A 55 year old woman, who, by all accounts, had an active and vibrant life both personally and professionally up till that point in her life, was struck by a school bus while crossing the street. She suffered a brain injury and since that time, has presented with a range of symptoms including chronic pain, limited mobility, headaches, dizziness and other emotional issues due to her cognitive and physical limitations.
She tried repeatedly to go back to work as a nurse but found she could not maintain the daily physical and mental pressures. At first, her insurer was paying two types of benefits; one for income replacement and another for ‘attendant care expenses’ including help with housework, home nurse visits and other such services.
Problems with Insurers
Her insurer stopped her monthly income replacement after claiming that she hadn’t followed through on a recommended treatment. In fact, she had followed the treatment, but at the advice of her own medical professional and not the consultant hired by the insurer. She appealed and after two and a half years, they reinstated the benefits suddenly and without explanation – just before an arbitration hearing that was about to resolve the dispute.
Her attendant care payments were also cut off after two years based on another consultant’s report that characterized her disability as ‘not catastrophic’. Limitations on benefits after a two year period are a common feature of many disability benefits.
The second dispute involving attendant care payments did make it to arbitration, where the arbiter disagreed with the insurer and promptly reinstated payments.
The case illustrates some important points:
- You may not be – and probably won’t be – fully aware of the extent of your injuries immediately following an accident, even though the time you have to claim benefits is limited.
- Insurance companies will often pay benefits for the initial period and then bring in more stringent criteria, including consultant and other examinations, in order to deny them later on.
- Persistence and the willingness to see a dispute through to its legal resolution is often the only way to get satisfaction from these proceedings.
You Don’t Need to Go It Alone!
If you’ve been involved in a motor vehicle accident, you owe it to yourself to get professional help.
Even if the injury seems minor, you should contact your insurance company and a motor vehicle accident lawyer right away. The severity of soft tissue injuries common to car accidents is often only apparent some time later. Since the time you have to file a suit is limited, you want to be safe rather than sorry.
Petrillo Law has been providing competent, caring legal advice to car accident victims in Mississauga, the Greater Toronto Area (GTA) and across Ontario for over 20 years. We can evaluate a case to determine whether it meets the provincial threshold required to start a lawsuit as well as represent injured people who have been denied accident benefits by their own insurance company.
Call us today at (905) 949-9433 to schedule your free initial consultation. We look forward to hearing from you.