What should I do if I get involved
in an motor vehicle accident?
When should I see a lawyer?
Do I have to pay any fees up front?
Am I entitled to monetary compensation
or benefits even if my injuries are
my own fault?
What can I claim if my injuries are
a result of a Slip & Fall?
What if I don’t have insurance?
What benefits can I claim from my
insurer if I am injured in a motor vehicle
accident?
How do I make a claim for benefits?
What if my insurer denies my benefits?
What is a Mediation?
What is a mediator?
What if my Mediation is unsuccessful?
What is Arbitration?
What is a Pre-arbitration hearing?
What is a Full & Final settlement?
What if I get involved in another
accident?
How much money will I receive?
How long will it take to resolve
or litigate my case?
Will my insurer have surveillance
on me?
What should I do if I get
involved in an motor vehicle accident?
Being involved in an accident can be scary. You may feel shocked
and not realize your responsibilities. In order to effectively
commence a claim for accident benefits, you should report your
accident to the police within 24 hours if possible, and inform
your insurer that you have been injured in an accident within
7 days of your accident.
Try to obtain details of the parties involved in the accident
including their name, address, phone number and insurance policy.
If any witnesses are present, get their details too.
More importantly, make sure that you are seen by a doctor, either
at a hospital a walk-in-clinic, or by your family physician.
All of this information can sometimes be crucial in establishing
your claim.
When should I see a lawyer?
Strict timelines may apply for you to commence a claim. A failure
to comply with these limits may be damaging or prejudicial to
your case, and in some circumstances may bar you from brining
any action. Therefore, we recommend that you seek legal advice
immediately following your injury.
At Mazin Rooz Mazin, our lawyers will be able to accurately
advise you on the steps to take and how to proceed with your
claim for accident benefits or how to commence a claim against
the party at fault.
Do I have to pay any fees
up front?
No, we never require any of our legal fees to be paid up front.
At Mazin Rooz Mazin we understand the negative impact an injury
can have on your life and the various financial stresses you
may face. Mazin Rooz Mazin puts its client’s needs first.
We will fight for your rights and when you get paid is when
we will get paid. Occasionally however, we may require a small
retainer to cover our disbursements.
Am I entitled to monetary
compensation or benefits even if my injuries are my own fault?
In Ontario, even if you are involved in a motor vehicle accident
in which you are entirely at fault, you may still be entitled
to receive accident benefits. This system is known as “no
fault insurance”. In addition, you may receive a lump
sum of money at the conclusion of your case in the form of a
settlement.
What can I claim if my injuries
are a result of a Slip & Fall?
If your injury is a result of a slip and fall, you may be entitled
to claim compensation for pain and suffering known as damages,
from the party or parties who may have been negligent in fulfilling
the duty of care that they may have owed you.
What if I don’t have
insurance?
In Ontario, if you do not have insurance coverage and you are
involved in
a motor vehicle accident, the rules of priority would allow
you to obtain coverage through your next of kin, spouse or parent’s
automobile insurance. If you do not have access to either of
these, it is likely that your claim will proceed through the
insurance company for the other vehicle involved in your accident.
Should neither of these options be available to you (for example,
if you were a victim of a pedestrian hit and run accident) your
claim will likely proceed through the Motor Vehicle Accident
Claims Fund of Ontario, where you may be entitled to compensation
similar to that which you would have been entitled to from an
insurance company.
What benefits can I claim
from my insurer if I am injured in a motor vehicle accident?
If you are injured in a motor vehicle accident you may experience
difficulties performing your everyday activities, work, housekeeping,
child care and personal care. In such situations, you may be
entitled to the following benefits from your insurer:
• Medical and Rehabilitation benefit.
This benefit is designed to allow you to receive treatment
such as chiropractic, massage, acupuncture and other modalities,
which ought to rehabilitate you from your injuries.
• Attendant care benefit. You injuries
may leave you incapable of taking care of yourself. This benefit
is designed to allow you to seek help from another person
to take care of your personal needs, such as personal hygiene,
bathing, dressing and feeding. If you or your doctor feels
that you require this help, you may be entitled to this benefit
• Housekeeping assistance. Your injuries
may prevent you from carrying out your activities of normal
living, including cleaning your home, preparing food, doing
the laundry and grocery etc. Should your situation be as such,
you are entitled to claim housekeeping assistance for a maximum
of $100.00 per week. The assistance you decide to hire to
help you with these activities is entirely your choice, and
can even be your own family members.
• Caregiver Benefits. You injuries
may prevent you from taking care of a person in need of care
with whom you reside. This benefit is designed to allow you
to seek help from another person to provide the care to the
person in need of care. You may be entitled to this benefit
to a maximum of $250.00 for the first person and $50.00 for
each additional person, per week.
Please note that you may qualify for both Caregiver Benefits
and Income Replacement Benefits (discussed below). However,
the law only allows you to claim one benefit, either Caregiver
or Income Replacement Benefits. If you are entitled to both,
it is important that you discuss your options with a lawyer,
who will be able to advise you as to which option is better
suited in your circumstances.
• Income Replacement Benefits (IRB).
This benefit is designed to replace any loss of income you
may suffer as result of the accident.
You may receive this benefit if you meet the following criteria:
• You were employed and working at the
time of the accident;
• You were not employment at the time of the accident
and had worked at least 26 weeks in the 52 weeks prior to
your accident, or were receiving benefits from Employment
Insurance (EI);
• You were 16 years of age or more or were excused
from attendance at school under the Education Act
at the time of the accident; or
• Were not employed at the time of the accident but
were entitled at the time of the accident to start work
within one year under a legitimate contract of employment
that was made before the accident and that is evidenced
in writing, and
If one of the above criteria applies to you, you must also
satisfy that as a result of the accident, you are substantially
unable to carry out the activities of your pre-accident or
future employment (if you were entitled to begin work under
a legitimate contract of employment).
Your insurer may request that you provide them with a doctor’s
disability certificate indicating that that you are unable
to work.
Please note that you may qualify for both IRBs and Caregiver
Benefits (discussed above). However, the law only allows you
to claim one benefit, either Caregiver or IRBs. If you are
entitled to both, it is important that you discuss your options
with a lawyer, who will be able to advise you as to which
option is better suited in your circumstances.
How do I make a claim
for benefits?
Commencing your claim against your insurer can be frustrating.
At Mazin Rooz Mazin we will take care of all the paper work
so you don’t have to. As your lawyers, we will have
the direct authority to communicate with your insurer.
What if my insurer denies
my benefits?
If your insurer denies your benefits, you are entitled to
apply
for a Mediation with the Financial Services Commission of
Ontario (FSCO). FSCO is the governing body for all Statutory
Accident Benefits Claims. Only after a mediation can a lawsuit
or arbitration be commenced.
What is a Mediation?
A mediation is a method of dispute resolution typically structured
in the form of teleconference meeting between you, your lawyer,
your insurer and a mediator from FSCO. This meeting is the
first step in attempting to resolve your claim with your insurer
and is designed to allow you to discuss your claim openly
and to appreciate the position both parties will take in respect
to the dispute. If appropriate, a mediation can also be an
opportunity to discuss resolution of your claim.
What is a mediator?
A mediator is a neutral third party who will assist your discussions
with your insurer. The mediator does not have the power to
determine your entitlement to a benefit.
What if my Mediation
is unsuccessful?
If your mediation fails, you are entitled to apply for either
an arbitration with the Financial Services Commission of Ontario,
or commence an action in court.
What is Arbitration?
An arbitration is a method of dispute resolution. Arbitration
hearings are
similar to court proceedings, but a lot less formal, and cost
efficient. Your lawyer will present your case with medical
evidence to an arbitrator, and you may be required to give
oral evidence. Witnesses may also be called to testify in
relation to the claims being advanced. You may also be cross
examined by the insurer. Once the evidence has been presented
and submissions have been made, the hearing arbitrator will
then have the power to decide the your entitlement to the
disputed benefits.
What is a Pre-arbitration
hearing?
If you decide that you want to apply for arbitration, you
will have another
chance to meet your insurer at a Pre-arbitration hearing.
This hearing is
designed to allow you to meet face to face with your insurer
in the presence of an arbitrator, prior to the actual arbitration
hearing. This hearing is an opportunity to discuss what concerns
the insurer may have with your file and allows the parties
to sometime engage in meaningful settlement discussions. If
you and your insurer are not able to come to a settlement,
a date will be selected to hear the arbitration.
Much like a mediator, the pre-hearing arbitrator will not
have the power at the pre-hearing to determine your entitlement
to your benefits. The arbitrator may however order that certain
documentary disclosure be made and may impose costs upon a
party who fails to show for the hearing or fails to obey the
their obligations under the Dispute Resolution Code.
This hearing is also an opportunity to allow settlement negotiations,
which if successful, may result in a full & final settlement
of your claim.
What is a Full &
Final settlement?
If you and your insurer agree to settle your claim on a Full
& Final basis, this means that you will not be entitled
to apply for any more benefits in relation to the accident
in which your were involved. The release that you will sign
will relieve your insurer of any obligations that they may
owe you an relation to that particular loss.
What if I get involved
in another accident?
If you are involved another accident, you may make another
application to your insurer.
How much money will I
receive?
Mazin Rooz Mazin is committed to obtaining maximum awards
or settlements for its clients. Since every case is unique,
only after a careful review of a particular file is it possible
to provide an estimation of how much the case is “worth”.
It is often not possible to make an accurate estimate of the
value of your case until sufficient documentation has been
reviewed and until your medical prognosis is apparent.
How long will it take
to resolve or litigate my case?
It is difficult to approximate exact timelines as to when
your case will resolve. A number of different factors will
be relevant if we are to appreciate the length of time it
will take. These include the following:
• The cause of injury, whether it is a motor
vehicle accident, or slip & fall
• The nature of your injury - whether it is minor or
complex injury and whether it is temporary or permanent and
ongoing
• The time at which you consult or obtain legal advice
• The applicability of legal time limitations and legislation
• The type of judicial system under which your claim
will proceed, for example the Small Claims Courts, Superior
Court General Division or through the Financial Services Commission
of Ontario
Depending on the exposure your claim may have on your insurer
or the negligent party, settlement of your claim can occur at
anytime. In addition, it is useful to note that subject to some
exceptions, recent changes in the law do not allow parties to
engage in settlement of a claim for accident benefits prior
to the 1 year anniversary of the loss.
Will my insurer have surveillance
on me?
Depending on the nature of your injuries and complaints and
the types of benefits that you are advancing, your insurance
company may hire a company to conduct surveillance on you. The
purpose of this surveillance may be to identify some of the
following:
• Status of your employment following the loss
• To investigate the nature of your injury and the
types of things that you may be able to do
• To confirm that you are receiving assistance, for
either housekeeping, attendant care or caregiver assistance,
for which you are invoicing your insurer
• To confirm that you are receiving treatment
• To investigate any suspicious or fraudulent claims
that may be advanced
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