At Foisy and Associates, we are dedicated to ensuring that our clients receive the justice they deserve, especially in the realm of personal injury law. We are pleased to announce our latest victory in the case of Radebach v Intact Insurance Company, a decision that has garnered attention industry-wide for its impact and implications for future personal injury law cases.
For those unfamiliar with the specifics of the case, Radebach v Intact Insurance Company revolved around crucial issues related to insurance claims and the rights of individuals seeking compensation, specifically regarding brokerage fees.
Insurance Companies and Brokerage Fees
For years, there have been issues with insurance providers regarding the responsibility of brokerage fees. For those unaware, brokerage fees are a cost that arises when a treatment provider (e.g. occupational therapist) is responsible for planning treatment for a client, like the organization of meetings and appointments, communicating and coordinating treatment from different providers, and more.
In catastrophic cases, insurance providers assign their claimant a case manager who takes on these responsibilities. This simplifies the case and makes it easier for the client. In these cases, the brokerage falls to the case manager to organize.
In non-catastrophic cases, insurance providers do not provide coverage for a case manager, and instead, this responsibility falls to the claimant, their family, and their medical providers to complete. When medical providers are involved in the planning and coordination of treatment like this, they charge a brokerage fee to pay for their services.
Insurance providers, however, have largely been unwilling to pay such brokerage fees. Their claim is often that because they do not pay for a case manager for non-catastrophic clients, they should not pay brokerage fees either. Instead, they have recommended that providers set aside time in their client appointments to communicate with other providers, coordinate treatments, and complete other work of this kind that is non-treatment related but is to the benefit and safety of the client. For several reasons, this is not possible or realistically achievable.
Radebach v Intact Insurance Company
In this precedent-setting case, Radebach v Intact Insurance Company, our client was denied brokerage fees, despite being a catastrophic claimant. While brokerage fees are generally accepted by insurance when charged by a case manager, in this situation the brokerage fees were charged by an occupational therapist, so the insurance provider denied the claim.
Our team decided to push this case; in most situations where we receive a case of this kind, the insurance company settles with us before the case is brought to an appeal. However, doing so also means that the insurance company continues to deny brokerage fees in the future. Our team refused to cave and pursued the appeal to finally get some answers from the License Appeal Tribunal (LAT).
We are pleased that once the appeal was heard, the adjudicator found that the request for payment of brokerage fees was deemed reasonable and necessary.
We are proud of our team’s hard work and are grateful for the support and recognition from esteemed organizations like the Ontario Rehab Alliance. In their August 2023 newsletter, the Ontario Rehab Alliance highlighted the importance of this decision, emphasizing its potential implications for future cases and the broader landscape of personal injury law in Ontario. Their recognition of our efforts and the positive outcome of this case is a testament to the dedication and expertise of our team.
This case serves as a reminder of the importance of robust legal representation in personal injury matters and the significant impact such representation can have on the lives of individuals seeking justice.
For a detailed overview of the Radebach v Intact Insurance Company decision, please visit our reported decisions page.
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.