Glossary of Personal Injury Terms
Medical and income benefits that are payable by your car insurance company when you are involved in a car accident. The basic coverage is up to $100,000.00 in medical and rehabilitative services for a 10 year period after the accident. Where an injured person is deemed to be Catastrophically Impaired then that person is entitled to up to $1,000,000.00 in medical and rehabilitative services over a life time. These benefits are available to anyone hurt in a car accident, regardless of fault.
Term used to describe the commencement of a claim through the courts against the at-fault party.
Activities of Daily Living
Refers to the usual activities that an injured person would engage in during the period prior to the accident. These would include personal hygiene tasks like bathing, dressing, grooming; recreational activities and housekeeping and home maintenance tasks. Generally all activities outside of the workplace setting.
An individual who acts on behalf of the insurance company to gather information, assess and monitor an insurance claim. There will be an adjuster for accident benefits and an adjuster on behalf of the at fault party.
A statement that contains evidence that is sworn before a lawyer or Commissioner of Oaths.
A claim made in a pleading, such as a Statement of Claim, setting out what the party expects to prove at court.
Alternative Dispute Resolution
An alternative to settling a claim without having a trial. This can be done by way of a mediation with a mediator or a settlement meeting between the parties and legal counsel.
A request by a party to have a decision from a court or administrative tribunal reviewed by a superior or higher court.
A process used to resolve disputes by an impartial party. This is used as an alternative to litigation. It is often utilized as part of the dispute resolution process where the injured person and the accident benefit insurer are unable to agree.
The person who conducts an arbitration.
Generally a medical assessment, most often used by the accident benefit insurer to determine the extent of the insured's injuries and the approval of any further treatment plan submitted on behalf of the injured person.
Assumption of Risk
When a person knowingly and voluntarily proceeds to undertake an activity with the full knowledge of the dangers associated with the activity. If the person is injured as a result of the activity then that person cannot later claim damages.
The person responsible for the accident that caused the injuries. The defendant in a court action.
Assistance that may be required by an injured person to assist with various personal tasks, including personal hygiene, monitoring for safety, payable by the insurer after an assessment, usually by an occupational therapist.
Term used to describe an act that is done with an intention to deceive or mislead. As opposed to negligence, bad faith suggests active ill will on the part of the person who deliberately refused to perform a duty or function.
Beyond a Reasonable Doubt
Standard of proof required in a Civil action. Generally described as 50% plus 1. This is considered a lower standard of proof than in a criminal matter which is Proof Beyond a Reasonable Doubt.
Similar to a precedent decision. A decision from another court, usually a superior or higher court that guides the decision of the court and in most cases binds the lower court in the decision it is to make.
Physical injury to the body that will arise from the trauma or whiplash forces of a car accident. In most instances the injury to the body will be felt immediately at the time of the accident.
An injury that will occur immediately as a result of a trauma, such as a car accident, resulting in some impairment in the functionality of the brain. The injury can arise as a result of direct trauma to the head or as a result of a severe whiplash movement of the head and neck. Indices of brain injury can be loss of consciousness at the scene, amnesia regarding the accident or a Glasgow Coma Scale below 15.
Burden of Proof or Standard of Proof
In a Civil Action the plaintiff has the onus of proving injuries that have been sustained as a result of the accident as well as the cause and liability for the accident.
CT Scan - Computerized Axial Tomography
A series of x-rays taken at different levels of the brain that allows the direct visualization of intracranial structures. A scan is often taken soon after the injury to help decide if surgery is needed. The scan may be repeated later to see how the brain is recovering.
Termination of an insurance contract before the end of the policy period, by the insured or insurer.
A form of insurance that protects against losses involving cars. Car insurance provides protection from losses resulting from owning and operating a car or vehicle. The insurance covers losses to the insured's property and losses for which the insured is liable as a result of owning or operating a car.
A person that is assigned to assist the insured with obtaining medical and rehabilitation services. A Case Manager will be assigned to an insured where the insured is deemed to be Catastrophically Impaired.
A designation that is provided under the Accident Benefits schedule according to specific definitions. These include a Glasgow Coma Scale rating of 9 or less or a Whole Person Impairment rating of 55% or more. It is important to assess whether your injuries would meet the Catastrophic Impairment definition. A person who is deemed to be catastrophically impaired is entitled to a higher level of medical and rehabilitation benefits and attendant care benefits over a life time. The actual approved medical and rehabilitation benefits and attendant care benefits are still determined based on the need of the injured person.
Catastrophic Impairment Definition under the Statutory Accident Benefits Regulations
For the purposes of this Regulation, a catastrophic impairment caused by an accident that occurs after September 30, 2003 is,
- paraplegia or quadriplegia;
- the amputation or other impairment causing the total and permanent loss of use of both arms or both legs;
- the amputation or other impairment causing the total and permanent loss of use of one or both arms and one or both legs;
- the total loss of vision in both eyes;
- brain impairment that, in respect of an accident, results in,
- a score of 9 or less on the Glasgow Coma Scale, as published in Jennett, B. and Teasdale, G., Management of Head Injuries, Contemporary Neurology Series, Volume 20, F.A. Davis Company, Philadelphia, 1981, according to a test administered within a reasonable period of time after the accident by a person trained for that purpose, or
- a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale, as published in Jennett, B. and Bond, M., Assessment of Outcome After Severe Brain Damage, Lancet i:480, 1975, according to a test administered more than six months after the accident by a person trained for that purpose;
- an impairment or combination of impairments that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in 55 per cent or more impairment of the whole person; or
- an impairment that, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition, 1993, results in a class 4 impairment (marked impairment) or class 5 impairment (extreme impairment) due to mental or behavioural disorder.
Injuries of a severe nature arising from a car accident. This type of injury will generally have a devastating affect on the injured person's ability to work and ability to carry out the pre accident normal activities of daily living and recreational activities. These injuries will include paraplegia or a severe brain injury. (See the definitions above)
A request or demand for payment under the terms of the insurance policy. Also a term used to describe a Statement of Claim.
A person responsible for investigating and overseeing the claim on behalf of the insurance company. The Claim Adjuster will be the insured's primary contact with the insurance company. The Claim Adjuster will be responsible for approving medical and rehabilitation treatment plans submitted on behalf of the insured by treatment providers. Also known as an adjuster.
An individual (insured) presenting a claim to the insurance company. Can also refer to a person making a claim for damages arising from injuries suffered directly or indirectly from an accident.
Insurance benefits that are available to an injured person usually from an employer's health benefit plan. In a car accident, Accident Benefits from the injured person's auto insurer is referred to as First Party Benefits.
An amount of money that is sought by a person for injuries sustained in an accident. Compensation can include damages for pain and suffering (General damages), past and future income loss, future medical expenses and future housekeeping/home maintenance expenses.
Contingent Fee or Agreement/Retainer
This refers to an agreement between the plaintiff and his/her lawyer in which the lawyer is not paid anything until the case is won. Aside from shouldering all the costs from data gathering and research to negotiations, court preparation, and the trial itself, the lawyer also pays for medical reports and other expenses pre-settlement. His/her compensation is usually based on a percentage of the amount recovered after winning the case.
A doctrine of law where the court assigns a percentage of liability among the parties to an accident. A claimant does not have to show that the at-fault party is 100% liable for the damages arising from the accident in order to collect damages. However, if the court feels that the claimant is party responsible for the accident, then the court will assign blame between the plaintiff and the defendant on a percentage basis.
A claim made by the defendant against the plaintiff. Arises where the defendant is of the view that the plaintiff owes damages to the defendant. A counterclaim rarely arises in personal injury actions/claims.
This refers to the individuals (named insured, spouse, resident relatives, etc.) who are insured under a policy of insurance.
During trial, the cross examination occurs after a witness has provided his/her evidence in chief. This allows that other party to challenge the basis for evidence and the evidence itself. The examining party is provided more leeway.
Loss or harm to a person or property.
Damages Compensation sought in an Injury Claim
The damages can include pain and suffering (general damages), past and future income loss, future medical expenses and future housekeeping/home maintenance expenses.
A dollar amount the insured person must pay on each loss to which the deductible applies. The insurance company pays the remainder of each covered loss up to the policy limits.
Deductible (Tort claim)
In Ontario, insurance legislation provides that the insurer for the party that caused the injury is not required to pay the first $30,000.00 for pain and suffering damages where the damages are $100,000.00 or less. There is no deductible for damages over $100,000.00. There is also a deductible of $15,000.00 that applies to Family Law Act claims that are $50,000.00 or less.
The party against whom a claim is brought by the injured person (Plaintiff).
A letter sent to the lawyer for the insurer outlining the injured party's case and providing a settlement proposal.
A person who relies on another for support, such as a child.
An illness that involves the body, mood, and thoughts that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.
The signs and symptoms of depression include loss of interest in activities that were once interesting or enjoyable, including sex; loss of appetite (anorexia) with weight loss or overeating with weight gain; loss of emotional expression (flat affect); a persistently sad, anxious or empty mood; feelings of hopelessness, pessimism, guilt, worthlessness, or helplessness; social withdrawal; unusual fatigue, low energy level, a feeling of being slowed down; sleep disturbance with insomnia, early-morning awakening, or oversleeping; trouble concentrating, remembering, or making decisions; unusual restlessness or irritability; persistent physical problems such as headaches, digestive disorders, or chronic pain that do not respond to treatment; thoughts of death or suicide or suicide attempts. Alcohol or drug abuse may be signs of depression.
The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease). Major depression causes a combination of symptoms that interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.
Dysthymia is a less severe type of depression with long-term chronic symptoms that do not disable, but keep one from functioning well or from feeling good. Many people with dysthymia also experience major depressive episodes at some time in their lives.
Bipolar disorder (manic-depressive illness) is characterized by cycling mood changes: severe highs (mania) and lows (depression). Sometimes the mood switches are dramatic and rapid, but more often they are gradual. When in the depressed phase of the cycle, one can have any or all of the symptoms of a depressive disorder. When in the manic cycle, one may be overactive, overtalkative, and have excess energy. Mania often affects thinking, judgment, and social behavior in ways that cause serious problems and embarrassment. For example, the individual in a manic phase may feel elated, full of grand schemes that might range from unwise business decisions to romantic sprees. Mania, left untreated, may worsen to a psychotic state. Bipolar disorder is not nearly as common as other forms of depressive disorders.
Also known as an Examination in Chief. The first questioning of a witness before a trial.
May refer to a physical or psychological injury suffered by the injured person as a result of the accident.
Person responsible for assisting an injured person with making a transition from the hospital to home. This requires a coordination of a variety of medical and rehabilitation resources in the community. A Case Manager can assist in making the necessary arrangements for the transition back to home.
Also known as an Examination for Discovery. This is an opportunity for the parties in a lawsuit to ask each side questions about their case. The examination is recorded under oath and a written transcript is prepared after the examination. For the defendant, the questions primarily deal with liability issues. For the plaintiff, he questions will cover a wide range including pre and post accident medical condition, treatments, activities of daily living and recreational activities, impact of injuries on employment and future prospects.
The closure or termination of a claim.
Dog Owner's Liability Act
An Ontario statute that provides that a dog owner is legally responsible for any injuries caused if his or her dog bites another individual.
Duty of Care
The level of care that one is required to maintain in relation to another person. For example, the owner of a property has a duty of care to ensure that it is safe for visitors to come on the property.
Total financial loss resulting from the death or disability of a wage earner, or from the destruction of property. Includes the loss of earnings, medical expenses, funeral expenses, the cost of restoring or replacing property and legal expenses. It does not include noneconomic losses, such as pain and suffering caused by an injury. Also known as Pecuniary Damages.
A psychological or mental injury arising from an accident. Damages can be awarded for emotional distress alone where the injury arises directly or indirectly from an accident.
Examination for Discovery
This is an opportunity for the parties in a lawsuit to ask each side questions about their case. The examination is recorded under oath and a written transcript is prepared after the examination. For the defendant, the questions primarily deal with liability issues. For the plaintiff, he questions will cover a wide range including pre and post accident medical condition, treatments, activities of daily living and recreational activities, impact of injuries on employment and future prospects.
A person who, through education or experience, has developed skill or knowledge on a particular subject, so that he or she may form an opinion that will assist the Trier of fact. It is important that the Expert Witness not appear to be advocating for one party over another as that defeats the purpose of the Expert Witness in assisting the court.
Family Law Act Claim
A claim made by family members of the injured person seeking damages for the loss of care, companionship and guidance that was provided by the injured person to the Claimant before the accident.
An insurance adjuster who works primarily outside of an office and often meets personally with the public. Field adjusters can conduct face-to-face meetings, negotiations with claimants, scene investigations, and damage inspections. They can be employees for the insurance company or Independent Adjusters hired by the insurer for specific assignments such as investigating the cause of an accident and the outcome from the accident.
Financial Services Commission of Ontario
(FSCO) The regulatory body within the Ontario Government that is responsible for overseeing the administration of Financial Institutions and Financial Services. This includes automobile insurance in Ontario.
First Party Benefits
These are the benefits that are available to the injured person from that person's own insurer. This pays policyholders and others covered by the policy in the event of injury, no matter who caused the accident. These benefits are referred to as Accident Benefits and can include medical and rehabilitation expenses, loss of income, funeral and death benefits.
First Party Claims
A claim for damage, loss or injury made by an insured.
First Party Definition
Term used to refer to an insured.
An act done to intentionally mislead another party. This can include a false statement intended to deceive the insurer.
The extent to which an injured person's ability to carry Activities of Daily Living and workplace tasks are impaired after an accident causing injury.
These are losses the injured person is expected to suffer from in the years following the accident as a result of injuries suffered in the accident. These future losses include loss of income, including wages, overtime and bonuses, future medical and rehabilitation expenses, housekeeping and home maintenance and others.
Damages awarded to an injured person for pain and suffering. This would cover things like loss of enjoyment of life and the overall impact of the injuries on one's activities of daily living. For car accident claims all general damages at $100,000.00 or less are subject to a $30,000.00 deductible.
Glasgow Coma Scale
A neurological scale developed to establish a consistent, objective method of recording a person's conscious state. This scale is used during an initial assessment of an accident victim and during periodic assessments to determine progress.
Injuries to the head can be difficult to identify. These injuries are also identified as Brain Injuries. These injuries can range from mild to moderate to severe. A Glasgow Coma Scale rating is a good indicator of a head injury. They are not always an indicator of outcome. Mild to moderate head injuries can be difficult to identify. The symptoms connected with a head injury will take approximately 2 years before recovery has plateaued.
Health Care Expenses
The cost for services provided to the injured person by a Health Care provider. Before a Health Care Provider (ie. physiotherapist, chiropractor) they must obtain prior approval from the insurer providing the Accident Benefits. Expenses cover a broad range of services.
Health Care Provider
The person providing health care services. This term covers a broad range of professionals from physiotherapist and chiropractors to rehabilitation support works and specialist.
This term has a specific definition as provided under the Statutory Accident Benefit regulations:
In respect of a particular impairment, means a physician or,
- a chiropractor, if the impairment is one that a chiropractor is authorized by law to treat,
- a dentist, if the impairment is one that a dentist is authorized by law to treat,
- an occupational therapist, if the impairment is one that an occupational therapist is authorized by law to treat,
- an optometrist, if the impairment is one that an optometrist is authorized by law to treat,
- a psychologist, if the impairment is one that a psychologist is authorized by law to treat,
- a physiotherapist, if the impairment is one that a physiotherapist is authorized by law to treat;
- a registered nurse with an extended certificate of registration, if the impairment is one that the nurse is authorized by law to treat, or
- a speech-language pathologist, if the impairment is one that a speech-language pathologist is authorized by law to treat;
Housekeeping and Home Maintenance
These services can be provided to a person injured in a car accident through their Accident Benefits insurer. In most cases the benefits are available for a 2 year period following the accident to a maximum of $100.00 per week. This is also an area of damages that can be claimed for future needs in the law suit against the at-fault party.
Benefits (IRBs) Income paid to an injured person who has been injured as a result of a car accident. The IRB is paid by the injured person's car insurance company. The rough calculation is 80% of your net income up to a maximum of $400.00. You can purchase coverage that provides up to $1,000.00 per week. You should review this with your car insurance sales person/broker to ensure you have sufficient coverage.
The principle which provides that where a loss occurs then the insured should be put back in the position they were before the loss occurred. They are put back to their pre-accident position and should not be made better or worse. Of course, the concept of no perfect justice applies in that it is hard to put one perfectly in that desired position.
A person that works on behalf of an insurance company but is not an employee of the company. Insurance companies will use such adjusters to deal with a claim for accident benefits or to investigate the loss associated with a claim.
Independent Living Program
Community-based programs that are intended to provide victims with services to maximize the person's ability live independently within the community. It is generally self-directed.
An attempt to falsify or exaggerate the facts of an accident to an insurer in order to obtain a higher settlement payment than would be normally justified. Some types of insurance fraud would include a staged accident, falsely and inaccurately prepared insurance documentation, exaggerated injuries and exorbitant medical bills.
A person that is covered by a policy of insurance.
A company that provides insurance coverage.
Joint and Several Liability
Where there are multiple defendants in an action that are found liable arising from a single incident, then any finding of split fault among defendants leaves any defendant liable to pay the full amount of damages awarded to the plaintiff, regardless of a division of liability among defendants.
|There are no terms beginning with K in our glossary.|
Lapse in Coverage
A period of time when an insurance policy has been canceled by the insurer or terminated due to failure to pay the premium or where the insurance policy is voided by the insurer for other relevant reasons.
Liability that arises by law as opposed to liability that arises from a breach of an agreement or contract.
Responsibility by an at fault party for an injury or damage suffered by another person.
This adjuster is responsible for investigation of the accident. The adjuster can be responsible for car repairs and collision payments; payments for property damage; and payments in connection with bodily injury settlements including past and future loss of income; future medical expenses; and housekeeping and/or home maintenance services.
The maximum amount that an insurance company will be required to pay for a particular incident/loss. For example, most car insurance policies have a maximum policy limit of $1,000,000.00. What this means is that if the injured party's losses exceed $1,000,000.00 then the insurance company will only be required to pay out $1,000,000.00. The person that caused the harm, the insured person, will be required to make up any difference over and above the policy limits. You should review your car insurance policy with your broker and inquire into any additional coverage available and the cost for that coverage. You will be surprised how inexpensive the additional coverage will be and it may be worth it to purchase additional protection.
Refers to the risk that must be assessed in determining what the likelihood of success is for a trial of your personal injury matter. From the very first time that you meet with your lawyer, the lawyer will be assessing this risk. Where your litigation risk is high, meaning that you have a low chance of success at trial, then it will be necessary to consider this when attempting to reach a settlement of your file. The insurance company, their adjusters and defence counsel, will also be assessing the litigation risk. The risk assessment will be a big factor in each party determining how aggressive they will be on a matter.
The value assessed for damage and/or injury suffered by an injured party in an accident. Loss can include pain and suffering damages, past and future income loss, future medical care and future housekeeping and home maintenance services.
Magnetic Resonance Imaging (MRI)
A high tech diagnostic tool to display tissues unseen in x-rays or by other techniques. An MRI may be obtained through Accident Benefits available after an accident involving a motorized vehicle in a shorter period of time than through OHIP.
Major Head injury
Trauma to the brain resulting in loss of consciousness. Such head injuries frequently result from penetration of the brain by a foreign object such as a piercing wound or a crushing blow. However, the brain may sustain a major injury without a penetrating injury of the skull.
Where the injured person is seen to be Faking or creating a conscious deception. It is the voluntary production of symptoms for an ulterior motive such as personal financial gain or compensation.
There are several forms of mediations in a personal injury matter. Where an insured is disputing eligibility for accident benefits, such as medical treatment plans or the denial of income replacement benefits, mediation is the process of negotiating. Both the insured and the insurer will negotiate in order to achieve a resolution of the dispute. In some instances the negotiations can result in a legally binding settlement and if one is not achieved then arbitration is the next step.
Another type of mediation can occur during the litigation process. This is a settlement mediation that can involve the injured party and their counsel, along with the insurance company for the party at fault and their counsel. The other significant party is the mediator. The mediator will work to see if a compromise settlement can be reached between the two parties. The mediator is a neutral party that does not take sides or makes a decision, but rather works with all parties to see if settlement can be reached. A settlement mediation is conducted on a without prejudice basis which means that if it is not successful then nothing said at the mediation can be used against either party at a later trial.
Benefits that are available to an individual by various insurance companies and under different coverages or plans. One may have a medical benefit plan through their place of employment. Where you are injured in a car accident, regardless of who is at fault, you are entitled to a number of medical and rehabilitation benefits and income replacement benefits through your own car insurance policy. If you do not have a car insurance policy, you will receive coverage from another car insurance plan. This includes any car insurance policy covering a dependant, such as a child that is an occasional driver, or where the injured person does not have any car insurance coverage, then the injured person could receive benefits from the at fault driver's car insurance coverage.
Medical benefits available under Statutory Accident Benefits:
The medical benefit shall pay for all reasonable and necessary expenses incurred by or on behalf of the insured person as a result of the accident for,
- medical, surgical, dental, optometric, hospital, nursing, ambulance, audiometric and speech-language pathology services;
- chiropractic, psychological, occupational therapy and physiotherapy services;
- prescription eyewear;
- dentures and other dental devices;
- hearing aids, wheelchairs or other mobility devices, prostheses, orthotics and other assistive devices;
- transportation for the insured person to and from treatment sessions, including transportation for an aide or attendant;
- other goods and services of a medical nature that the insured person requires.
Mental Status Examination
Standardized tests which evaluate verbal responses and behavioral reactions; a procedure used to determine the mental competency of an individual. A Neuropsychologist is trained to administer a wide array of tests to assess an individual's mental status and the extent of any brain injury sustained, usually the result of a car accident or trip and fall which leads to trauma to the injured person's head.
The degree of competency an individual displays when given standardized tests to determine intellectual, emotional, psychological and personality functions.
Minor Head Injury
Trauma to the head regardless of severity that does not necessarily result in the loss of consciousness. Frequently called Concussion, Traumatic Brain Injury, and Closed Head Injury.
Where one makes a written or verbal statement that is misleading or not true.
A person injured in an accident is required by law to reduce or minimize any possible damages by taking appropriate action. One example of mitigation is where the injured person attempts to return to work as soon as the person is fit to return to work. It is good for the injured person, in attempting to prove economic loss, to have attempted to return to work. This provides the best evidence of the individual's ability to work.
The failure to display or act with the care that is expected of a reasonable person in similar circumstances. Usually referred to as a standard of care.
A physician who specializes in the nervous system and its disorders.
Neuropathic/Spinal Cord Pain
Neuropathic (nerve-generated) pain is a problem experienced by Spinal cord injury (SCI) patients. A sharp, almost electrical shock, type of pain will be felt to the left of the injury and is the result of damage to the spine and soft tissue surrounding the spine. Phantom limb pain or radiating pain from the level of the lesion is related to the injury or dysfunction at the nerve root or spinal cord.
An evaluation of the injured person's brain functions relating to behaviour; based on the results of standardized tests, history, present circumstances, attitudes and the expectations of the patient was well as the patient's behaviour during the examination.
A psychologist who is an expert in working with an individual who has suffered injury to the brain. Neuropsychologists will conduct special tests of brain function and may provide cognitive rehabilitation. A Neuropsychologist can work very closely with the rehabilitation team.
A surgeon who is an expert in nervous systems diseases. Neurosurgeons operate on the brain and spinal cord and are often attending physicians for patients with brain injuries.
The Province of Ontario provides for a modified no-fault insurance system. Under the Ontario insurance scheme, the injured person's insurance policy will pay for your medical treatment, lost wages, or other accident-related expenses regardless of who caused the accident. This coverage is subject to the terms, limits and conditions of your policy contract. In order to be able to sue the at fault driver for any injuries suffered in a car accident, the injured person has to be suffering from a permanent and serious injury of an important physical or psychological function.
Under Accident Benefits, the insurer shall pay its insured person who sustains an impairment as a result of an accident a non-earner benefit if the insured person meets any of the following qualifications:
- The insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident and does not qualify for an income replacement benefit.
- The insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident, received a caregiver benefit as a result of the accident and there is no longer a person in need of care.
- The insured person suffers a complete inability to carry on a normal life as a result of and within 104 weeks after the accident and,
- was enrolled on a full-time basis in elementary, secondary or post-secondary education at the time of the accident, or
- completed his or her education less than one year before the accident and was not employed, after completing his or her education and before the accident, in an employment that reflected his or her education and training. The amount of the benefit is initially $185.00 per week for the first 54 weeks and then increases to $320.00 per week.
The member of a rehabilitation team who helps maximize an injured person's independence. Occupational therapists (OTs) teach daily living activities, health maintenance and self care, and consult on equipment choices.
A claim that is made against the owner or owners of the property where the injured party suffered a personal injury. The Occupier Liability Act is Ontario legislation that outlines the legal obligations of a person or party that owns or occupies the property where the accident occurred.
Out of Court Settlement
A settlement that is reached between the parties that does not require the approval of the courts. The Settlement is usually reached prior to the commencement of trial.
Out of Pocket Expenses
These are also referred to as Special damages. This is money that the injured person has spent, out of their own funds, to pay for expenses incurred due to the injury. This would include things like parking, gasoline for travel or certain medications or assistive devices that are not covered under a medical plan.
Pain is a sensory symptom of tissue damage or disorder that can either be acute or chronic. Researchers have learned a great deal about pain and its physiological and psychological basis, leading to pain management treatments that can provide complete or partial pain relief. Untreated pain can interfere with the healing process by affecting the immune system. In cases of back pain, discomfort can impede the rehabilitation process by interfering with exercise and increasing psychological distress. Chronic back pain tends to be very difficult to treat, especially in cases involving failed back surgery or nerve pain. Pain is inherently subjective, and a greater awareness of the need for taking pain seriously is growing among the health community as well as the public.
Pain Management is a medical approach that draws on disciplines in science and alternative healing to study the prevention, diagnosis and treatment of pain. For painful spine and musculoskeletal disorders, pain management is employed as an aggressive conservative care program that helps to identify the source of neck and back pain and rehabilitate the patient as an alternative or follow-up to surgery. A physician who is practicing pain medicine or pain management is usually an anesthesiologist who has been certified or trained on the relief and/or management of pain. A physiatrist may also specialize in pain medicine. Pain management programs can employ massage therapy, analgesic medications, and physical therapy and epidural steroid injections, among others to treat back pain.
Pain and Suffering
An area of damages also referred to as General damages or Non-pecuniary damages. These damages are to compensate an injured person for the physical and psychological injuries suffered in an accident. Physical injuries can be defined unless the issue is chronic pain. This may have both a physical and psychological component. Psychological injuries include depression, post traumatic stress disorder and emotional pain.
Damages for loss of past and future income.
A physician specializing in physical medicine and rehabilitation. Physiatrists specialize in restoring function to people with injuries to the muscles, bones, tissues, and nervous system.
Physical therapists examine patients' medical histories, test and measure strength, range of motion, balance and coordination, posture, muscle performance, respiration, and motor function, in order to develop comprehensive treatment plans. During a course of treatment, physical therapists document the patient's progress and conduct periodic examinations. Other medical specialists frequently refer their patients to a physical therapist for rehabilitation.
The method for treating injury, pain, or disease by physical means, as opposed to medical, radiological, or surgical methods. It aims to assist in the injured person's recovery and prevent the onset of physical disabilities which may arise from the injury or disease.
A person that commences a lawsuit. In a car accident claim the plaintiff would be the injured person who has commenced a law suit against the other party, the defendant, that has caused the injuries arising from the accident.
Amnesia A period of hours, weeks, days or months after the injury when the injured person demonstrates a loss of day-to-day memory. The patient is unable to store new information and therefore has a decreased ability to learn. In a serious car accident the injured party may have no recollection of the accident. The first memory may be when the person is at the hospital.
The prospect as to recovery from a disease or injury as indicated by the nature and symptoms of the case.
A professional specializing in counseling, including adjustment to disability. Psychologists use tests to identify personality and cognitive functioning. This information is shared with team members to assure consistency in approaches. The psychologist may provide individual or group psychotherapy for the purpose of cognitive retraining, management of behavior and the development of coping skills, such as pain management, by the patient/client and members of the family.
Quadriplegia refers to paralysis from the neck down, including the trunk, legs and arms. The condition is typically caused by an injury to the spinal cord that contains the nerves that transmit messages of movement and sensation from the brain to parts of the body. Quadriplegia is most likely to occur from a spinal cord injury to the neck at C5 (cervical 5) to C7 (cervical 7). The spinal cord cannot transmit messages below the damaged area, resulting in the loss of mobility in the arms and legs and the loss of function in breathing, bowel and bladder control. In some cases, slight movement can be regained through intensive rehabilitation. Another prefix that has become increasingly more common is "tetra" to mean four, so a patient may be described as having tetraplegia.
Quality of Life
An assessment of the kind of existence a person experiences. In assessing the injured person's quality of life the following items could be considered 1) activities of daily life; 2) mobility and organization; 3) social relationships and interaction; 4) present satisfaction with life; 5) work or leisure activities; and 6) future prospects.
Legally binding contract stating that all obligations past, present or future arising from a particular accident or occurrence have been fulfilled and the injured party is releasing the other party, usually an insurance company and/or the party that has caused the harm, from any and all claims in connection with the incident that caused the injury.
An agreement that is signed between the injured person and the personal injury lawyers which outlines how the personal injury lawyer will be paid for the services provided. Our firm approach is to charge a fee only after there has been a lump sum settlement. Our fee is a percentage of the settlement. This is also referred to as a contingency fee or arrangement. We will provide you with a written retainer agreement when you hire our firm to act on your behalf. You will not be required to provide us with any payment as we will cover all litigation costs and disbursements. No amount is paid back unless there is a settlement in your personal injury matter.
inability to recall events prior to the accident; it may be a specific span of time or type of information.
Rules of Civil Procedure
The Rules that apply to a claim that is brought by a plaintiff in court for injures arising from an accident caused by another person or person employed by an entity such as a municipality. The Rules provide guidance as to how the claim is to be brought and all steps that follow after the initial preparation and service of a Statement of Claim.
Speech Language Pathologist
The Rules that apply to a claim that is brought by a plaintiff in court for injures arising from an accident caused by another person or person employed by an entity such as a municipality. The Rules provide guidance as to how the claim is to be brought and all steps that follow after the initial preparation and service of a Statement of Claim.
Speech-language pathologists, sometimes called speech therapists, assess, diagnose, treat, and help to prevent disorders related to speech, language, cognitive-communication, voice, swallowing, and fluency.
Speech-language pathologists work with people who cannot produce speech sounds or cannot produce them clearly; those with speech rhythm and fluency problems, such as stuttering; people with voice disorders, such as inappropriate pitch or harsh voice; those with problems understanding and producing language; those who wish to improve their communication skills by modifying an accent; and those with cognitive communication impairments, such as attention, memory, and problem solving disorders. They also work with people who have swallowing difficulties.
Speech, language, and swallowing difficulties can result from a variety of causes including stroke, brain injury or deterioration, developmental delays or disorders, learning disabilities, cerebral palsy, cleft palate, voice pathology, mental retardation, hearing loss, or emotional problems. Problems can be congenital, developmental, or acquired. Speech-language pathologists use special instruments and qualitative and quantitative assessment methods, including standardized tests, to analyze and diagnose the nature and extent of impairments.
Stacking of Limits
The application of more than one policy limit to the same loss or occurrence. In some jurisdictions, courts have required stacking of limits when multiple policies, or multiple policy periods, cover an occurrence. For example, Uninsured motorist bodily injury limits of $100,000/300,000 on two policies owned by the same person may be added together to pay a loss. In this event, the total amount of coverage available for an accident would be $200,000/600,000. However, in Ontario this practice is not permitted. Where an insured's policy provides for coverage in excess of the coverage provided by the defendant's insurer, then the excess coverage may be available for damages arising from the accident. For example, if total damages will exceed $1,000,000.00, and this is the total coverage available from the defendant's insurer, then where injured party's policy provides for $2,000,000.00 in coverage, there is an extra $1,000,000.00 available to satisfy the damages above $1,000,000.00.
Statement of Claim
A document prepared by the lawyer for the Plaintiff. This document starts a lawsuit in the courts and states the damages being claimed by the Plaintiff from the Defendant. The Statement of Claim also provides details about the parties involved and how the accident occurred and the injuries suffered. The Statement of Claim is a very important document as it outlines for the court the extent of the Plaintiff's claim. All aspects of the claim and the damages claimed must be covered in this document.
Statement of Defence
The response of the Defendant to a Statement of Claim. This is usually drawn up by the lawyer of the defendant, and more often than not, it will repudiate the allegations written on the Statement of Claim.
Under Ontario's no-fault insurance laws, the threshold level represents the degree of injury a claimant must establish before being allowed to sue the at fault party. The threshold was verbal, regarding the severity of the injuries, until 2003 when the Ontario government added a written threshold to the auto insurance regulations. Ontario also has a second threshold. It is based on a dollar amount. For accidents prior to 2003, there is a $15,000.00 deductible for pain and suffering damages (General damages). For any family member that is also putting forward a Family Law Act claim (claim for loss of care, companionship or guidance), there is a deductible of $7,500.00. For accidents after October 2003, the deductible for pain and suffering damages, where the award would be $100,00.00 or less, then the deductible is $30,000.00. For Family Law Act claims that are valued at $50,000.00 or less, then the deductible is $15,000.00. The deductible for General damage claims and Family Law Act claims beyond those amounts were eliminated. Where a person's injuries exceed the threshold level, they may also make a claim for future medical expenses without any deductible. There is no threshold or deductible that applies for claims related to future and past economic loss or future housekeeping and home maintenance assistance.
A private wrong or harm (other than a breach of contract) committed against another, resulting in legal liability. A tort is either intentional or accidental (negligent). Automobile liability insurance is purchased to protect one from suits arising from unintentional torts.
The person employed by the insurer for the at fault driver to administer and oversee the file. The adjuster's role is to gather information regarding the accident, the injuries and the overall impact of those injuries on the person's ability to work and perform activities of daily living. The tort adjuster would be responsible for determining the Reserve that will be set for the particular claim. Tort adjusters may be employees of the insurance company or independents that are hired as needed by the insurer for particular tasks, such as gathering information regarding the car accident.
The claim put forward by the person that has been injured due to the fault of another party. The at fault party is provided written notice of the claim. In the event that the matter cannot be resolved before the end of the limitation period, then the injured person will continue the claim by having a Statement of Claim issued at the court and served upon the at fault party.
The person who commits a tort (see the definition of tort).
A definition that applies to a level of disability under a Long Term Disability policy. The most common definition provides that Disability applies where the disabled person is unable to continue to do the job the disabled person was doing at the time of the accident. This definition usually applies to the first two years of disability. After two years the definition usually changes to the substantial or complete inability to perform any employment based on education, training or experience. This is a very subjective test and the courts have noted that this does not include any employment that would only be part-time, if the person previously worked full-time, or employment that provides a wage that is considerably less than what was earned before the onset of the disability.
Also referred to as "written off". The condition of an automobile or other property when damage is so extensive that repair costs would exceed the value of the vehicle or property.
Traumatic Brain Injury
An injury to the brain regardless of the severity. Usually the result of an external physical force that can cause an altered state of consciousness. It can result in a variety of symptoms including nausea and dizziness and an impairment of a person's cognitive abilities or proper emotional functions.
A form that must be completed by any treatment/healthcare provider before the accident benefit insurer will consider funding the requested treatment. This includes any and all health care and rehabilitation benefits available through accident benefits. It is important that the insured confirm with the treatment provider that the accident benefit insurer has approved the treatment plan before starting treatment or there could be an issue with respect to who is paying for the treatment performed prior to the insurer's approval.
The hearing of a legal issue by a court. Trials tend to involve testimony from witnesses.
Trier of Fact
The person(s) who hear testimony and review evidence to rule on a factual issue. For example, in a jury trial, the jurors are the triers of fact, whereas in a trial before a judge-alone, it is the judge. In a jury trial the role of the judge is to assist the jurors in determining the law to which the jurors are solely responsible for applying the facts of the case presented.
Provides high limits of additional liability coverage above the limits of your homeowner's and auto policy. In addition, it provides coverage that may be excluded by other liability policies.
Insurance coverage that compensates a victim of personal injury, resulting from an accident involving an at fault driver who is responsible for the injuries but whose policy of insurance provides insufficient coverage to compensate the injured person for the injuries in full. In this case the injured person's own insurance coverage will provide compensation for injuries up to the maximum provided in the insurance policy. This requires the injured person's coverage to exceed that provided in the policy of the at fault party. For property damage claims, this could arise where the policyholder failed to buy sufficient insurance. An underinsured policyholder may only receive part of the cost of replacing or repairing damaged items covered in the policy.
During the Examination for Discovery a number of promises will be made by the party that is being examined to provide the questioning party with additional documents. This promise is called an Undertaking. These documents usually include medical records, income tax returns, and employment records. The Undertaking is provided on the record and there is a legal obligation to provide the documents after the conclusion of the Discovery.
A type of insurance coverage that compensates a victim of personal injury, resulting from an accident involving a driver who is responsible for the injuries but who is not covered by liability insurance.
A condition in which the person utters no words and does not follow commands or make any response that is psychologically meaningful. The person is awake but has no cognitive function.
A judge or jury's decision in a trial.
If an insured person sustains an impairment as a result of a car accident, the insurer shall pay for reasonable and necessary expenses incurred by the following persons as a result of the accident in visiting the insured person during his or her treatment or recovery:
- The spouse, children, grandchildren, parents, grandparents, brothers and sisters of the insured person.
- An individual who was living with the insured person at the time of the accident.
- An individual who has demonstrated a settled intention to treat the insured person as a child of the individual’s family.
- An individual whom the insured person has demonstrated a settled intention to treat as a child of the insured person’s family
One who, in the course of judicial processes, provides evidence to assist a party or the court in a trial. Witnesses fall into two broad categories - Lay and Expert. Lay Witnesses are usually family members, friends and co-workers. In a personal injury action they are important as they provide evidence about the injured person's medical condition and life before the accident and after. This is especially important in cases involving chronic pain where the cause (etiology) of the injury cannot be shown through any diagnostic tool like an x-ray, MRI or CT scan. An Expert Witness is a person who, through education or experience, has developed skill or knowledge on a particular subject, so that he or she may form an opinion that will assist the Trier of fact.
Where the negligence of one person has resulted in the death of another individual.
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