Glossary of Terms

To easily navigate this page, choose from the glossary terms here to be directed immediately to the definition.

ACCIDENT BENEFITS (AB)

Called 1st party no-fault benefits, indicating that you have a private contract as a policyholder or 'insured person' from your auto insurance company, this contract gives you assistance and is available whether you are or are not responsible for causing the motor vehicle accident that brought about your injuries. ABs mostly focus on reimbursing you, in part, for loss of wages and for other out-of-pocket expenses incurred after an accident and while rehabilitating from accident related injuries (i.e. therapy, medications, transportation, job retraining, housekeeping, babysitting, etc.). Limited coverage is available for funeral costs and other death benefits. Additional benefits are paid, after approval by the insurer, for things like private medical assessments, lost tuition fees, or travel expenses for family visitors who come to check on you. Optional benefits to enhance coverage in scope, duration and limits can be purchased from your insurer.

ADJUSTER

The person working for, or on behalf of, an insurance company to administrate and adjust insurance claims, including property damage (house fires, floods, residential or commercial property issues like burglaries, vandalism, etc.)? automobile claims (ABs, vehicle repairs, bodily injury cases in a negligence suit, etc.)? CGL (commercial general liability) or E&O (errors and omissions or professional negligence claims). The adjuster advises on what claims you can and cannot make, determines the reasonableness of your claim, and makes payments according to the policy, case law and personal judgment.

ARBITRATION

A binding decision-making process managed and adjudicated by a mutually agreed-upon party in the Arbitrations Act or by a government tribunal designated to be the forum to hear certain types of disputes, including: Landlord Tenant, Canada Pension Plan, Labour Board, Worker Safety Tribunals (WSIB/WSIAT), and the Financial Services Commission of Ontario (FSCO = AB disputes between policy holders and their own insurer). An arbitrator is a finder of fact with powers similar to a Superior Court Justice. An Arbitration result is binding, but in certain cases can be appealed to a multi-judge panel of the Divisional Court of the Superior Court of Justice in Ontario.

ASSESSMENT

A medical assessment done at the request of your own insurer, the party you are suing, or at your own or your doctor's request, in an insurance dispute, as a fact-finding exercise to provide a diagnosis and prognosis of your medical condition, and to determine whether the accident or incident played a role in causing your current and likely future state of health and impairment.

ATTENDANT CARE (A/C)

AB policies recognize A/C as the personalized in-home assistance by an aide/attendant (i.e. a personal support worker, nurse, private aide) for tasks such as bathing, dressing, grooming, feeding, walking, etc. In some cases, family members have also been paid for their contributions. Funding is also available for recuperation at respite or rehabilitation hospitals, and for long-term care facilities on a permanent basis. Consult with our long-term disability lawyer in Brampton for more information.

CASE MANAGER

A trained medical 'point person', appointed mutually by the client and the insurance company, to organize and orchestrate rehabilitation efforts in serious injury cases. The case manager sets and measures goals with the aim of rebuilding the life and health of an injured party to achieve, as closely as possible, pre-accident living.

CATASTROPHIC IMPAIRMENT (CAT)

A defined level of injury in the first party statutory accident benefits schedule (SABS) that qualifies the person for additional enhanced benefits, significantly increasing the amount of funding and duration of assistance from the insurer. The coverages can be deemed available with the onset of immediate and egregious injuries (i.e. loss of limbs or sight, brain injuries, etc.), but can also accrue for those who suffer extraordinarily enhanced and entrenched disabilities that have not dissipated 24 months after the original accident, if medical evidence supports a poor prognosis.

COSTS ENDORSEMENT

Following a trial or arbitration, an order, by a finder of fact, regarding the amount and fair value, to be paid, for legal services and disbursements (e.g., office overhead, faxes, photocopies, fees for medical records, etc.) by either the defendant/insurer or the plaintiff/applicant, depending on the relative success in pursuing a legal action to its conclusion (a trial) instead of proposing or accepting a reasonable settlement before trial or arbitration.

DAC (DESIGNATED ASSESSMENT CENTRE) PROCESS

A mandated scheme developed by the government between 1996 and 2006 wherein assessment teams of medical professionals served as a 'neutral party' between the insurance company and its policy holder, to determine the outcome of coverage disputes in AB claims. DACs were abolished in the spring of 2006 as a cost savings measure for the industry.

DAMAGES

Monies sought for reimbursement and compensation to the party which has suffered a loss through the negligence of another party. Damages in civil litigation in Ontario are typically classed as: PECUNIARY, for financial losses (typically in earnings)? SPECIAL, for out-of-pocket expenses and purchases not otherwise intended (e.g., medical costs) and GENERAL, for the valuation of pain and suffering, and loss or diminution of enjoyment of life.

DEDUCTIBLE

An amount reducing the impact of a monetary claim against an insurance company. In property and automobile claims, the size of the chosen deductible influences the amount of premium you pay the insurer. In automobile personal injury negligence cases, the deductible is set under the Insurance Act, reducing the claim for General Damages for pain and suffering by between $15,000 and $30,000 (depending on when the accident occurred), implemented to curtail minor injury or nuisance claims.

DEFENDANT

The party being pursued in a civil action for financial remedy by the injured party (plaintiff) who believes that negligence has brought about an injury or loss.

FIDUCIARY DUTY

The responsibility that a party carries on your behalf in case of a power imbalance in a relationship, such that you rely on the advice of said party to take a course of action, i.e., doctor to patient, insurer to insured client. It is the duty of an insurer, for example, to provide information about policy conditions and requirements, and to act in the utmost good faith in its dealings with a client to help make proper and timely applications for assistance.

GLASGOW COMA SCALE (GCS)

An official medical measurement developed and published in 1974 as a tool to understand brain function or its limitations after a trauma.

HEALTH CARE EXPENSES

Cost of items obtained, services or devices of a medical nature, including medications and procedures to improve one's condition and functioning.

LEGAL ACTION

A claim pursuing a legal remedy against a party who has wronged another party and caused a loss.

LIMITATION PERIOD

A limited period of time under the law within which one is required to provide a notice of intention to pursue a legal remedy, for a reported loss. Failure to obey a defined limitation date can seriously impede, if not eliminate, the right of an injured party to pursue another person or legal entity for a remedy.

NON-CATASTROPHIC DESIGNATION

In first party AB claims, an individual who does not qualify for the CAT coverage levels afforded to those who suffer the most egregious injuries, whether before or after determination by medical review. A 'regular' level of claims coverage is available to those who are 'non-catastrophic'.

NON-EARNER BENEFITS

A weekly specified benefit, under a 1st party AB claim available to students, retirees and the unemployed, as a means of limited compensation for those who have suffered auto accident injuries that render them completely disabled from their activities of daily living. Since 1996 the weekly benefit amount has been fixed at $185/week, paid following a 6 month waiting period from the date of the accident.

NOTICE PERIOD

A phrase commonly used to denote the initial 120 day period after a motor vehicle accident during which, pursuant to the Insurance Act, a potential plaintiff/litigant should provide written notice to a defendant of his/her intention to commence a legal claim for bodily injury. The date of the service of notice also fixes the date for the start of calculation of prejudgment interest to be paid on damages obtained in the final result.

NO FAULT

Denotes the Ontario auto insurance regime in existence since 1990, wherein an injured party will obtain direct and immediate compensation and indemnity for property damage, and limited personal injury losses/expenses from his/her own insurance carrier, while still being eligible for further compensation for pain and suffering, and extraordinary medical expenditures, from a negligent 3rd party, who can be pursued in a civil tort action through the courts.

OCCUPATIONAL THERAPY (OT)

A medical discipline and area of practice that focuses on the study of a person in their environment domestically, socially and vocationally, to help overcome accident related limitations

PARAPLEGIA

The loss of significant function in the lower extremities through paralysis, usually as a result of a spinal cord injury.

PERSONAL INJURY

A legal practice area that focuses on physical and psychological harm to an individual or group of individuals (e.g., a class action) brought about by the negligence of a 3rd party through misfeasance (acting improperly), malfeasance (deliberately doing harm), or nonfeasance (failing to act).

PHYSICAL THERAPY

Usually refers to modalities delivered by regulated health professionals in Ontario, including, but not limited to: physiotherapy, chiropractic, massage, and acupuncture treatments.

PLAINTIFF

The person who commences a legal action or application in court with the aim of seeking a civil remedy (damages) for an actionable wrong, as a means of appropriate compensation for resulting injuries.

PRE-CLAIM EXAM

In 1st party no-fault legislation, an insurer’s examination, conducted by your insurance company with your consent, in order to measure certain medical needs and attendant care requirements while you seek discharge from hospital into a safe recuperative environment, in the immediate period after an accident.

QUADRIPLEGIA

The loss of significant function in all four limbs through paralysis, including loss or extremely restricted motor function and/or sensation, usually as a result of a spinal cord injury.

STATEMENT OF CLAIM

The legal pleadings laying out the foundation of a plaintiff’s claim, including his/her accusations of wrongdoing, and the demands for damages and compensation sought therein.

STATEMENT OF DEFENCE

The legal pleadings of a defendant in a civil action, in reply to accusations rendered in a Statement of Claim.

THRESHOLD

As described in the Insurance Act and noted in case law, the minimum standard in the evaluation of medical injuries in motor vehicle claims that a person must prove in order to overcome a legislated legal barrier limiting the number of litigants who can obtain compensation for general ‘pain and suffering’ damages. Failure to ‘cross the threshold’ excludes a plaintiff from obtaining compensation for what would otherwise be deemed ‘minor’ injuries. The test essentially focuses on whether injuries are permanent and significantly interfering whether they be related to physical, or mental/psychological post-loss.

Information

Gillis Injury Law

1595 16th Avenue, Ste. 301

Richmond HIll, ON 

L4B 3N9

Phone: 905-709-7447

Email: mbrown@gillisinjurylaw.ca

Hours

Monday - Friday 09:00 AM - 05:00 PM

Saturday - Sunday Closed

Saturday and Sunday by appointment only

Fast-track appointments at the office, hospital or home

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