The Power of Optional Benefits in Securing a Client’s Future

By Roger Foisy on February 7th, 2024

At Foisy & Associates, we proudly call ourselves lawyers for the people, treating every client as a person first. With our guidance, we ensure they receive the care they need, and the designation required to support them through their injuries.

In our case stories series, we will be highlighting people we have helped over the years, sharing their experiences and how Foisy & Associates ensured they received the treatment and compensation they needed.

Meet “Sarah”

Our client, Sarah (name changed for privacy), a dedicated healthcare practitioner with over 30 years of experience, was travelling for work when her life took an unexpected turn. Sarah was a middle-aged woman with a successful career, living with her husband and two children in the GTA. While travelling to visit a client, Sarah was in an accident as a rogue piece of material, improperly secured to a passing vehicle, tore free and collided with her car.

The impact was terrible, leaving her with not only a physical concussion but also profound psychological scars in the form of severe PTSD. This incident marked the beginning of a challenging journey, one that would test her resilience and emphasize the value of her foresight in matters of insurance and personal advocacy.

Before the accident, Sarah had meticulously prepared for potential risks inherent in her line of work as an independent contractor. Understanding the intricacies of healthcare and insurance, she had wisely invested in non-catastrophic optional benefits, increasing her coverage to $1 million for life—a stark contrast to the standard limit of $65,000 over five years. She also purchased additional income replacement benefits as she knew as an independent contractor, she would not be entitled to short or long-term disability benefits.

This preparedness was not born out of mere caution but from Sarah’s intimate knowledge of the field and the risks of her career. Sarah understood the problems insurance providers often had with claimants and also understood that because she frequently travelled to visit her clients, she was more likely to get into a motor vehicle accident.

The Need for Legal Support Despite Optional Benefits

When the accident occurred, Sarah’s expertise led her to quickly realize that the path to recovery would be as much a legal battle as a medical one. Her initial dealings with her insurance company were discouraging, and so she sought legal support to help her advocate for the benefits that she was owed.

 The firm she first approached for legal counsel did not meet her expectations, leading her to sever ties in search of a firm that would provide the advocacy she required. That search brought Sarah to the doors of Foisy & Associates.

Upon taking up Sarah’s case, our team at Foisy & Associates was struck by the disparity between her expertise and the treatment she received from the insurance company. Despite her being an insider with a comprehensive understanding of insurance protocols, she faced hurdles that any person might face—her advanced knowledge and preparation were seemingly disregarded.

Our legal strategy was constructed with a dual focus: to assert Sarah’s well-deserved benefits and to counter the insurance company’s narrow interpretation of her policy. We aimed to ensure that Sarah’s claim was not only recognized but respected, reflecting the full scope of the benefits she had secured. Our argument was clear: Sarah’s investment in optional benefits was a legitimate and foresighted exercise of her rights, not a loophole to be contested or minimized.

Comprehensive Coverage Thanks to Additional Benefits

As we delved deeper into Sarah’s case, we found that the additional coverage she purchased played a pivotal role in her ability to maintain financial stability while focusing on her recovery. The $4,000 she could set aside monthly, thanks to her income replacement benefits, provided a buffer that many in her situation could only hope for. It allowed her the breathing room to prioritize healing over financial anxiety, a luxury that the standard policy limits would have never afforded.

Her optional benefits also allowed her access to many treatments which otherwise would have been outright denied. Thanks to her $1 million in lifetime coverage, treatments that cost $10,000 dollars were more easily approved, as her insurance company understood that the amount was much less impactful than if it had been for $65,000 over 5 years.

After only two years, Sarah’s insurance company reached out to settle her case, as they recognized the expense of her case due to her optional benefits coverage. Two years is a remarkably short period of time; most standard cases take at least four years.

In negotiating with the insurance company, we highlighted not just the immediate needs but the long-term implications of Sarah’s accident. We presented a case that projected the future costs of care, accounting for the psychological support and treatments that would be essential in the years to come. This comprehensive approach was instrumental in securing a settlement that was much higher than the typical compensations awarded in such cases.

The culmination of our efforts was a seven-figure settlement that far exceeded the standard non-catastrophic benefits cap. This settlement was not just a financial victory but a testament to the importance of obtaining optional benefits and the need for expert legal representation, even for those who may seem most prepared.

The Importance of Advocating for What You Deserve

Sarah’s story is one of preparedness. Her proactive measures, combined with our firm’s expertise in personal injury law, created a formidable strategy that navigated the complexities of the legal system to reach a successful outcome. Her case serves as an example of why optional benefits are essential and why an advocate is necessary to ensure that these benefits are fully honoured.

At Foisy & Associates, we take pride in offering not just legal expertise but a partnership that respects and values the foresight of our clients. We understand that each case is more than a file—it’s a person’s life permanently altered.

Sarah’s journey through recovery and the legal triumph that followed stands as a beacon for those who seek justice in the aftermath of an unforeseen event. It underscores the message we wish to impart to all our clients: with the right preparation and the right advocate, you can overcome even the most daunting challenges.

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.

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