FREQUENTLY ASKED QUESTIONS

In addition, Ontario legislation mandates certain timelines and limitations which need to be met in order to advance a claim. A failure to comply with these limits may be damaging or prejudicial to your claim and in some circumstances may bar you from bringing any action.

In these circumstances, you will need trustworthy and reliable legal representation. At Grillo and Associates, we will provide professional and sound legal advice and representation for every step of your claim, so that you can focus on your recovery.

Legal fees can be very costly and some law firms may require a retainer of hundreds, or even thousands of dollars to work on your file. At Grillo and Associates, we operate on a “no-win, no-fee” arrangement. This means that you only pay us, when you get paid. Occasionally, we may require a small retainer for our disbursements.

An Accident Benefits Claim is a claim that you make to your own automobile insurer for benefits you may be entitled to as a result of the accident. These benefits may include: Income Replacement Benefits; Caregiver Benefits; Non-Earner Benefit; Housekeeping Benefit; Attendant Care Benefit; and your Medical and Rehabilitation costs.

If you do not have insurance, certain provisions may still allow you to claim accident benefits under another insurance policy. For example, through the insurance of a spouse, an employer, or even the third party involved in your action.

Yes you may, however, you may be restricted from claiming certain benefits, such as housekeeping and income replacement benefits.

Your accident related injuries may leave you incapable of carrying out your work, personal care, activities of daily living and looking after your children or elders. If so, you may be entitled to the following benefits from your insurer:

• Medical and Rehabilitation benefit: This includes physiotherapy, chiropractic, massage, acupuncture and other modalities.
• Attendant care benefit: You may be entitled to compensation to hire help from another person who can care for your personal needs. This includes taking care of your personal hygiene, dressing and feeding.
• Housekeeping assistance: You may be entitled to claim housekeeping assistance for a maximum of $100.00 per week, to have someone do the housekeeping activities you normally did prior to the accident. This benefit is only payable if you incur the expense of the housekeeping help.
• Caregiver Benefits: You may be entitled to this benefit to a maximum of $250.00 per week, if you are the primary caregiver for a person in need of care, plus $50.00 per week for each additional person requiring care. This benefit is also only payable if you incur the expense of that care.
• Income Replacement Benefits (IRB): You may be entitled to claim this benefit to replace your loss of income for up to 70% of your net weekly income prior to the accident, to a maximum of $400.00 per week.
• Non-Earner Benefit: You may be entitled to $185 per week if you are not employed at the time of the accident. This benefit only starts six (6) months after your accident.

If your insurer denies your benefits, you are entitled to apply for Mediation with the Financial Services Commission of Ontario (FSCO).

Mediation is a form of alternative dispute resolution, usually in the form of a teleconference meeting between yourself, your lawyer, the insurer and a mediator appointed by FSCO. This process is designed to allow an open discussion between you and your insurer, and can often be an avenue to discuss a partial or final resolution of your claim.

If your mediation fails, you are entitled to apply for an arbitration with the Financial Services Commission of Ontario.

An arbitration is another method of alternative dispute resolution. Arbitration hearings are similar to court proceedings, but a lot less formal, and cost efficient. The ultimate decision will be made by the hearing arbitrator who will have the power to decide your entitlement to the disputed benefits.

A full and final settlement of you claim is a binding contract between you and an insurer (your own insurance or 3rd party insurance company) to settle your claim completely. This means that you will not be entitled to apply for any more benefits in relation to the accident in which you were involved. The release that you will sign will relieve the insurance company of any obligations that they may owe you in relation to that particular loss.

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
• How long you take to obtain legal advice
• The applicability of legal time limitations
• 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

Yes. Ontario automobile legislation mandates that your claim remain open for at least 1 year.

A tort claim is a claim you make against an at-fault party in your motor vehicle accident, or, if your injury arose from a slip and fall or faulty product, against the relevant negligent party. This claim is designed to compensate you for your pain and suffering, loss of income, and out of pocket expenses that result from the incident.

No. If your tort claim arises from an automobile accident, you must meet the following requirements:

• You are not at fault;
• You suffer a permanent and serious impairment of an important physical, mental or psychological function, or a permanent serious disfigurement;
• Your injuries surpass the statutory deductible of $15,000.00 if your accident occurred before October 1, 2003, or $30,000.00 if your accident occurred after October 1, 2003.

Your lawyer will assess your claim and advise you whether your claim will meet these requirements. Please note that the above requirements are not applicable if your claim is as a result of a slip and fall, or a faulty product.

For the most part, a third party claim must be commenced within 2 years of your accident. There are few exceptions to this rule, one of our lawyers can tell you if one of the exceptions applies to you.

Yes they may. Pursuant to the Family Law Act, children, grandchildren, parents, grandparents, brothers and sisters of the person injured/killed in an accident are entitled to recover their monetray losses resulting from the injury or death of that family member. Such monetary losses may include:

• actual expenses reasonably incurred for the benefit of the person injured or killed;
• actual funeral expenses reasonably incurred;
• a reasonable allowance for travel expenses actually incurred in visiting the person during his or her treatment or recovery;
• where, as a result of the injury, the claimant provides nursing, housekeeping or other services for the person, a reasonable allowance for loss of income or the value of the services; and
• an amount to compensate for the loss of guidance, care and companionship that the claimant might reasonably have expected to receive from the person if the injury or death had not occurred.

Anyone who has sustained injuries as a result of a motor vehicle accident, regardless of the damage, is entitled to claim Accident Benefits.

The insurer will be made aware that you are being represented for your AB Claim. Although we are copied on every correspondence sent to our clients, it is important that you review these letters to keep up to date on the status of your file. Ensure that you are not responding directly to the insurer when receiving these letters. Any requests made by the insurer will be handled by our firm. If we require additional information from you, you will be contacted by your legal representative directly.

Claimants who are unable to work due to their accident injuries may be entitled to Income Replacement Benefits. If you have Short/Long Term Disability Benefits available to you, this may affect your entitlement to this benefit. Please consult your legal representative.

For more information on the Income Replacement Benefit, please refer to the following article: (insert link article on irbs)

As per the Statutory Accident Benefits Schedule, any extended health benefits coverage must be exhausted before the auto insurer will pay for your treatments and medication. If you are covered under any collateral benefits plan, ensure to advise your legal representative and the clinic you attend for treatment.

Once your legal representative has requested and reviewed the relevant medical documentation, they will determine whether or not your pre-existing condition has an effect on your AB claim.

Definitely. It is extremely important that your legal representative is aware of any benefits you are receiving as this may directly affect your entitlement to a specified benefit.

As of September 2010, claimants may be entitled to the Housekeeping Benefit only if it is purchased as an optional benefit on their auto policy or their injuries are considered Catastrophic. In any case, please advise your legal representative of your difficulties with these tasks, as it can still be important to your claim.

Reasonable out of pocket expenses incurred as a result of the accident can be considered by the auto insurer. Please speak to your legal representative for more details.