Accident Benefits – Benefits in the form of money or assistance provided to persons injured in a motor vehicle accident, regardless of who is at fault. Types of accident benefits include: non-earner, income replacement, attendant care, caregiver, medical, rehabilitation, funeral expenses, visitor expenses, housekeeping and home maintenance.
Adjuster – A person who investigates and/or adjudicates insurance claims on behalf of an insurance company.
Attendant Care – A type of accident benefit an injured person receives to pay for assistance in his or her daily living. Assistance may take the form of cooking, cleaning, helping the injured person get dressed or supervising the injured person. In most instances, at least part of the costs for providing attendant care may be paid by the insurance company to the person providing the care, whether it be a health care professional or a family member.
Case Manager – A rehabilitation professional who coordinates rehabilitation services following an injury.
Catastrophic Impairment – The most serious of personal injuries. Examples include injuries resulting in an impairment of 55% or more of the whole person, quadriplegia, paraplegia, amputation of both arms or legs, brain impairment measured at a score of 9 or less on the Glasgow Coma Scale, marked or extreme mental or behavioural impairment, and severe disability from brain injury measured using the Glasgow Outcome Scale. A person having a catastrophic impairment becomes entitled to maximums of $1,000,000.00 for medical/rehabilitation needs, plus $1,000,000.00 for attendant care plus housekeeping expenses, payable over the lifetime of the injured person.
Damages – In a lawsuit, damages are the losses the plaintiff has suffered as a result of the defendant’s conduct. These losses can take many forms including compensation for pain and suffering, loss of income or ability to attend or complete schooling, physical, mental or psychological impairments, loss of social or familial relationships, etc. Damages are also what a plaintiff seeks to recover in a lawsuit usually in the form of money to compensate for the losses.
Deductible – In lawsuits arising from a motor vehicle accident, after an award for compensation for pain and suffering is established in court or during the settlement negotiations, the defendant has the right by law to deduct an amount from the award, reducing the total award to be paid for pain and suffering. This is referred to as “the deductible”.
Defendant – In a lawsuit, a defendant is a person/persons and/or corporation that are being sued by a Plaintiff. Examples of defendant corporations include an insurance company, a leasing company, a municipality, a tavern, a property owner, a hospital, etc. Most defendants in personal injury lawsuits are insured. A defendant’s insurer will usually appoint a lawyer to act on behalf of the defendant.
Glasgow Coma Scale – A medical test used to determine brain impairment as a result of an accident. It is based on a scale of 3 to 15, with a lower score indicating a more serious injury. A score of 9 or less results in the person being deemed to have sustained a catastrophic impairment.
Health Care Expenses – A category of accident benefits and tort entitlement, which includes medical, dental, and nursing expenses, as well as medication costs, prescription eyewear and other goods and services of a medical, rehabilitation, attendant care or non-medical nature which an injured person requires.
Insurer Examination Centre/Section 42 Assessment – The insurer may appoint health care professionals of their choosing, to perform assessments in order to determine whether to pay a benefit. Legal advice should be sought before you decide whether you should submit to such an assessment.
Occupational Therapy (OT) – Therapeutic use of self-care, work, and recreational activities to increase independent function, enhance development, and prevent disability; may include adaptation of tasks or environment to achieve maximum independence and optimum quality of life.
Limitation Period – When a person suffers an injury, the law imposes a time limit in which to issue a Statement of Claim. If one fails to issue the Claim within the time period allotted, all rights to compensation are lost.
Loss of Consciousness – The loss of ability to perceive and respond, ranging from an altered state of awareness to total unconsciousness (coma).
Non-earner Benefit – An accident benefit for individuals who are no longer able to carry on a normal life and who do not qualify for an income replacement benefit. An example of someone who may qualify for a non-earner benefit is a student or a person who has not been employed in the last 26 of 52 weeks.
Paraplegia – Total or partial paralysis of both lower extremities, generally from the waist down. Total and partial paraplegia are catastrophic impairments.
Personal Injury Law – The area of law that concerns persons who have been injured as a result of being in an accident. Accidents include motor vehicle accidents, slip and fall, medical malpractice, boating accidents, pedestrian accidents, assault, ATV or motorcycle accidents, etc.
Pre-Claim Examination – The accident benefit insurer may request an assessment by health care professionals of its choosing, before you even apply for benefits. The injured person has the right to refuse this assessment and may do so without penalty.
Plaintiff – In a lawsuit the person or persons who have sued another person(s), corporation or insurer (the “defendant”).
Physical Therapy (PT) – 1. Treatment of pain, disease, or injury by physical means; Syn: physiotherapy. 2. The health profession concerned with promotion of health, with prevention of physical disabilities, with evaluation and rehabilitation of persons disabled by pain, disease, or injury, and with treatment by physical therapeutic measures as opposed to medical, surgical, or radiological measures.
Quadriplegia – Total or partial paralysis of all four limbs, generally from the chest down. Total and partial quadriplegia are catastrophic impairments.
Ranchos Los Amigos Scale – An evaluation used to measure the severity of deficit in cognitive function following a brain injury. A person is categorized from level one (no response) to level eight (purposeful, appropriate)
Statement of Claim – A document that begins a lawsuit and claims “damages” from one or more Defendants based on the Defendant’s negligent acts or omissions causing loss, injury or harm to the Plaintiff. A Statement of Claim is generally prepared by the Plaintiff’s lawyer.
Statement of Defence – A defendant’s response to the Statement of Claim. It is usually prepared by the Defendant’s lawyer. Often, it will deny the allegations made in the Statement of Claim.
Threshold – To succeed in a motor vehicle personal injury lawsuit, an injured person must prove that their injury meets a threshold test. This means that the injury must be either a permanent, serious disfigurement (like a scar) or a permanent, serious impairment of an important physical, mental or psychological function. There are many court decisions which help a lawyer specializing in personal injury law to advise you about whether your injuries “meet the threshold”.
Tort – An area of law in which one party sues and seeks monetary compensation (money) for injuries and losses suffered as a result of the fault or negligence of another party. This contrasts with no-fault benefits (accident benefits) where benefits are paid without reference to fault.