About: Roger Foisy
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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.
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.
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.
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:
- Does my policy or quote include maximum optional benefits for non-catastrophic Medical Rehabilitation Attendant Care and catastrophic benefits for life?
- 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.
Roger R. Foisy has been invited to participate as a panelist on the Ontario Trial Lawyers Association (OTLA) roundtable on Examination for Discovery of an LTD Defendant.
Other prominent lawyers who will be part of the panel include Nainesh Kotak, Steve Rastin, and Najma Rashid.
Roger is regularly invited to speak at OTLA and other organizations on topics relating to Long-Term Disability, Personal Injury, and Practice Management.
The 60-minute in depth roundtable will focus on the defendant discovery in LTD cases. Topics discussed will include:
- Timing of discovery
- Who to examine?
- Areas of questioning
- Refusals and undertakings
- The use of Simplified Rules
The event scheduled for March 2, 2022, is exclusive to OTLA LTD section members and is free to attend.
If you are an active or retired union member, your insurance policy might cover long-term care (LTC). Similar to other policies, to claim LTC benefits, the union member must require assistance due to cognitive impairment or be unable to perform 2 or more activities of daily living listed below:
Are Spouses Covered Under Union Long-Term Care Insurance?
If you are the spouse of a current (or retired) union memory, you may be eligible for LTC insurance coverage as well, depending on the wording of the policy. Under some union LTC policies, spouses of active or retired union members may be eligible to receive LTC benefits. Typical conditions under such union LTC policies include meeting the following requirements:
- The spouse becomes eligible for the coverage at the same time as the insured (or when they become your spouse) starts receiving LTC benefits, provided he/she is not eligible for a Basic Daily Benefit claim at that time.
- Spouse’s eligibility ends when the insured’s eligibility ends, except in the case of the insured’s death while in benefit.
- Spouse’s eligibility is extended for 2 years commencing on the insured’s death, provided they (the insured) was receiving LTC benefits on the date of their death.
If you are an active or retired union member or spouse, you might be eligible for LTC benefits.
The team at Foisy & Associates wishes you and your loved ones Merry Christmas and a Happy New Year! We hope your holiday season is filled with joy, laughter, happiness, and relaxation. As we look forward to 2022, our team remains committed to providing every client with a very personal level of attention and maximizing their disability and personal injury settlements.
December 24th: Closed at 1 pm
December 27th-28th: Closed
December 31st: Closed at 1 pm
January 3rd: Closed
Foisy & Associates continues to support the Brain Injury Association of Peel and Halton (BIAPH). BIAPH is a non-profit organization that exists for the needs of families and survivors of brain injury in the Peel and Halton Regions. BIAPH facilitates measures to promote the prevention of brain injury, improve quality/care of life, provide community education, and conduct resource searches on behalf of members.
Social media evidence is now commonly used in personal injury cases, with defendants and insurance companies increasing their monitoring of plaintiff accounts. As a lawyer, you need to know what your clients post to their profiles because what may seem like a harmless post can have dire consequences on your file.
There are several examples of courts in the U.S. and Canada allowing social media posts to be admitted as evidence in personal injury cases. In some cases, these posts have had a direct impact on the outcome of the settlement value.
In Sedie v. US, a California personal injury case, social media evidence in conjunction with medical evidence was used to discredit the severity of the plaintiff’s injury. This led to the court concluding that the damages sought by the plaintiff were inflated.
In an Ontario personal injury case, Moretto v Nicolini-Femia, social media evidence was used to reduce the plaintiff’s damages in the assessment of her general damages.
You can read more case law on social media evidence in personal injury cases in the U.S. and Canada here.
The examples above demonstrate the role social media evidence can play in helping insurance companies discover or discredit a plaintiff’s claim about the extent of their injuries.
Clients suffering from injury or disability generally post positive content on their profiles that are only snapshots in time. This content rarely reflects the severity of a person’s pain and suffering. If lawyers are aware of what their clients are posting, during proceedings, they will be able to provide context so evidence can be based on the entirety of the facts and not simply on a single social media post.
Benefits of Monitoring Client Social Media
Increase Value of Files: Building a social media report that paints a picture of your clients’ life before and after their injury or disability can be instrumental in maximizing the value of their claim.
Avoid Bad Clients: You can use social media to determine if a prospective client is telling you the entire story and if they are indeed a file you want to invest in.
Reduce Client Risk: Social media is a rare outlet for clients that are suffering from an injury or illness. However, their posts may be misrepresented in court. Our team’s experience is that once clients become aware that their social media accounts are being monitored, we have noticed an immediate and significant decrease in their social media activity.
How Can Lawyers Monitor Client Social Media?
With more case law emerging that confirms the detrimental effect of social media usage on clients’ settlement values, lawyers can no longer ignore their clients’ activity.
Instead of spending several hours every week manually going through clients’ social media accounts to generate reports, lawyers and paralegals can now rely upon sophisticated tools that save time and increase the value of their files.
At Foisy and Associates, we use Private Footprint. This powerful tool allows our lawyers and paralegals to quickly view, organize, and make sense of the overwhelming volume of social media content generated by clients. Our team easily monitors social media activity for each client separately, flag specific posts, and quickly generate detailed reports that document the lives of our clients before and after life-altering events such as a personal injury or disability.
If you have sustained a personal injury or disability, please contact Foisy and Associates for a free consultation.
Jason purchased long-term care insurance 20 years ago to alleviate his children from the burden of long-term care costs and ensure he was taken care of in his senior years if the need arose.
Jason paid his insurance premiums religiously, but when he became ill and required ongoing assistance, Jason’s (now adult) children assisted him in filing a long-term care insurance claim. They were shocked when Jason’s benefits were denied by the insurance company.
Jason and his children are not alone; this is a scenario repeating itself all too often and is becoming a significant concern for long-term care insurance policy holders.
It may appear that insurance companies have been surprised by the escalating cost of long-term care and have been doing everything in their power to reduce their losses. In fact, a major Canadian insurance provider recently stopped offering long-term care insurance altogether, while others have significantly reduced benefits and increased premiums.
When Can Insurance Companies Deny Long-Term Care Claims
In Jason’s and most long-term care policies, a person is considered dependent if:
- They cannot perform two or more duties of daily living without substantial assistance.
- Require constant supervision due to cognitive impairment to protect themselves for their safety and health.
An insurance company will deny your claim if you fail to meet their definition of dependent. You need to understand how activities of daily living and cognitive impairment are defined and if you are in fact meeting the criteria listed in the policy.
Jason moved in with his son because he required assistance in performing activities of daily living. However, the insurance company denied his claim, stating he was able to perform the said activities.
There are strict limitations periods in contractual agreements between parties where the limitation period could be one year or more. If there is no mention of a limitation period, the Ontario Limitations Act, 2002, provides the limitation period which is usually two years from the date of denial of the long-term care claim.
Since there was no mention of a limitation period in Jason’s long-term care insurance contract, he and/or his family must commence legal action within two years of the denial of Jason’s claim for long-term care.
At the point of denial, it would be beneficial to contact a lawyer and seek representation in the case against the insurance company. In Jason’s case, he requires stand-by assistance from another person (his son) to safely perform two or more of the activities of daily living, as described in his policy. This appears to fit the criteria of physical dependency, and Jason may be successful in challenging the denial with the help of a lawyer experienced in disputing and litigating long-term care insurance denials.
Legal representation is also essential when challenging long-term care policy denials based on an insurance company’s interpretation of cognitive impairment which we will discuss in a future blog.
If your long-term care insurance claim has been denied or terminated, contact Roger R. Foisy & Associates for a free consultation. Call us at (905) 286-0050 or fill out the form on this page.
You have seen little if any improvement in your physical and mental health, but your long term disability has been terminated. You have not received the go-ahead from your doctor to return to work, and you continue to take the same or more medication.
So, how can the insurance company doctor who barely knows you or saw you only once, decide that you can go back to work?
Ask yourself what changed…Why did the insurance company terminate your benefits?
What changed was the definition your insurance company now uses to define disability and your ability to return to work.
If you were told that a diagnosis is required to be eligible for long term disability, let me assure you that this is not true.
Watch our short video that explains why you should contact a lawyer if your long term disability claim has been terminated.
Foisy and Associates personal injury and disability law firm represents individuals who have had their long term disability claims terminated. We have been handling long term disability terminations for more than 20 years, and have a track record of success.
If you face a situation where your long term disability claim has been terminated, contact us and speak to one of our lawyers.
We can help get you the benefits you deserve!
Your long term disability claim has been denied, and your insurer has offered you to appeal its decision. At this point, you need to pause and think for a moment…what are the chances that the same insurance company that denied your claim will overturn its own decision?
I’ve been a long term disability lawyer for 20 years and have rarely seen an insurance company overturn its denial, and even in those cases, it was usually due to an administrative error.
If your claim was denied, time is running out to file a lawsuit against your insurance company. Your chance of a successful resolution increases ten-fold if you let our offices work with you as soon as you experience an initial denial.
Let us assist in managing your file, and let us communicate with your insurance company. After reviewing and critiquing your insurance company’s file, we can determine if the denial was valid.
Watch our short video that explains why you should contact a lawyer if your long term disability claim has been denied.
Foisy and Associates personal injury and disability law firm represents individuals who have had their long term disability claims denied. We have been handling long term disability denials for more than 20 years, and have a track record of success.
If you face a situation where your long term disability claim has been denied, contact us and speak to one of our lawyers.
We can help get you the benefits you deserve!
As of January 29, 2021 Ontario’s Occupiers’ Liability Act was amended to add a requirement of written notice for claims arising from injuries caused by snow and ice.
If you’ve been injured from a fall due to snow or ice in Ontario, you have ONLY 10 DAYS to provide written notice by registered mail to the Municipality if the fall occurred on a municipal sidewalk or roadway. For all other properties, you have ONLY 60 DAYS to provide written notice by registered mail to the property owner or responsible maintenance contractor.
Action Against Ontario Municipalities
The Municipal Act states that no action shall be brought for the recovery of damages against a municipality unless written notice of the claim and of the injury has been hand-delivered or sent by registered mail to the municipal clerk’s office within 10 days after the occurrence of the injury.
Failure to give notice may not prevent you from taking legal action but only if a judge finds that there is reasonable excuse for the insufficient notice and that the municipality is not disadvantaged in responding to your claim. This places the onus on you to prove and may be a difficult threshold to meet. Therefore, we strongly recommend that you adhere to the 10 days’ notice requirements mentioned above.
Action Against Property Owners and Maintenance Contractors
Under the new Section 6.1 of the Occupiers’ Liability Act, no action shall be brought for the recovery of damages for personal injury caused by snow or ice against an occupier or a maintenance contractor retained to remove snow and ice unless written notice of the claim (including the date, time and location of the occurrence) is provided within 60 days after the occurrence of the injury, except in the case of death of the injured person as a result of the injury.
Written notice is to be hand-delivered or sent by registered mail to at least one of the occupiers of the premises, or the independent contractors employed to remove snow or ice on the premises.
As with municipalities, failure to give notice may not prevent you from taking legal action but only if a judge finds that there is reasonable excuse for the insufficient notice and that the occupier and/or the independent maintenance contactor is not disadvantaged in responding to your claim. This once again places the onus on you to prove and may be a difficult threshold to meet. Therefore, we strongly recommend that you adhere to the 60 days’ notice requirements mentioned above.
If you’ve been injured in Ontario from a slip, trip, and fall due snow or ice, you must act quickly. contact us and speak to one of our lawyers.
We can help you get the settlement you deserve!
People who are suffering from mental health issues tend to blame their workplace and employer for psychological distress. Focusing on your employer can undermine your long-term disability case because your insurer will just ask you to change where you work.
You are dealing with more than just the general stress of life. These could be issues that are happening in the world, in your home, in your personal life or a health issue such as chronic pain.
Watch our short video that explains the link between phycological distress and long term disability.
Foisy and Associates Personal Injury and Disability Law Firm represents people who are suffering from psychological distress. We have been handling long term disability claims for more than 20 years, and have a track record of success.
If your psychological distress is impacting your ability to work, contact us and speak to one of our lawyers.
We can help you get the benefits you deserve!