Glossary of Terms
September 22, 2015
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, caregiver, attendant care, medical, rehabilitation, education, damage to clothing, visitation, housekeeping and home maintenance, funeral, etc.
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 care/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. The cost of providing attendant care may be paid by the insurance company to the person providing the care, whether it is a health care professional or a family member.
Case Manager (Qualified) – A rehabilitation professional who coordinates rehabilitation services following an injury.
Catastrophic Impairment – The most serious of personal injuries. Examples include: quadriplegia; paraplegia; tetraplegia, severe impairment of ambulatory mobility; amputation; loss of vision in both eyes; certain traumatic brain injuries; physical impairments that result in a 55% or more physical impairment of the whole person; and mental disorders that satisfy specific criteria. A person having a catastrophic impairment becomes entitled to $1,000,000.00 for medical/rehabilitation and attendant care.
Damages – The losses the plaintiff has suffered because of the defendant’s conduct. These losses can take many forms including compensation for pain and suffering; loss of past, present and future income; health care costs; loss of social or familial relationships; etc.
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 award may in some case be reduced by statutory amount.
Defendant – A person and/or corporation that is 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.
Health Care Expenses – A category of tort entitlement that includes goods and services for medical expenses, rehabilitation, and attendant care.
“Incurred” Expense – New definition of “incurred” requires the claimant to pay or promise to pay the expense and requires that the service provider provide the service in the course of the employment, occupation or profession, in which he/she would have normally been engaged, but for the accident, or that the person has suffered an economic loss in order to provide the service.
Insurer Examination/Section 44 Assessment – The insurer may appoint health care professionals of their choosing, to perform assessments in order to determine whether to pay a benefit.
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 allotted, all rights to compensation are lost.
Minor Injury – One or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae.
Optional Benefit – Additional Benefits purchased by the Insured or in some cases a family member of the Insured.
Personal Injury Law – The area of law that involves persons who have been injured in an accident. Accidents include motor vehicle, slip and fall, medical malpractice, boating, assault, 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 – A person who has sued another person, corporation or insurer (the “defendant”).
Statement of Claim – A document that begins a lawsuit and claims “damages” from one or more defendants based on the defendant’s 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 – A level of impairment or disfigurement that a Plaintiff must prove in order to recover certain compensation in a motor vehicle tort claim. 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 that 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 because of the fault or negligence of another party. This contrasts with accident benefits (no-fault benefits) where benefits are paid without reference to fault.