Personal Injury Glossary
Accident Benefits: These are the benefits available to anyone injured in a car accident, regardless of who was at fault. These car insurance company paid benefits can provide for income or care giving replacement costs as well as assist with medical, rehabilitation, visitor, attendant care and housekeeping expenses.
Action: A legal proceeding which commences a claim, or a lawsuit, through the courts against the at-fault party, whereby one party prosecutes another for being the cause of loss, damage, or injury.
Activities of Daily Living: These are the usual activities that an injured person would carry out on a daily basis before the accident. This includes activities for personal hygiene and health, recreational activities, and housekeeping. It need not include activities regarding the workplace.
Adjuster: A person who represents the insurance company who is assigned an insurance claim where s/he gathers information, assesses, and monitors that claim. Through investigating the claim, the adjuster determines the reasonableness of the claim and makes payments according to the insurance policy and their assessment. At the end they usually recommend a value to settle the insurance claim.
Affidavit: A written statement, sworn before a lawyer and confirmed by oath, which presents evidence and declares facts with respect to a claim.
Alternative Dispute Resolution: An alternative approach to settling a claim, meaning resolving a conflict without going to court. This can be done through arbitration, mediation, and settlement meetings.
Appeal: A request by the defeated party to bring an administrative or court decision to a higher board or court in order to be reviewed.
Arbitration: One of the alternative ways to settle a claim when the two parties are unable to agree. The arbitrator is a third party who is impartial, usually agreed upon by both the plaintiff and the defendant, and who makes the final binding decision to settle the dispute.
Assessment: This is a medical assessment which is requested by the insurer and used to determine the extent of an insured’s injuries and to approve any treatment plans for this person.
Assumption of Risk: When a person is aware of the dangers associated with an activity and still participates in this action. If this is the case, and the person is injured as a result, they may be unsuccessful in receiving damages from another party or their own insurance company.
At-fault Party: The person or party who is responsible for an accident which causes injury, also known as the defendant.
Any Occupation Test: It is a time period, usually after two years, where you will be eligible for long term disability benefits if you are unable to perform any occupation for which you are reasonably qualified, or could become qualified for, by reason of education, training or experience.
Attendant Care: One type of accident benefit where the insurance company pays for any assistance with tasks of daily living that is needed by an injured person, like dressing, feeding, bathing, supervision, etc. The insurance company pays the person or company who provides the care.
Back Pain: This type of pain affects 80% of the North American population at some point in their lives, ranging from lower back pain to back pain with sciatica. This type of pain results from nerve and muscular problems, degenerative disc disease, and arthritis. Back Pain is a common complaint following a slip and fall or motor vehicle accident.
Bad Faith: In general, this term refers to an act performed by someone with the malicious intention to deceive, thereby benefiting them or the company with whom they are employed. With regards to insurance companies, this can occur when they it intentionally delays benefits to an insured person who has a reasonable claim.
Bodily Injury: Physical injury to the body as a result of trauma. This can occur as a result of a slip and fall, car accident or some other type of traumatic accident.
Brain Injury: This type of injury results from trauma, like whiplash or a direct hit, and causes some impairment of the brain. An acquired brain injury is damage to the brain which occurs after birth and is not related to a degenerative disorder. It can result in a loss of consciousness or amnesia, and the severity can be tested with the Glasgow Coma Scale.
Bulging Disc: This occurs when a spinal disc’s soft center squeezes out and weakens the outer covering of the disc. As it bulges out, it can press on nerves, causing numbness and pain throughout the body.
Burden of Proof/Standard of Proof: This is the responsibility of the plaintiff to prove the existence of their injuries due to the accident and prove both the cause and liability in order to respond to the defendant disputing any claims.
Car Insurance: Insurance which protects the insured from losses which result from owning and driving a car. It covers both damage done to the insured’s property and the losses that the insured is liable for as a result of owning or operating a car.
Caregiver Benefit: If you are catastrophically injured in a motor vehicle accident and are no longer able to provide full-time care to dependants, you may be eligible for this benefit. This is also an optional benefit that can be purchased by an insured person who is non-catastrophically injured in a motor vehicle accident.
Carpal Tunnel Syndrome: This syndrome causes pain and numbness in your hand and results from placing too much pressure on the median nerve in the wrist.
Case Manager: A person who is chosen by the insured to help them with the coordination of medical and rehabilitation services. The case manager aims to make goals and plan services to ensure that the injured person’s life eventually resembles their life before the accident as closely as possible.
Catastrophic Impairment: This is the most serious of all injuries where the injured person has access to more medical and rehabilitation benefits throughout their life, including an increase in both the funds and the time period of assistance. Under the Statutory Accident Benefits Regulation, a catastrophic impairment is defined as paraplegia, quadriplegia, an amputation, loss of vision, brain impairment (level 9 or less on the Glasgow Coma Scale, or qualified as vegetative or a severe disability on the Glasgow Outcome scale), or have an impact on 55% or more of the whole person.
Catastrophic Injuries: Including paraplegia and brain injury, these injuries are severe and usually result from a car accident. These injuries generally have a devastating impact on a person’s ability to work and carry out their lives as they did before the accident, including normal activities of daily living, employment and recreational activities.
Cervical Disc Disease: The bones which form the spine are cushioned by flat discs. If these discs become damaged, they may bulge or rupture and, instead of keeping the spine flexible, will result in a herniated or slipped disc.
Chronic Fatigue Syndrome: This condition causes someone to feel tired to the extent that they can no longer fulfill normal daily activities. It has been controversial within the medical community as it is difficult to objectively diagnose.
Chronic Pain: This type of pain is constant in muscles, joints, or a particular area in the body. In order to attend to this, pain management is important. The person should get a pain assessment, enabling a doctor to prescribe pain medicine or other pain treatment to offer pain relief. One such pain treatment is psychotherapy to enable a person to use new coping skills to help with the pain.
Claim: An assertion of a legal right and a demand for compensation. It is a request for payment based on an insurance policy, or a demand for benefits to be provided by an insurance company.
Collateral Benefits: Benefits provided by an insurance company which are available to an injured person, usually based on an employer’s health benefit plan.
Compensation: The money requested or demanded by a person injured in an accident which includes damages for pain and suffering, income loss, medical expenses, and housekeeping and home maintenance.
Completely Disabled: (See Totally Disabled)
Contingency Fee/Agreement or Retainer: An agreement made between the plaintiff and the lawyer where the fee for services is only payable when there is a favourable result. This means that the lawyer is not paid until the case is settled in the plaintiff’s favour or a court judgment is arrived at in the plaintiff’s favour.
Contributory Negligence: When the court assigns a percentage of liability between the parties in an accident. In order to collect damages, the plaintiff does not have to prove that the at-fault party is 100% liable, but if the court feels that the plaintiff is responsible for the accident, the blame will be assigned on a percentage basis.
Counterclaim: A claim and action made by the defendant in response to the claim being made by the plaintiff. This occurs when the defendant feels that the plaintiff owes damages.
Cross Examination: The examination of a witness by the opposing party, allowing the opposing party to test the truth and challenge the evidence given.
CT Scan (Computerized Axial Tomography): X-rays taken of the brain at different levels allowing for a complete visualization of intracranial structures. This is usually done right after the accident to determine a plan of action and later done again to show brain recovery.
Damages: These are the losses that the plaintiff has suffered and requests to be reimbursed or compensated for by their insurance company and/or the defendant. These can include compensation for pain and suffering and reimbursement of lost income and medical expenses. There are three types of damages: Pecuniary (financial losses), Special (out-of-pocket expenses), and General (the value of how much the person has suffered, i.e. enjoyment of life).
Deductible: This is the amount of money that an insured person is required to off-set from an award of pain and suffering as more explicitly defined in the Insurance Act. It relieves the insurer from having to pay a certain amount of money (the deductible) reducing the award for compensation that is determined through court or settlement.
Defendant: A person or corporation who is being sued by a plaintiff, where a claim or charge is brought against them for financial compensation by an injured person or party.
Degenerative Disc Disease: The condition which highlights the normal changes in the spine as a person ages. Spinal discs separate the interlocking bones that make up the spine. Over time, the discs degenerate, most commonly causing pain in the lower back and neck and creating problems for daily living.
Dementia: A loss of mental skills which can affect daily life. It is mainly associated with memory problems and gets worse over time. The impact of dementia over time depends on the individual.
Dependant: A person who depends on another person to live their life, and whom another person has the obligation to support.
Death and Funeral Benefit: In the event you die as a result of a motor vehicle accident, the death benefit provides a lump sum payment to your spouse and your dependants. In addition, a lump sum payment is made to cover the costs of your funeral expenses.
Depression: An illness which affects a person’s daily life, like eating and sleeping, how someone feels about themself, and how they think. Without treatment, symptoms of depression can be long-lasting, but treatment can help most people. There are three types: major depression, dysthymia, and bipolar disease. Major depression causes symptoms which affect a person’s ability to work, sleep, and enjoy life. Dysthymia is less severe, but still keeps a person from functioning normally or feeling good and happy. Bipolar disorder involves mood changes, from highs to lows. Everyone may feel sad and depressed at times, but when this feeling is intense and long-lasting, it needs professional care.
Direct Examination: The questioning of a witness by a party who asked them to testify.
Direct Compensation-Property Damage (DC-PD): If another person was at least partially at-fault in a motor vehicle accident this compensation covers some or all of the damage to your vehicle. This compensation is collected from your own insurance company. The accident must have also occurred in Ontario and at least one of the other vehicles involved is also insured by a licensed insurance company in Ontario.
Discharge: In law, it refers to when a person performs their legal duty, therefore completing any obligation they might have had in a claim.
Disability: This refers to an illness or injury which can either be physical, psychological or psychiatric in nature and prevents a person from working and/or carrying on with their usual activities of daily living.
Disability Insurance: It can be purchased privately from an insurance company and/or may be available through your employer. In the event that you are unable to work as a result of illness or injury you will receive payments that replace some of the earnings lost from being disabled.
Disability Benefits: Payments that an insured person receives if a disability is covered in the policy provisions.
Disbursements: These are expenses incurred by a lawyer on behalf of their client, in order for the lawyer to proceed with their client’s lawsuit. For example, these may include the cost of expert medical reports, legal fees for filing a court claim, photocopying, and courier expenses.
Dismissal: Refers to the closure or termination of a claim, action, or charges.
Dog Owner’s Liability Act: An Ontario statute which states that a dog owner is responsible for any harm that their dog causes to another individual.
Duty of Care: The amount of care an individual or corporation is expected to have for another person, i.e. ensuring that the property is safe for visitors.
Economic Loss (Pecuniary Damages): The total money loss due to the death or injury of a wage earner who can no longer work. This does not include noneconomic losses, like pain and suffering.
Emotional Distress: A psychological or mental injury as a result of an accident. Damages can only be given when this type of injury is either directly or indirectly a result from the accident.
Examination for Discovery: The opportunity for the parties, plaintiff and defendant, to question one another, or another person, while under oath. A record is taken of this event in the form of a transcript. For the defendant, the questions are in regards to liability. For the plaintiff, the questions take a broader range, from looking at pre- and post-accident medical conditions to the impact of the injury on their employment and future.
Expert Witness: A witness who does not advocate for one side over the other, but instead has the education and experience to form and state their opinion on the matter which will assist the trier of fact when making their decision on the claim.
Elimination Period: The period of time in a short term or long term disability policy, also referred to as the qualifying period, during which a person must be disabled before they will begin receiving benefits. This ‘waiting time’ may be 5 days for short term disability claims and 90-180 days for long term disability claims.
Evidence of insurability: In order for a person’s application for insurance to be approved there needs to be evidence of insurability which likely includes proof of your physical or health condition and may include medical, financial, lifestyle, and family medical history information and other personal history.
Family Law Act Claim: The claim which is made by the injured person’s family in order to receive damages for the loss of care, guidance and companionship which was originally provided to them by the injured person before the accident. Family Law Act Claims in personal injury matters are derivative claims.
Fibromyalgia: This is a chronic condition that causes widespread pain, stiffness, and tenderness of your muscles, tendons and joints. It can cause fatigue, restless sleep and have negative implications for your mental health.
Financial Services Commission of Ontario (FSCO): The provincial government’s regulatory body which monitors the Financial Institutions and Financial Services, including automobile insurance.
First Party Benefits: Benefits available to the injured person from their own insurance company, accessible to all those involved in the accident no matter who was at-fault. In car accident cases, these benefits are known as statutory no-fault accident benefits (SABs) and include medical expenses, loss of income, and death benefits.
First Party Claims: A claim made by the insured for damage, loss, or injury sustained after an accident.
Fraud: An action to intentionally mislead, falsify, or exaggerate the facts of the accident with the main motive being to obtain a higher settlement payment. One such example is a staged accident.
Functional Limitations: The permanent or temporary inability to complete activities of daily living and workplace tasks after a person has been injured in an accident.
Future Damages: Losses which are usually pecuniary in nature that the injured person is expected to suffer as a result of the injuries suffered in the accident. These damages can include such things as income, medical expenses, and housekeeping.
General Damages: These are the damages representing non-monetary losses, or those awarded for pain and suffering. These cannot be given a quantitative value and attempt to cover loss of enjoyment and the impact of the injury on daily life.
Glasgow Coma Scale: In order to classify brain impairment, this scale was developed to have an actual method when determining the seriousness of an injury. It is used directly after the accident and during later assessments to test progress. The scale runs from 3 to 15, where a lower score indicates a more serious injury and a score of 9 or less means a catastrophic impairment was sustained.
Grace Period: This is a period of usually 30 or 31 days after the due date of an insurance premium, where if the premium is paid there will not be a penalty and the insured person will still be covered under their insurance policy.
Group Long Term Disability Insurance Policy: This policy may be provided through your employer. As an employee you may pay all or part of the premiums through your paycheck. If you find that the coverage is not sufficient you may choose to buy additional private long term disability insurance.
Head Injury: Injuries to the head are generally identified as brain injuries, which can range in severity from mild to moderate to severe. The Glasgow Coma Scale is a good indicator of this severity. Usually the symptoms associated with head injuries will take up to two years before any recovery has reached a stable level.
Health Care Expenses: The cost of medical services that a health care provider provides to an injured person to improve their condition and functioning. In car accident cases, before the injured person sees a health care provider, they must gain approval for the treatment from their own insurance company to ensure that they are entitled to these services and that the expenses will be covered.
Health Care Provider: A broad range of professionals which provide an injured person with health care services.
Health Practitioner: According to the Statutory Accident Benefit Regulations, this is a physician or a chiropractor, a dentist, an occupational therapist, an optometrist, a psychologist, a physiologist, a registered nurse, or a speech language pathologist. The determination of who is considered a health practitioner is whether the professional is authorized to treat the particular impairment of the injured person.
Herniated Disc: Sometimes referred to as a “slipped disc”, occurs when there is a tear in the outer part of the spinal disc allowing for the central portion to bulge out. (See also: Cervical Disc Disease or Degenerative Disc Disease)
Housekeeping and Home Maintenance Benefit: The benefits available through the statutory accidents schedule of an automobile policy which provides for $100 a week to an insured who is catastrophically injured following an automobile collision. Outside of the no-fault benefits, injured persons are still entitled to make pecuniary loss claims which include loss of valuable services (ie: housekeeping/home maintenance services) as against any at-fault parties.
Housekeeping and Home Maintenance Benefit: If you are catastrophically injured in a motor vehicle accident and as a result you are unable to perform your usual household duties, this benefit pays for reasonable and necessary expenses for someone to complete them. This is also an optional benefit that can be purchased by an insured person who is non-catastrophically injured in a motor vehicle accident.
Income Replacement Benefits (IRBs): The reimbursement of income which has been lost by an injured person as a result of an automobile accident. It is usually paid to the injured person by their automobile insurance company following an automobile accident. For accidents on September 1, 2010 or later, IRBs are calculated at 70% of the injured person’s gross income up to $400.00 a week. If additional coverage has been purchased, an insured could receive up to $1,000.00 per week.
“Incurred” Expense: This requires that the claimant pay, or at least promise to pay, the expense for a service being provided. It also requires that the service provider being paid, actually provide the service which the injured person would normally have completed before the accident or suffers an economic loss to provide the service for the injured person.
Indemnity: When a person suffers a loss, this is the idea that they should be returned back into the position they were in before the loss occurred. This means they are put back to their pre-accident condition, not better or worse. This applies of course to the no perfect justice concept because it is hard to get someone in precisely the position they were once in. Joint and Several Liability: This occurs when there are multiple defendants in a claim which are found to be liable in a single accident. Each defendant is responsible for paying the full amount of damages to the plaintiff no matter their share of liability. Specifically, joint liability is liability shared amongst parties, while several liability is liability separate from other parties.
Insured: A person who is covered by an insurance company through an insurance policy. The policy or agreement agrees to indemnify them for any losses by providing benefits and services.
Insurer: A company that provides insurance coverage to its clients.
Insurer Examination/Section 44 Assessment: An assessment performed by heath care professionals who have been chosen by the insurance company. The purpose of the assessment is to help the insurance company determine whether or not to approve a treatment plan and pay for a benefit.
Incontestability Period: This is a two year time limit in which an insurance company has a right to dispute a policy’s validity if incorrect or misleading information was provided in the application. In the case of fraud there is no time limit.
Lapse in Coverage: A time period where a person who has not paid their premium to the insurance company has their insurance policy cancelled, or if the insurance company cancels the policy for other reasons, leaving the customer without insurance coverage.
Legal Action: When a party has wronged another party, this is the efforts taken through a claim in order to find a legal resolution.
Liability: Liability begins as an obligation to do something, or refrain from doing something. If this obligation is not met and wrong or harm is brought against another person, liability then becomes the obligation of the at-fault party to take responsibility for the injury or damage experienced by another. This would include paying money for damages when an injury occurs.
Liability Limits: The highest amount that an insurance company has to pay out to the insured for a loss. In most car insurance policies, this limit is $1,000,000 and if the losses exceed this limit, it is then the responsibility of the at-fault party to pay for any additional losses. It is important to consult an insurer or your insurance broker to view the policy, inquire about its liability limits and ask about the cost of additional coverage.
Limitation Period: This is the time limit in which a person can issue a claim and pursue a legal remedy for a loss they sustained. After this time period, a lawsuit can no longer be brought and the right to compensation for losses is lost. The specifics of all limitation periods in Ontario are outlined in the Limitations Act, 2002.
Litigation Risk: In order to determine the likelihood of success of a personal injury matter, the litigation risk must be assessed. The lawyer representing the injured party automatically begins assessing this risk at the first meeting and continues throughout the case. At the same time, the defendant and more likely the defendant’s insurer is also assessing the risk of the plaintiff’s success in successfully proving their case as against the defendant. If the litigation risk is high, this means that it has a lower chance of success whereas as lower litigation risk means it has a higher chance of successful resolution.
Long Term Disability Benefit Period: This is the maximum amount of time that an insured person will be able to receive payments from a disability. It is subject to requirements according to your long term disability policy. The set time frame is usually the retirement age of 65, but may extend for 5 or 10 years beyond age 65, or even for life.
Lumbar Disc Disease: (See Cervical Disc Disease and Degenerative Disc Disease)
Lumbar Radiculopathy: (See Sciatica)
Magnetic Resonance Imaging (MRI): A high-tech diagnostic tool which shows tissues that cannot be seen on an x-ray or other diagnostic tools.
Major Head Injury: Trauma to the brain as a result of an accident and causing a loss of consciousness. Many major head injuries result from penetration of the brain, but a major brain injury can still occur without a penetrating injury to the skull.
Malingering: When the injured person fabricates or exaggerates physical or psychological symptoms for a secondary gain.
Mediation: A process with the main aim of settling a claim through negotiation. In mediation, both parties will attempt to resolve their dispute. In many cases, a mediator is present, a neutral third party who assists the parties in reaching an agreement. The mediator will work to see if a compromise is possible, ensuring that sides are not taken.
Medical Benefits: These are the benefits available through your car insurance policy. Regardless of fault, anyone injured in a car accident is entitled to medical benefits from their no fault insurer. This coverage can come from your own insurance policy, the policy of a dependent, or even the at-fault driver’s insurance company. These medical benefits pay for all reasonable expenses which result from the accident in regards to medical services, like surgery, physiotherapy, medication, assistive devices, like hearing aids, and transportation.
Mental Status: Evaluated through standardized tests, this is the degree of competency that an individual shows. It is meant to highlight a person’s intellectual, emotional, psychological, and personality functions.
Mental Status Examination: A standardized test which evaluates verbal responses and behavioural reactions. It is meant to determine the mental competency of a person. It is administered by a neuropsychologist who uses it to assess a person’s mental status and investigate the effect of a brain injury as a result of an accident.
Minor Head Injury: Trauma to the head which does not necessarily lead to a loss of consciousness, i.e. concussion.
Minor Injury: When a person sustains one or more of the following injuries: sprain, strain, whiplash associated disorder, contusion, abrasion, laceration, or subluxation and any clinically associated sequelae, meaning additional conditions which result from the original injury.
Misrepresentation: When someone makes a statement, either written or verbal, that is misleading or false.
Mitigation: By law, a person who has been injured in an accident has the obligation to minimize the possible damages by taking action. One such way is to attempt to return to work as soon as possible.
Negligence: The failure to act with reasonable care which is expected of a person in order to prevent harm to others. Negligence can either be enacted through action or by not taking any action.
Neurologist: A physician who is an expert on the nervous system and its disorders and injuries.
Neuropathic/Spinal Cord Pain: This type of pain is a result of a spinal cord injury. The pain is sharp, almost feeling like an electrical shock, and results from damage to the spine and the soft tissue surrounding the spine.
Neuropsychologist: A clinical psychologist who works with patients who have suffered brain injuries or other brain disorders. They administer tests for brain function and may provide cognitive rehabilitation.
Neuropsychological Assessment: Using standardized tests, history, present circumstances, attitudes, and behaviour, this type of assessment evaluates an injured person’s brain function and relates it to their behaviour.
Neurosurgeon: A surgeon who is an expert with the nervous system, operating on the brain and spinal cord. They are often the attending physicians for those injured persons with brain injuries or spinal cord injuries.
No-fault Insurance: No-fault implies that the injured party will gain compensation and indemnity for property damage and injury losses from their insurance company up to a limited amount, while possibly still being eligible in a separate action for further compensation for pain and suffering from the negligent party. No-fault insurance means that the insurance policy of the injured person will pay for their medical treatment, partial wage loss, and other expenses regardless of who caused the accident.
Non-Catastrophic Injury Designation: For those injured persons who do not qualify for catastrophic injury coverage determined by a medical review, a regular level of claims coverage is available to those whose injuries are “non-catastrophic”.
Non-Earner Benefits: These benefits are paid weekly to injured persons who are students, retirees, and the unemployed. It is limited compensation for those who have become disabled from their activities of daily life. The insurer pays the insured this benefit if the person is unable to carry on life and does not qualify for income replacement or caregiver benefit. This applies to those who suffer a complete inability to carry on their normal activities of daily living and are over the age of 16. The non-earner benefit does not commence until 26 weeks following the motor vehicle accident.
Non-Pecuniary General Damages: Damages which compensate the claimant for the non-monetary aspects of the specific harm suffered. This is usually termed ‘pain, suffering and loss of amenity’. Examples of this include physical or emotional pain and suffering, loss of care, guidance and companionship. This is not easily quantifiable, and depends on the individual circumstances of the claimant. Judges will base the award on damages awarded in similar previous cases with guidance for appeal courts like the Supreme Court of Canada which has ruled on the upper limit of non-pecuniary general damages. (See also pain and suffering)
Notice Period: In personal injury law matters, there are certain statutes which require a notice period which could affect or restrict the receipt of certain damages. While a notice period is usually less stringent than a limitation period, it is important to determine what the effects of missing a notice period could have on a personal injury action. One common notice periods in personal injury actions are in motor vehicle accident torts claims which require a potential plaintiff to provide a notice of a potential action as against the at-fault driver within 120 days after a car accident. A second common notice period is under the Municipal Act where a person is injured on a highway (highway being broadly defined to include municipal sidewalks, etc.) resulting from snow or ice. In this case, a potential plaintiff must provide a 10 day written notice from the date of the cause of action to be delivered to the City Clerk via registered letter or personal delivery, otherwise they risk the possibility not being able to commence any future action as against the city for their personal injuries.
Occupational Therapist: A registered health care professional who is part of the rehabilitation team and aims to retrain injured persons and maximize their independence. They do so by teaching daily activities, recommending equipment, and training and teaching adaptations to increase the injured person’s function in their daily lives.
Occupational Therapy: A medical discipline that focuses on studying injured persons in their environment at home, with friends, and at work to help them overcome any of the limitations they have experienced as a result of the accident.
Occupier’s Liability: The owner or occupier of a piece of property has a legal responsibility for whatever may occur on that property. Therefore, a claim can be made against the owner of occupier of the property where an accident occurred and an injury resulted, making that owner or occupier liable.
Optional Benefits: Additional benefits purchased by the insured or a family member providing additional coverage. In Ontario optional benefits are available to each automobile policy owner in an effort to increase the basic statutory accident benefits coverage.
Out-of-Court Settlement: When two or more parties reach a settlement, resolving the dispute usually before the commencement of a trial. In certain cases (where minors or other disabled persons are included in the dispute) approval of the out-of-court settlement will need a Judge’s approval.
Out-of-Pocket Expenses (Special Damages): These are the expenses that an injured person pays with their own money for such things as parking, travel, assistive devices, and prescriptions which are incurred due to their injury from a slip and fall accident; a motor vehicle accident or some other negligence matter.
Own Occupation Test: For most long term disability insurance policies you are usually eligible to receive long term disability benefits for the first two years if you are unable to perform the essential duties of your own occupation.
Pain and Suffering (General Damages): (See Non-pecuniary general damages)
Pain Management: This is a medical approach to study the prevention, the diagnosis, and the treatment of pain. Generally, the associated physician is an anaesthesiologist, who is trained in the relief of pain, but also a physiatrist, who specializes in pain management can be a valuable resource to a suffer of chronic pain.
Paraplegia: The loss of motor or sensory function of the bottom half of the body (lower extremities, usually as a result of a spinal cord injury or a congenital condition such as spina bifida.
Partial Disability or Residual Disability: This refers to a disability that is not total. As the definition varies, consult the definition section of your insurance policy. Typically it is defined as “the inability of the insured to perform one or more of the essential duties of his or her occupation”. Its purpose is to encourage a person to return to work, part-time or full-time, even if they have limited capacity. If they return to work with a loss of earnings they may be eligible for benefits.
Pecuniary Damages: Damages that can be quantitatively measured in money value, like the loss of past and future income.
Personal Injury Law: The area of law which focuses on physical and psychological harm to a person or group due to an accident involving the negligence of another party, whether it is acting improperly, purposely doing harm, or not taking action to prevent harm.
Physiatrist: A physician who specializes in medicine and rehabilitation. Their goal is to restore function to people who have been injured, whether it is in the muscles, bones, or even the nervous system.
Physical Therapist: Physical therapists create treatment plans for patients by studying their medical histories, testing and measuring their abilities like motor function and document their observations at numerous examinations to highlight the patient’s progress. Patients are usually referred to a physical therapist by their doctor or a medical specialist for rehabilitation.
Physical Therapy/Physiotherapy: Physical therapy is the multiple ways that therapy is offered by health professionals. It is concerned with recognizing and increasing quality of life through preventative measure and/or treatment following injury or disease affecting a person’s well-being. In personal injury matters, its focus is to assist injured persons with their recovery and restore normal functioning, preventing further disability as a result of the injury.
Plaintiff: The person who begins a lawsuit, suing another person, group, or insurance company (the defendant). This person is seeking damages, or compensation, for the injuries and losses sustained from an accident.
Post-Traumatic Amnesia: A time period after the accident, ranging from hours to months, when the injured person has a loss of memory. This means that they are unable to store new information, therefore unable to learn, or have no memory of the accident.
Prognosis: The expectation of recovery from an injury based on the nature and symptoms of the case.
Psychologist: A professional who specializes in counselling, using tests to first identify personality and cognitive function. It is an expert who diagnoses, manages, and prevents any emotional or behavioural problems, aiming to retrain the brain, manage behaviour, and develop coping skills in those who have sustained an injury.
Premium: This is the periodic payment required to keep an insurance policy in effect and depending on your insurance policy it may need to be paid annually, quarterly or monthly.
Quadriplegia: The complete paralysis of all four limbs or the whole body below the neck, leaving the injured person with restricted motor function. It usually results from a spinal cord injury, leaving the spinal cord unable to transmit messages below the damaged area.
Radicular Pain/Radiculopathy: Caused by injury to a spinal nerve, like a herniated disc, radicular pain radiates into the lower extremity of the body. The most common symptom of this type of pain is radiculopathy, or sciatica, where the pain radiates along the sciatic nerve down into the buttock area, into the back thigh and possibly into the calf and foot. It can be treated with physical therapy, medication, and epidural injections, or through decompressive surgery.
Radiologist: This is a doctor who specializes in the use of x-rays to diagnose and treat medical problems. Radiologists have the expertise to analyze the cross-sectional scans of the body, reading and interpreting what they see for diagnosis and treatment.
Reasonable Care: Based on a general community standard, this is the common sense and expected behaviour of a person in particular situations.
Reflex Sympathetic Dystrophy (RSD): This syndrome, also known as complex regional pain syndrome, is a disorder of the sympathetic nervous system which causes chronic pain. The sympathetic nervous system regulates the involuntary functions of the body, like increasing blood pressure. When the system cannot make these responses normally, it is thought to cause severe burning pain.
Rehabilitation: The process to restore skills to an injured person so that they regain independence and self-sufficiency, once again being able to function in a normal manner, or as close to it as possible, after losing this ability due to an accident or illness.
Rehabilitation Benefits: When a person has been injured, they are offered benefits from either a private or an employer medical benefit plan. Specifically, if a motor vehicle accident has occurred, these benefits cover the reasonable approaches to help an injured person reduce the effects of their disability or assist them in reintegrating into society and the workforce. According to the Statutory Accident Benefit Regulations, the rehabilitation benefits available include skills training, counselling (from social to employment), workplace, home, and vehicle modifications, and transportation.
Rehabilitation Support Worker: A rehabilitation professional who provides support services to injured persons. These support services are meant to assist clients in returning to their independent living, help them monitor their health needs, and provide all other services to enable maximum rehabilitation.
Release: A legal contract which states that all obligations from an accident have been completed by the at-fault party, or the insurance company, and the injured party is releasing them from any claims in relation to the accident or injury.
Residual Disability: (See Partial Disability)
Retainer Agreement: An agreement signed by both the injured person and their lawyer which states how the lawyer will be paid for the services they provide.
Retrograde Amnesia: This is the inability to recall events before the accident occurred.
Rheumatoid Arthritis: This is a chronic type of arthritis which involves fatigue, pain, and suffering. As time goes on, this condition is associated with aches and a loss of appetite. Early and effective treatment can improve the pain management and may help prevent any further injury.
Rules of Civil Procedure: These are the rules which are applied to proceedings in court and must be followed by both parties. They outline how a claim is to be brought by a plaintiff to another person or group who caused them injury and all the steps following the production of a Statement of Claim.
Riders: These are additional insurance policy options that offer extra protection. They can be purchased through your insurance company or brokers.
Sciatica: This is pain and numbness which arises due to the irritation of nerve roots leading to the sciatic nerve. The sciatic nerve is made up of the nerve roots in the lower back near the spine. This then extends into the buttocks and down the back of each leg.
Speech Language Pathologist: A health care professional who specializes in disorders with speech, auditory skills, comprehension, attention, and reading and writing. They assess, diagnose, treat, and help to prevent problems relating to any of these areas. These types of disorders can be a result of many things, like a stroke, brain injury, developmental disorders, learning disabilities, or hearing loss. Speech language pathologists use assessments and tools to analyze and diagnose the extent of the impairment and aim to resolve the issues it presents for the patient.
Statement of Claim: This is a document prepared by the lawyer on behalf of the plaintiff. It commences a lawsuit in court, stating the damages that are being claimed by the injured person due to the action, or lack thereof, of the defendant causing loss or injury. It also provides facts and information of how the accident occurred and of the injuries which resulted.
Statement of Defence: This statement is made by the lawyer of the defendant as a response to the Statement of Claim. It will generally refuse the allegations which were made in the plaintiff’s statement of claim.
Statutory Accident Benefits (SABS): These are benefits or payments that you may be eligible to receive if you have been injured in a motor vehicle accident. Benefits include medical and rehabilitation, income replacement, attendant care, caregiver, non-earner, dependant care, housekeeping and home maintenance, and funeral and death benefits.
Temporal Mandibular Jaw Dysfunction (TMJ): The temporal mandibular joint is the hinge joint connecting the lower jaw to the skull. The disorders associated with this joint result from problems with the jaw and surrounding face muscles which control chewing. People with this type of dysfunction experience pain and discomfort which is either temporary or long-lasting.
Threshold: An impairment level that must be proven by a plaintiff in order to allow them to sue the at-fault party for certain claims in a motor vehicle accident claim. In Ontario this means that the injury must be a serious or permanent disfigurement or impairment which greatly impacts physical or mental functioning. The threshold is the description of the seriousness of the injury and the minimum standard that should be observed when the injury is assessed. The purpose of this restriction is to limit the amount of people able to make certain claims to receive compensation. When the threshold is surpassed, the injured person can make a claim for pain and suffering and also for future medical expenses.
Tort: A wrong or harm, whether intentional or accidental, that was committed by one person or group to another which results in legal liability. With this law, one person seeks compensation for the injuries they sustained as a result of the fault or negligence of another, initiating a civil suit.
Tort Feasor: The person who commits a tort, or the person who commits harm to another person.
Total Disability: The level of disability as indicated under a Long-Term Disability policy. Most common in a group policy (through an employer) the first two years after the accident or illness, total disability is applied where a disabled person is no longer able to do the normal tasks of their job that they were able to do prior to the accident or illness. After two years, this definition changes, applying total disability to the substantial or complete disability of the injured person to perform any employment that they are qualified for based on education and experience.
Total Loss: When the car or any other damage is too extensive and the repair costs would actually exceed the value of the vehicle or property, making the repair costs useless and “writing off” the property.
Totally Disabled or Completely Disabled: Each insurance company has their own definition of what it means to be ‘totally’ or ‘completely’ disabled; consult the definition section of your own policy. This definition can be broad or restrictive and it is used to determine if a person is unable to perform the functions of one’s occupation or of any occupation.
Traumatic Brain Injury: An injury to the brain, regardless of severity. It is usually the result of an external force causing a change in consciousness. Some of the symptoms can include nausea, dizziness, ringing in the ears (tinnitus), sensitivity to light and an impact on both cognitive and emotional functions.
Treatment Plan: A form completed by a health care provider where it is determined that the injured party is in need of treatment. This is provided to the insurance company who approves the Treatment Plan before releasing funding. It is always important for the insured to confirm with the treatment provider that the insurance company approved the treatment plan, otherwise it could lead to confusion over who is paying for the treatment.
Trial: The hearing of a legal issue in court where testimony from witnesses are heard.
Trier of Fact: The person(s) who are present in court and hear testimonials from witnesses, reviewing the evidence, and eventually ruling on a claim based on facts. This can be a jury or even just a judge.
Umbrella Insurance: Insurance coverage which provides a large amount of additional liability coverage in comparison to general policies. Also, it provides coverage that might be excluded from other liability policies.
Underinsured Coverage: When an at-fault driver, responsible for injuries, has an insurance policy that does not provide enough liability coverage to compensate the injured person. Underinsured coverage ensures that the injured person’s insurance coverage will provide the compensation for their injuries up to the maximum amount as indicated in their insurance policy. This requires the injured person’s coverage to exceed the amount indicated in the at-fault party’s policy.
Undertaking: The promises made during an examination for discovery by the party being examined. The party promises to provide the questioning party with documents they ask for throughout the examination. These documents include medical records, income tax returns, employment files, etc. Since the examination is recorded, there is a legal obligation to provide these documents after the examination.
Uninsured Coverage: Uninsured coverage is a type of insurance that provides compensation for the victim of the accident when the at-fault party who caused an accident resulting in injury is not covered by liability insurance. In this case, the injured party would use the uninsured coverage from his or her own policy to compensate for their damages.
Underwriter: This is an individual, working on behalf of an underwriter company or an insurance company, who has the responsibility of making the decisions regarding the acceptability of an insurance applicant. They evaluate your insurance application and make decisions regarding coverage amount and premiums.
Underwriting: This is the process that and insurance company uses in reviewing an application for insurance before accepting and issuing an insurance policy. The purpose is to determine the risk associated with insuring a particular person. There is also determination of what your coverage amount would be as well as what your premium would cost in order to be insured.
Vegetative State: A coma-like condition where a person is but unable to speak, follow commands, or make any kind of response. The person is awake by not cognitively functioning.
Verdict: The decision in the trial made by the trier of fact, i.e. the jury or the judge.
Visitor Expenses: When an insured person is injured in an accident, the insurer will pay the reasonable expenses which his/her visitors incur in visiting the injured during the recovery or treatment. These visitors include a spouse, child, or other direct family members, someone who is living with the insured, a person who has intended to treat the insured as a child of their family, or a person who is treated like a child by the insured and their family.
Witness: A person who attends a trial in court and provides evidence. There are two types: lay and expert. Lay witnesses are usually family members, co-workers, or friends who provide evidence about the injured person’s medical condition and life before the accident and compare it to afterwards. An expert witness has knowledge, based on education and experience, of the subject and forms an opinion to assist the trier of fact. In order to testify as an expert in court, a Judge must accept that the witness is qualified to give expert testimony.
Wrongful Death: This occurs when the negligence of one person leads to the death of another.