the LAT, visit our LAT resources page.

Why do I need legal representation for the LAT?

Technically, you are not required to have a legal representative when you appear before the LAT.

At Roger R. Foisy & Associates, we strongly recommend that you retain the services of a legal representative, whether that be a paralegal or lawyer. Both paralegals and lawyers are governed by the same laws and principles, but there are some differences between the two types of legal representation.

Paralegals may seem to be a more affordable option than a lawyer, however in this area of law paralegals and lawyers charge the same or very similar contingency fee rates. It is important to note that paralegals are restricted in the types of benefits they can dispute before the LAT. Lawyers are able to represent clients in a wider range of case situations, specifically disputes involving the determination of catastrophic impairment.

If you have suffered serious injuries, it is especially important to hire an experienced lawyer who can effectively argue your case before the LAT. At Roger R. Foisy & Associates, we have worked extensively with the LAT and are confident in our lawyers’ ability to achieve the maximum compensation for our clients.

Why should I use a lawyer when I appear before the LAT?

The best choice for your advocate is one who understands the LAT and can represent you no matter your situation.

For effective advocacy before the LAT, you should strongly consider using a lawyer with experience and a thorough understanding of the regulatory framework and behaviours during an appeal. Your lawyer should have experience appearing before the LAT, including the completion of oral hearings. An experienced lawyer will have examined and cross-examined lay witnesses, treating witnesses and expert witnesses.

More importantly, an experienced lawyer will be able to guide you through the process where the opportunity of a fair and reasonable settlement can be achieved.  However, if an insurance company is unwilling to settle, an experienced lawyer will be able to properly represent you at the LAT hearing.

Additional Costs

Depending on the type of appeal you are advancing, your case may also require additional costs.

If you are appearing before the LAT for complex issues like income replacement benefits, attendant care benefits, or the determination of catastrophic impairment, you will need expert witnesses to provide the information you need to win your case.

Experts require payment for their reports as well as their testimony if they are to appear as an expert on your behalf at an oral hearing at the LAT. Some law firms including ours will advance the costs associated with hiring expert witnesses for your case, which can vary between $25,000-$35,000.

In these situations, your law firm requires the financial means to handle the expenses of third-party medical reports and expert testimony.

It is important to understand that the law firm you hire is prepared to fund these expenses in the event you are required to appeal your insurance company’s denial of your accident benefits.

If you or someone you love has been denied benefits by your automobile insurance provider, we encourage you to contact us for a free consultation. Roger R. Foisy & Associates is a team with extensive experience in handling complex personal injury and long-term disability cases, and are lawyers for the people who fight to receive maximum dollars for their clients.

Roger R. Foisy, Harpreet S. Sidhu, and Daniel Berman are Ontario Personal Injury Lawyers with extensive experience in motor vehicle accident cases. They are strongly supported by Rusald Laloshi, a senior paralegal who has also represented many clients before the LAT. If you have been injured in a motor vehicle accident, please get in touch with us for immediate support and a free consultation.

On June 1, 2016, Ontario changed the benefits for automobile insurance, making adjustments that limit your access to long-term medical and rehabilitation benefits. This change was made quietly, and the people of Ontario were uninformed about the amendments made to their insurance policies.

These changes were silent but created serious consequences, leaving thousands of Ontarians affected since June 2016.

Meet Adam

Adam* purchased automobile insurance in August of 2016 thinking he had coverage that would protect him from any injuries he may obtain in the event of a motor vehicle accident.

Like every Ontarian, Adam shopped around. He knew it was mandatory to have coverage but wanted to save money, so he purchased the standard policy at the best price he could find and assumed he had the best protection available. He did not know to ask any further questions, nor did his broker make him aware of additional options available.

When Adam got into an accident in March 2017, he suffered serious injuries which were deemed non-catastrophic by his insurer. Under the new benefits limits, that meant Adam would be eligible for a maximum of $65,000 of medical rehabilitation and attendant care coverage for a fixed period of five years – whichever came first. Between his auto insurance coverage, work benefits plan, and OHIP, he and his family assumed he would be able to fully pay for the rehabilitation support he needed for as long as it took for him to recover.

Shouldn’t OHIP and work benefits have covered that?

As Adam worked on his recovery the money quickly dwindled. Adam, like many Ontarians, thought that OHIP would cover him for any costs required for treatment, with his auto policy and work benefits paying for the difference. However, he soon realized that funding through his work benefits was limited, as was the protection provided by OHIP. In fact, the majority of the treatment he needed for recovery was only available through private clinics and had to be paid for by his auto policy.

When he turned to OHIP, he was permitted 4 hours per day of personal support care. His work benefits provided no coverage for personal support care, and so he was left without support for 20 hours per day.

His wife was able to take a few days off work to assist him, however, he would require aid for a 3-month period. His wife was unable to take that much time from work, and so they had to find another option.

When Adam turned to his auto insurer, he learned that he was entitled to a maximum of $3,000 a month for the assistance of a Personal Support Worker (PSW) at the hourly rates set by the provincial regulations for persons injured in an auto accident.

With the actual current rate of $40 per hour, this only gave him 75 hours of attendant care per month versus the over 700 hours per month that he actually required – particularly in the first three months when he was immobile and unable to perform basic tasks for himself.

Assuming that the insurance company paid him the $3,000 a month for treatment, Adam would have used $9,000 out of the $65,000 available from his policy just on the minimal amount of attendant care support he received. Before Adam had even begun treatment, he had used up 14% of his total benefits available to him over the five-year coverage period.

Adam now needed to pay for regular physiotherapy, massage therapy, and rehabilitation therapy to begin his recovery. His employee benefits covered the first $300 of each type of therapy, but that was not going to be nearly enough.

Because of the injuries that made him non-weight bearing, Adam’s physiotherapy was in-home for the first month, followed by in-clinic treatment for months afterward. Considering that the average in-home physiotherapy session cost is $100 (plus travel time for in-home care) and that he needed 2-3 sessions per week for the near future – never mind the other types of therapy he needed, plus medication – Adam began to realize how little coverage he had.

The Five-Year Limit Surprise

Worst of all as Adam began his recovery, he quickly understood that it would not take weeks or even months, but rather years to heal. In fact, some injuries would require a lifetime of therapy to allow him to function adequately at home and, when he eventually returned, at work.

He learned that the term “non-catastrophic” was an insurance term that did not reflect the reality of his situation which felt catastrophic and life-altering to him.

Because Adam did not buy the optional benefits that would have provided him with $1 million of LIFETIME coverage for non-catastrophic injuries, he discovered, to his surprise, that his insurance company’s financial assistance would only last him for five years, or when the limited non-catastrophic medical rehabilitation benefits of $65,000 were depleted. His injuries, however, would last him forever.

Adam was forced to either give up on many parts of his recovery, trying to spread out the remaining funds over the next four years or pay thousands of dollars out of pocket. He simply could not afford to go on with therapy the way that he wanted. His life was changed forever, and insurance was not able to help.

Very often, in other cases, the five years runs out before money does, creating a very heavy financial burden on the injured person and their family over the injured person’s lifetime.

What Might Have Been

If Adam had been made aware, by his insurer or broker, of the available optional benefits, things would have been very different. For around $100 a year, he could have protected himself for life with access to up to $1 million for non-catastrophic Medical Rehabilitation Benefits and $3 million if he was deemed catastrophic.

Adam made an easy mistake. He was uninformed and thought that he was making the best decision.

Why did Adam not know? Most people shop based on price and our clients tell us that their brokers and insurance companies did not take the time to explain optional benefits to them. Without the information necessary to make an informed decision, most people choose a standard policy without knowing the risks.

Are you protecting yourself?

Since June 1, 2016 hundreds of thousands suffered personal injuries while in an automobile accident in Ontario. If you or your family ever take trips on the highway, visit family, or commute to work, it is imperative to include optional benefits in your automobile insurance policy.

June 1, 2016, is known by many personal injury lawyers as Doomsday because of the impact it had on their clients and how many lives have been altered due to Ontario’s changes to automobile insurance. These changes have put the responsibility on YOU to be aware of optional benefits and how important they are to protect yourself and your family.

What changes have been made?

Before the adjustment, regular benefits provided the following:

• medical rehabilitation benefits of $50,000 for ten years
• attendant care benefits for $36,000 for ten years
• catastrophic injury benefits for medical and rehabilitation needs of $1 million for life
• attendant care of $1 million for life

With the June 2016 update, regular automobile benefits have been changed to offer the following:

• medical rehabilitation and attendant care benefits have merged and reduced to $65,000 for five years
• the catastrophic medical rehabilitation and attendant care benefits have merged to provide $1 million in total for Life Expectancy

These changes have been made to simplify things for auto insurance companies but provide you with less support and coverage. What are you supposed to do?

The best way to protect yourself and your dependants is by signing up for optional benefits.

The chart below illustrates the optional Medical Rehabilitation Benefits available to you and the estimated annual costs.

Download chart in PDF to discuss with your insurer or broker.

What do optional benefits provide? 

For an additional $100 a year**, you can adjust the coverage you receive in every situation.

Increase in Benefits

Adding optional benefits for non-catastrophic injuries provides $1 million in coverage for all medical, rehabilitation, and attendant care benefits needs – up from $65,000 for standard benefits.

You will also increase your support to $3 million for catastrophic injuries – up from $1 million for standard benefits. For catastrophic injuries, particularly if you are still of working age and have financial responsibilities, $1 million is not nearly enough for your support and recovery. 

Protection for Dependants

It is important to note that the automobile benefits that you have carry across for not only yourself and your vehicle, but your dependants as well. Purchasing the right insurance means keeping yourself and your family protected no matter what happens.

Lifetime Coverage

As we discussed earlier in the case of Adam’s “non-catastrophic” injuries, $65,000 was only going to be available for five years, assuming the money lasted that long. In many other cases, there are funds left over when the five years expire, despite needing to continue treatment. Optional benefits last for life.

While $1 million for catastrophic injuries sounds like a lot of money, the concern lies in the five year time limit to use the money available rather than just how much your insurance offers you financially. If it is not used in the five years of support offered, it is gone.

By definition, catastrophic injuries are just that – catastrophic. In our experience, the physical, emotional, and psychological problems do not go away in five years. Furthermore, you could try a different career ten years after your accident, bringing out an old injury, and need physiotherapy to help adjust.

These injuries will impact you for the rest of your life – your insurance should protect you for life, too.

How do I get optional benefits?

Ask Your Insurer/Broker Questions

There is nothing wrong with shopping for the best price on your automobile insurance. However, once you have the best price, ask the insurer or broker to add the maximum optional Medical Rehabilitation Benefits available. Ask for non-catastrophic coverage of $1 million and catastrophic coverage of $3 million. You will be shocked to find out that only a few extra dollars per month will provide so much more coverage for you and your family.

For those who are intimidated, we encourage you to download our helpful chart to send to your insurer or broker. We have also put together two questions to ask your current insurer or broker:

1. Does my policy or quote include maximum optional benefits for non-catastrophic Medical Rehabilitation Attendant Care and catastrophic benefits for life?
2. If not, how much will it cost to add the optional $1 million non-catastrophic Medical Rehabilitation Attendant Care (M/R/AC) benefit for life AND the $3 million (M/R/AC) catastrophic benefit for life?

Then ask yourself: for the additional few dollars a month, can I afford NOT to protect myself and my family for life in the event of an accident?

Find the Right Insurer/Broker

A good insurer or broker will be able to provide insight on how to integrate optional benefits into your plan. Be sure to give them time to answer your questions – some may not have the information about optional benefits that you need immediately, since this change was so swept up under the rug. If you do not get the answers you need, however, consider shopping around for another insurer or broker who will advocate for you.

Once you have added the optional benefits to your plan, ask your broker to show them to you in your policy. This way you can guarantee that your benefits are there, and they are not missed.

Optional Benefits Create Peace of Mind

While there are several types of benefits and features that you can add to your policy, we encourage you to choose the highest optional benefits for Medical Rehabilitation Attendant Care offered. The peace of mind provided by guaranteeing lifelong coverage is the best support you can ask for.

Share this blog with others who might not be aware to help them better understand how they can protect themselves.

Consider also providing these benefits to others who may not know the available options. What better gift to provide your parents for Christmas, or your children who are just starting a family? Peace of mind is a better present than another gift card, or worse: another cologne.

If you have sustained a personal injury or disability, contact Foisy and Associates for a free consultation to find out how we can help.

*Real name has been changed for confidentiality

**Rates may vary depending on your provider.

If you have car insurance this does not mean that you can’t still be sued personally if you are involved in a car accident. Your insurance company will only cover you up to the amount of insurance coverage you have. Many people are under the impression that they purchase insurance to protect themselves from being sued and losing their home.

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Most Ontario automobile owners purchase higher third party insurance liability limits than the mandatory minimum coverage of $200,000. However, I suggest that the reason a consumer chooses higher coverage (usually $500 thousand or $1 million) is only due to the fact their insurance agent suggests this amount will help keep the overall automobile insurance premium down.

While your insurance representative will be able to help you decide what level of coverage is best for you, it helps to be well-informed about what is available to you before making that call.
The current Ontario law requires that each motor vehicle owner carry a minimum of $200,000. This minimum amount has been in place for decades in Ontario despite the fact that injury awards have increased to keep up with inflation over the years. Take for example, if you were found at-fault for a motor vehicle accident back in 1978 and rendered an accident victim such as a quadriplegic, the courts would have awarded the injured victim approximately $100,000 for pain and suffering. Of course this award would not include other losses for possible past and future medical and/or income losses.

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Car accident benefits have been slashed up to 50% and some benefits have been eliminated — how will accident victims be able to cope?

My clients almost always tell me that before their car accidents, they thought insurance was both boring and confusing. For these reasons they decide to put their insurance coverage at the bottom of their priority list.

This fall, car insurance is moving from the back burner to the front burner. Despite the confusing nature of the insurance contract itself and whether or not anyone could ever spare the time to read all of the fine print contained within an insurance policy, here is what everyone needs to pay attention to:

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The Ontario government is introducing significant reforms to the auto insurance system, if you have never taken the time to consider the differences you can expect from your now Standard Auto Insurance Policy and what it will look like on September 1, 2010, it is imperative you take the time NOW:

Standard Auto Insurance Policy

All auto insurance policies will continue to include the following:

Third‐Party Liability

Uninsured Auto coverage

Direct Compensation‐Property Damage

Statutory Accident Benefits

In addition, if you previously purchased Collision and/or Comprehensive coverage, it will still be included in your policy.

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A Quick Summary of the Changes

Accident benefits for non-catastrophic injury claims will undergo some major changes, including:
• Caregiver Benefits – The $250 per week, plus $50 per additional person in need of care will be eliminated
• Medical and Rehabilitation Benefits – These benefits are being reduced to $50,000 from $100,000
• Attendant Care Benefits – These benefits will be reduced to $36,000 from $72,000 per annum
• Housekeeping Benefits – The $100 per week housekeeping benefit will be eliminated

Accident benefits for catastrophic injury claims will undergo some major changes, including:
• Treatment assessment costs will be deducted out of the specific benefit limit
• There will be no ability to apply for Catastrophic designation (whole person impairment test or the marked/extreme mental or behavioural test) in the first two years post-accident, except in cases where a brain injury is present
• There will incur a definition for “incurred” which will require the insured person to pay for the expense, and the service provider to be a professional provider, except in cases of family members whom are able to prove loss of income
• Assessment costs are limited to $2,000

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Planning on lots of driving this summer?

Heading up to the cottage this summer? Planning on a “see Canada” road trip vacation? A tune-up for your car before any big driving vacation is always a good idea but what about a “tune-up” for your insurance?

Before you pack, it’s always a good idea to check your insurance policies. The driving risks for cottager commuters, who spend many hours behind the wheel, increase during the summer months.

Unfortunately, the fun and relaxation for cottagers is sometimes overshadowed by the additional risks. Not only are there the driving risks on the road, but there is always the possibility of mishaps which can easily occur on the water or with a fire pit that accidently gets out of control. Many people are dismissive about mishaps, thinking that they always happen to other people.

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Should you be Increasing Your Liability Coverage?

Most Ontario automobile owners purchase higher third party insurance liability limits than the mandatory minimum coverage of $200,000. However, I suggest that the reason a consumer chooses higher coverage (usually $500 thousand or $1 million) is only due to the fact their insurance agent suggests this amount will help keep the overall automobile insurance premium down.

While your insurance representative will be able to help you decide what level of coverage is best for you, it helps to be well-informed about what is available to you before making that call.

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Housekeeping and Home Maintenance Benefits – What you need to know about your Insurance Policy Accident Benefits if you have been involved in a motor vehicle collision

Many individuals who have suffered injuries as a result of a motor vehicle accident in Ontario have come to realize that their injuries have affected their ability to carry-on with housekeeping and home maintenance in the same manner which they were accustomed to before their car accident.

Under the current Ontario Insurance Act, Statutory Accident Benefits Schedule, an accident victim is entitled to claim assistance from their own accident insurer if a health care provider confirms that they are unable to substantially perform the housekeeping and home maintenance services they normally performed before the accident. In this situation, an insurer shall pay up to $100 per week for reasonable and necessary additional expenses incurred by or on behalf of an insured person. These benefits were available to insured persons for 2 years from the date of their automobile accident.

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