While receiving a denial for your disability insurance may be disheartening, it is not uncommon. Insurance companies frequently deny claims, but this does not automatically mean that your claim is invalid or that you won’t ultimately succeed. A denial does not necessarily reflect the strength of your claim or its potential for success before an impartial decision-maker.

Therefore, it’s important not to be discouraged. Instead, you should continue to pursue your benefits. Contacting an experienced long-term disability lawyer can help ensure that your claim is handled properly and that you have the best chance of obtaining the benefits you deserve.

Regardless of the reason for your insurance claim denial, you should consider appealing the decision. Acting promptly is crucial to ensure you don’t miss any deadlines. You have two options for appealing: internally with the insurance company or externally through the courts, with a two-year deadline for court appeals.

Ontario law states that property owners and occupiers are responsible for the safety of people who come onto the property. Under the Occupiers’ Liability Act, R.S.O. 1990, c O.2, every person or entity that owns or occupies property – whether it be a house with a driveway, a grocery store, or a plot of land – owes two basic duties:

• 1) to take reasonable steps to keep people reasonably safe; and
• 2) to not act with intent to harm or reckless disregard.
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These duties are owed by municipalities, store owners, retailers, commercial tenants, condominium corporations, superintendents, maintenance workers, homeowners, landlords, and residential tenants, among others. The type of the property and the nature and circumstances of a slip-and-fall or trip-and-fall accident will decide which of the duties apply.

To succeed in a lawsuit, you are required to prove that the fall and the injuries were caused by a failure of the owner, occupier, maintenance contractor, and/or municipality to take reasonable care. However, owners and occupiers are not strict liability “insurers” of the premises, meaning that an injured person will only be entitled to compensation if the owner or occupiers acted unreasonably in their regard for the property.

In most situations, a person is walking along and either slips on a substance or trips over a hazard on a property where it is anticipated that a pedestrian would be walking. In those situations, the injured person must prove that the hazard caused the fall and that the hazard existed because the responsible party failed to take reasonable steps to keep the property reasonably safe. 

This often requires an in-depth understanding of the applicable industry standards for the location in which the fall occurred. It may also require investigation into issues of layout, signage, lighting, construction, building code compliance, and maintenance operations.

The law does not expect people to be free from injury or illness before an accident. Quite often, people have pre-existing psychological health conditions. Sometimes these events are related to a discrete event, like job loss or a divorce, and the condition often resolves. Other conditions are long-standing, such as a generalized anxiety disorder, mild depression, or attention deficit hyperactivity disorder.

At law, it is not the significant diagnosis but the change in your ability to function caused by the accident. Someone with mild depression may work full time, have a family, coach his daughter’s soccer team, and manage well on anti-depressant medication. Then, following an accident, that depression may deepen and then absences at work occur or lengthen, participation with the family diminishes, hygiene diminishes etc. A lawsuit primarily tries to restore a person’s lifetime financial trajectory, and it tries to provide funding for future treatment and services to diminish the impact of an injury. Accordingly, the most important in a lawsuit is the change in a person’s ability to function following an accident and the economic consequences of that impaired ability to function.

Typically, insurance companies try to establish that a person’s current level of function results from a prior psychological injury. This leads to an interesting debate between legal doctrines with historically crass titles: “thin skull” versus “crumbling skull.” The thin skull doctrine recognizes that some people are more vulnerable to the effects of injury than others and that those who harm a more vulnerable person are nevertheless responsible for the full extent of the injuries. The crumbling skull doctrine holds that if a pre-existing condition was bound to worsen, then the defendant is only responsible for the losses caused during the time that the condition was accelerated.

In psychological claims, often, the insurer will acknowledge a brief period of disruption but will ultimately blame the current status of the injured person on prior conditions.

Much of this debate is beyond the control of anything the injured person can do. Experts will have their opinions. However, the injured person can work with their injury lawyer to identify people who can give statements about the injured person’s level of function before the accident. The opinions of an expert about what a person was like are typically no match for a variety of people coming forward to describe their interactions with the person before the accident.

The other critical help the injured person can provide is their own sincerity in acknowledging their prior injuries. Cases involving psychological injuries put the injured person’s credibility at the forefront. Accordingly, it is critical to be sincere about your prior health issues.

People injured in motorcycle accidents are entitled compensation for personal injury. If you have been hurt in a motorcycle accident by another at-fault driver in Toronto or in Ontario, you can seek compensation from the other motorist by commencing a civil tort lawsuit in the Ontario Superior Court of Justice. 

1. Claim Against the At-Fault Driver: You can file a “tort claim” against the driver who caused the accident.
2. Vehicle Accident Benefits: You can receive benefits through your own automobile insurance policy or the policy of any other vehicle involved in the accident.

People injured in motorcycle accidents are entitled compensation for personal injury. If you have been hurt in a motorcycle accident by another at-fault driver in Toronto or in Ontario, you can seek compensation from the other motorist by commencing a civil tort lawsuit in the Ontario Superior Court of Justice.