Why Podcasting Matters

Bill Simpson and Nigel Gilby, the hosts of the Lerners’ Injury Law Podcast Series, are excited to explain what the podcast is all about and who it is intended for. Bill and Nigel have been speaking in public for years to a wide variety of audiences on topics that are interesting, helpful, and important. These podcasts are a natural extension of the communicating that Bill and Nigel have been doing for years. In fact, this podcast series is the first of its kind in Canada: the only podcast devoted to injury and disability topics for people wanting to know more about this area of the law and about the extremely capable lawyers at Lerners LLP.

There are two great guests in this episode: Larissa Gerow is a remarkable young woman who suffered a serious spinal cord injury and is quadriplegic as a result. Listen to Larissa and her Dad, Bob, talk about what their experience was like when they first met with, and ultimately hired, a Lerners’ lawyer. Also, make sure to ‘meet’ Alysia Christiaen, one of the up-and-coming lawyers on the injury and disability team, who sits down with Bill & Nigel to talk about her practice and areas of strength.

Taking questions from listeners, and giving answers that are smart, helpful and free, are a regular part of the podcast series. In this episode, Nigel and Bill deal with questions relating to how attendant care benefits are paid out and why extended health benefits have to be spent first before receiving accident benefits.

Episode 1 Transcript

Episode 1 Q&A

Q: My eight year old daughter was injured in an accident and needs attendant care. Can I receive the attendant care money if I choose to stay home and look after my daughter?

A: The short answer to the question is yes, however, it is a little more complicated than that. How a person can get attendant care changed February 1st. Very briefly, if your child had, what is considered to be a catastrophic injury, you would be entitled to receive up to $6,000 a month for attendant care. That was normally paid to a parent who would stay home and look after a child that had a catastrophic injury. If that injury was considered to be non-catastrophic then the amount received would be $3,000 a month and that has been basically the way the things were for a number of years. The insurance industry has been lobbying the government about increased insurance rates and really complaining a lot about all the money being paid out. Unfortunately, the government has listened to that and has now essentially said that the money you can receive, even though the need may be $6,000 a month or more, is only going to be the amount of money that you actually are losing from your workplace. For example, if you had a job where you were getting paid $1,200 a month and even though your child needed the $6,000 a month of attendant care, because of the nature of his/her injury you are only going to get $1,200 a month. That’s unfair for a number of reasons. You don’t go to work 24 hours 7 days a week but if you have a child that has a catastrophic brain injury or has a spinal cord injury, she/he may in fact require care 24 hours 7 days a week and yet you are only going to be paid the wage you are earning at your 8 hour a day job. If you work only part-time, then it’s going to be even less and, if you are a stay at home parent, you are not going to receive anything at all. If parents are losing a wage which is substantially less than the attendant care needed, in order to ensure their child does receive the care that is necessary, they are either forced to bring in nursing help or, cobbling together some other arrangement using other family members and friends whom, themselves, must also have to be going without their regular income in order to put together a team or a plan to provide that level of attendant care which is prescribed. Is that the likely reality? Yes, it is, and the problem with the second of those solutions is if you have a husband and a wife who both work and both decide to stay home and look after the child, you may get your wages covered but it may create problems in your employment. Your employer may say sorry but we need you at the work place, and if you are not there we are going to have to replace you so it can result in somebody losing their job. If you are trying to find other relatives and they face the same uncertainty, are they going to be prepared to give up their job at the risk of losing that job because an employer says sorry but you are not at the workplace so we are going to find somebody else to replace you? It places a huge burden on parents who have a child that has that type of an injury as to how they are going to cover that cost. The difficulty with hiring an outside professional agency is agencies, on average, charge $25 an hour. If you do the math it is not going to be that number of hours before your $6,000 a month is going to be used up and, obviously, half the number of hours to use up the $3,000 a month.

Q: Why do my work benefits, my extended health benefits, have to pay for my treatment first before any automobile insurance benefits pay especially when the accident wasn’t my fault?

A: The government determines how insurance works and the automobile insurance industry essentially has been able to get the government to say you have to look for all other insurance first, and then, only after you have exhausted all other insurance, does the insurance company for the automobile have to come to the table and start paying money. For example, if you required physiotherapy and your plan at work paid for $500 a year for physiotherapy and the physiotherapy plan that was put in place was going to cost $1,000, then your automobile insurance company doesn’t pay the first $500, that comes from your workplace, and they only come in after the first $500 is exhausted. It is really a matter of legislation and the government and just the rules of how the game is played. Unfortunately, in many respects, it does become a game and you become the pawn in that game. Where a person has benefits from work but there is a limit or a maximum percentage per treatment session which is paid, the difference between, say, 80% of physiotherapy and the left over 20% is paid by the automobile insurer in most circumstances. In theory, between the two insurance policies, a person receives 100% of the coverage costs provided the automobile insurer accepts the treatment. The automobile insurer can say, no, we don’t think that that treatment is reasonable and necessary and we’re not going to pay. At that point then you are not going to receive any benefit from your own automobile insurance company and you are going to have to get into a fight with them in order to receive that payment. As the rules around automobile insurance seem to be getting tighter it is good advice for people to take a look at the benefit coverage they do have from work and consider whether they want to supplement or add to it with coverage that either is purchased themselves, or bought as enhanced coverage through your automobile insurance company. The $50,000 that they are entitled to is in no way, shape, or form, enough to cover the expenses that could occur to get treatment they need to try and get as well as they can get.

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