Old Cases Not Necessarily Cold Cases

Personal Injury recovery: A Story of Hope

Conventional wisdom is that accident victims from incidents that happened long ago have a limited time frame to collect accident benefits required for rehabilitation and care. The following true story serves as an example for why this isn’t always the case. If you have an old case and have ongoing rehabilitation needs, there may yet be hope.

In 1994, Ms. S was in a motor vehicle accident and suffered physical and psychological injuries. Following the accident, she began experiencing involuntary muscle spasms and tremors at irregular intervals. Over the next two years, she received treatment funded by her insurance company. After two years, her accident benefits ran out and her claim was eventually closed.  A final settlement was never reached. 

Determined to “tough it out,” Ms. S returned to work in January 1995, although the tremors persisted and gradually worsened over time. Over the next 20 years, she sought ongoing treatment and specialist opinions for the condition, which was generally assumed to be a neurological disorder. By 2015, Ms. S’s symptoms had progressed, and included “brain fog” and other cognitive impairments. Her tremors were so severe and unpredictable that she was unable to continue working and relied on her husband and mother for support with her daily activities. She was virtually housebound.

Ultimately, Ms. S was diagnosed with a Conversion Disorder – a psychological condition characterized by uncontrollable neurological symptoms (such as the claimant’s tremors and pain) that cannot be explained by an underlying neurological disease or other medical condition. Having been advised that the 1994 collision was the probable cause of her Conversion Disorder, she reached out to her insurance company, requesting ongoing rehabilitation and attendant care benefits. The insurer promptly and repeatedly denied her requests, despite the obvious ongoing need for treatment, supervisory care and assistance. 

Finally, in 2020, Ms. S was forced to start a dispute at the Licence Appeal Tribunal, seeking past and ongoing attendant care benefits and payment of six disputed treatment plans. Although it acknowledged the reasonableness and necessity of the benefits sought, her insurance company argued that there was no causal connection between Ms. S’s current condition and the collision, despite evidence of psychological impairment at that time and the fact that the tremors started almost immediately post-collision. 

The Tribunal disagreed with her insurance company, noting that there was consistent medical evidence from 1994 to 2015 and forward documenting her ongoing struggle with tremors and other collision-related impairments. 

As a result, the Tribunal awarded payment of the disputed treatment plans, $150,000 in past attendant care, and ongoing at $5,064 per month. Also, the Tribunal ordered a Special Award totaling almost $85,000 against the insurance company for unreasonably withholding or delaying payment of the disputed benefits, on the grounds that there were no reasonable grounds for continuing to rely on its causation argument in the face of the medical evidence. 

Don't Suffer in Silence: You May Still Be Entitled to Accident Benefits Years After Your Car Crash

The purpose of this story is to demonstrate how accident victims, regardless of how long ago your accident happened, might still be entitled to ongoing accident benefits. Many Ontarians are suffering needlessly from the long-term impact of their car accident injuries when they could still be entitled to receive ongoing funding from their auto insurers.

Ontario auto insurance law establishes time limits to take certain steps when you have been injured in a car accident. Failure to comply impacts your rights and entitlements or can permanently deprive you of these rights. 

For example, you must let your insurer know that you were injured within 7 days of the accident. Once you receive an application package, you must apply for accident benefits within 30 days. If you miss either of these deadlines, you will have to fight to receive any benefits, and provide a satisfactory explanation for the delay.

Most importantly, if your insurer reduces, cuts off or denies a benefit, you have two years to start an application disputing the decision with the Licence Appeal Tribunal (LAT). Generally, missing these deadlines acts as a bar to challenging the decision.

Potential Exceptions to Timelines; Determining if you are Eligible

Even if you fail to meet the General Time Limitations, there are four exceptional circumstances that might allow you to fight for the right to ongoing accident benefits or a lump sum settlement. Despite what you have been told, you might still have a right to accident benefits in these or similar situations:

1. You were a minor  You did not file a claim for benefits or challenge a denial within the time limit under the Statutory Accident Benefits Schedule (SABS) but were a minor (under 18 years old) at the time of the accident;
2. You were incapable You did not file a claim or challenge a denial within the time limit but lacked capacity to make decisions;
3. Your claim was not clearly and unequivocally denied: Your insurer gave inadequate reasons when it denied an accident benefit you submitted, and you did not dispute the denial within two years or at all; or 
4. You settled, but your needs for care changed You recognized the need for ongoing accident benefits after you settled your claim, but your insurance company failed to properly disclose their obligations

If you think that any of these exceptions might apply to your case, we strongly encourage you to discuss your potential claim with us.  At Campisi LLP, our areas of expertise include accident benefits law – from our founding partner, Joseph Campisi (a professor of insurance law at Osgoode Hall), to our exceptional lawyers and accident benefits team. 

We are pleased to offer a free, no-obligation consultation so that you can understand your rights and options going forward.   You can also read further details about these exceptions in our Old Case Eligibility Guide.