Personal Injury

Denied benefits force injured plaintiffs to sue

By April Cunningham, Associate Editor

The story of a 28-year-old paralyzed man who is suing his insurance company after being denied $120,000 in claims is the kind of tale Toronto personal injury lawyer Darryl Singer hears on a regular basis.

“It happens almost every day,” says Singer, principal of Singer Barristers Professional Corporation. “What I tell my clients is your insurance policy doesn’t give you a right to make claims, it gives you the right to sue.”

According to CBC News, a former Nova Scotia resident was paralyzed in 2011 when he toppled seven metres over a railing at a restaurant after tripping on his flip-flop. He suffered a traumatic brain and spinal cord injuries, the article says.

The man thought he was covered under his mother’s insurance policy, but the insurance company only agreed to pay a $6,183 bill to cover a 10-week hospital stay. Even after doctors wrote letters to state he is paralyzed from the waist down, the company has denied his claim for further coverage for rehabilitation and medical treatment.

The insurer replied that he is “able to ambulate with the use of assistive devices,” and so he doesn’t meet the provision of “total and irrecoverable loss of use” as outlined in the insurance policy, the story says.

“‘If he doesn’t qualify, who does?’” the man's lawyer asked the CBC. “‘What’s the point of insurance?’”

Singer, who is not involved in the case and comments generally, tells AdvocateDaily.com he is working on many files representing clients whose insurance companies have refused to pay out for damages from loss of property during home break-ins or injuries from car crashes, for example.

While he says the story of the paralyzed man is on a greater scale, there is a constant battle between insurance companies and claimants — one that often forces individuals to sue.

Singer says insurance policies are inherently unfair and one-sided. He describes them as a contract that the insured person does not have a say in negotiating. He says policies often have vague clauses that provide insurance companies with a way out of paying someone in the event of a claim.

“The system is stacked against individuals who otherwise believe they are protected by insurance,” Singer says. “When in fact, their coverage continues to be clawed back further and further.”

Recent changes to Ontario’s Statutory Accident Benefits Schedule (SABS), which included big cuts to most benefits, is one example, Singer says.

“Imagine there was a law in Ontario that forced residents to pay lawyers a fee every month? That’s essentially what we have with insurance,” he says. “Anyone who drives pays insurance. Anyone who has a mortgage on a home has insurance, but when it comes time to make a claim, it’s a struggle.”

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