Our Practice Areas

Harry Steinmetz is Certified as a Specialist in Civil Litigation by the Law Society of Ontario

LTD Claims

Long-term disability insurance (LTD) compensates you when you suffer an injury or illness that keeps you from working by replacing a portion of your income. LTD can be provided by your employer, through private insurance, or through the Canada Pension Plan (CPP).

Motor Vehicle Accident

According to Transport Canada, there are 150,000 to 200,000 injuries in Canada each year as a result of motor vehicle collisions. When these accidents occur, injured parties and their families may have two types of claims in Ontario. One is as a result of the no-fault statutory accident benefits system (SABS) and the second is in a lawsuit against the responsible parties (tort claim).
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LTD claims are complex and involve large amounts of paperwork. At Steinmetz & Associates, we can assist in navigating the many pitfalls of making a claim by maximizing your chances of obtaining the benefits you are entitled to.

Appealing a Decision:
In order to obtain LTD benefits, you will have to prove that you suffer from a qualifying injury or illness under the terms of the policy. However, even when this is done and you have sent all the necessary paperwork, the insurer may still deny your claim.

Having your LTD claim rejected is both common and frustrating. Often, the insurer will use the wording of your own policy in its refusal letter to make it seem as though your claim is finished. At Steinmetz & Associates, we can help by appealing the insurer’s decision on your behalf. We will work to overturn the refusal by demonstrating that you have successfully fulfilled the conditions under the policy for payment of LTD benefits.

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Accident Benefits:
Under the accident benefits system in Ontario, you immediately must look to your own insurance company following a car accident. Among other forms, you submit to your insurer an Application for Accident Benefits, otherwise known as an “OCF-1” to initiate a claim. Benefits available to you from your insurer include: medical and rehabilitation benefits, attendant care benefits, income replacement benefits, and non-earner benefits. Optional benefits may also be available. For catastrophically injured claimants, in addition to increased coverage limits, benefits may include housekeeping and home maintenance expenses, as well as caregiver benefits.

It is important to have a lawyer who can help guide you through this process. A lawyer can provide you information on which coverage and benefit options are available and navigate you through the process. Further, they can protect your interests if a dispute with your insurance company arises.

Lawsuits (Tort Claim):
While the accident benefit system can provide some immediate financial relief to claimants, it is not without its limitations. For example, income replacement benefits are normally capped at $400/week following an accident. As such, accident benefits may not fully compensate injured parties for their losses. In these situations, we look to start what is called a tort claim (a legal action or lawsuit) against the at-fault party. Subject to certain limitations, you can seek compensation for pain and suffering, healthcare expenses, economic losses, as well as housekeeping and home maintenance expenses, among other claims.

Catastrophic Injury

The term “catastrophic injury” is not merely a descriptive phrase. It has legal implications that impact the compensation you can expect for your loss.

Wrongful Death

A claim of “wrongful death” is brought when a person’s death is the result of someone else’s negligence. Wrongful death claims can be brought against individuals, corporations, governments, and institutions.
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The term “catastrophic injury” has special significance for those injured in automobile accidents. To meet the definition in such cases, a licensed doctor must complete and submit form OCF-19 (“Application for Determination of Catastrophic Impairment”).

In order to be assessed as catastrophically impaired, you must meet certain criteria, which can include (but are not limited to):

  • Paraplegia or quadriplegia;
  • Amputation of an arm or leg;
  • Total loss of vision in both eyes;
  • Brain impairment

The OCF-19 has to meet the Statutory Accident Benefits Scheme (SABS) requirements for the injured person to qualify for statutory benefits in Ontario. At Steinmetz & Associates, we can help make sure that you meet these requirements. We are familiar with the necessary tests and assessments that must be conducted to prove catastrophic impairment. We can make sure that the extent of your injury is properly laid out in the OCF-19 and that you obtain the benefits you are entitled to receive.

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Typical Causes of Wrongful Death

Automobile Accidents: In most cases, these accidents are caused as a result of a driver being under the influence of drugs/alcohol, fatigued, inexperienced or distracted.

Medical Malpractice: May involve a failure to diagnose or misdiagnosis due to anaesthesia-related problems, or incorrect treatment/medication that leads to death.

Workplace Accidents: May involve unsafe work conditions that lead to death.

Defective or malfunctioning products, unsafe premises, and lack of security can also lead to wrongful death claims.

Ontario Family Law Act & Wrongful Death

The Ontario Family Law Act allows eligible family members to collect compensation in cases of wrongful death for:

  • Economic and non-economic losses for expenditures incurred before a person dies;
  • Funeral expenses;
  • Travel expenses;
  • Loss of present and future income for dependents;
  • Shared family income;
  • Loss of household services that would have been undertaken by the deceased;
  • Loss of companionship and guidance.

In general, the damages awarded are structured so that the claimant receives 60-70% of the net income that the deceased would have earned in the period commencing from the date of the accident up to the end of their working life expectancy.

Based on the circumstances and insurance policy criteria, eligible claimants may include:

  • spouse, children (including adopted children), grandchildren, parents, grandparents, siblings;
  • parents of unmarried children;
  • life-partners and/or those who believe in good faith that they were married to the victim;
  • partners, dependents and companions;
  • parents of a deceased fetus.

At Steinmetz & associates, we can assure that you are fairly compensated for the death of a loved one by assisting you with your wrongful death claim.

Social Host- Tavern Liability

Social hosts or tavern owners who serve alcohol can be held liable if the amount of alcohol consumed by the guest results in an accident that causes injuries.

Spinal Cord Injury

A spinal cord injury (SCI) involves damage to the spinal cord that affects the functioning of the rest of the body. This may cause a variety of symptoms, ranging from pain and numbness to complete paralysis.
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A “host” is any establishment that sells alcohol to its patrons (like a bar or a restaurant). When a host is aware that their guest is intoxicated or impaired and fails to take the necessary steps to prevent them from causing harm to third parties or themselves, the host is responsible for the actions of the guest.

At Steinmetz & Associates, we can assist you in bringing an action against any host that has failed to properly monitor their guests.

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SCI generally qualifies as a “catastrophic injury”. Long-term or permanent disability, as well as emotional trauma, can result from SCI. Therapy, rehabilitation, and lifestyle modifications are often required.

SCI can occur immediately following an accident or it may manifest some time later. SCI has to be dealt with by experts in the field. Surgery, rehabilitative therapies, traction, medication, physical therapies, psychological counselling, vocational training, and the use of assistive devices like wheelchairs, walkers, and leg/neck braces may be required. Often, the patient has to re-learn how to live. The ongoing medical and rehabilitation expenses, caregiving expenses, and loss of income are often significant.

At Steinmetz & Associates, we can assist a claimant in getting the compensation required to pay for of these expenses.

Slip & Fall

Emergency rooms and doctors’ clinics are most often visited by people who have been injured in a slip and fall or trip and fall accident. They can be caused by ice and snow or because of cracked pavement or poorly maintained stairs. These accidents can cause serious injuries.

Accident Benefits (AB)

Accident benefits (AB) refer to compensation provided when passengers, drivers or pedestrians are hurt or killed in a car accident. These benefits are available to all injured persons, regardless of fault.
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Under Canada’s Occupier’s Liability Act, property owners must ensure that their premises are reasonably safe for all those who visit them. If there are unsafe areas, adequate warning signs and prior notice must be given. Most accidents are caused by the owner’s or their contractor’s negligence.

There are several complex medical, legal and insurance issues involved in these kinds of accidents. In certain cases, especially when making a claim against a municipality, the claimant must act quickly if they hope to get compensation for their loss. At Steinmetz & Associates, we can help you advance a claim and obtain the compensation to which you are entitled.

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Under the current laws, victims are entitled to receive the following AB:

  • Income replacement benefits;
  • Caregiver benefits;
  • Housekeeping;
  • Non-earner benefits;
  • Medical and rehabilitation benefits;
  • Dependent care;
  • Replacement of damaged appliances like dentures, spectacles, and hearing-aids;
  • Indexation benefits;
  • Lost education expenses;
  • Visitors expenses;
  • Home maintenance;
  • Funeral and death benefits.

Benefits are awarded based on the circumstances of the case, type of injuries and their impact on the victim’s and family’s life.

One of the largest barriers to obtaining accident benefits involves victims and their families failing to file their claims within the specified time periods. They may also fail to provide complete documentation.

At Steinmetz & Associates, we are prepared to tackle the complex medical, legal and insurance issues involved in making an AB claim. We can handle the paperwork and help you get the benefits you are entitled to.

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