Glossary Of Personal Injury And Health Insurance Terms

Accident Benefits and Personal Insurance Benefits

Contractual insurance funds made available to its insured persons, injured in a motor vehicle accident, regardless of who is at fault. Types of benefits can include income replacement, medical and some forms of rehabilitation.

Accident Report

An accident report contains important information about your vehicle collision. This includes names of the drivers involved, information about the road conditions and weather conditions at the time of the collision, a description of the accident, and the make and model of all vehicles involved. 

Acquired Brain Injury (ABI)

An acquired brain injury is any injury to your brain that is not induced by birth trauma, degenerative, congenital, or hereditary. The leading causes of acquired brain injuries are strokes, car accidents and other types of accidents or trauma.

Appeal

An appeal can be requested after a verdict has been decided. It’s a request for a higher court to review the decision made by a lower court or arbiter.

Assignment of Benefits (AOB)

An agreement that transfers the insurance claim rights or benefits from the policy to a third party. This allows the third party to make decisions, collect insurance payments, or file a claim without involving the policyholder.

Attendant Care

Attendant care is care given by a person who takes on personal tasks which another person can no longer do for themselves. This can be done in a facility or in-home. These services often include bathing, washing, toileting, meal preparation, and more.

Bad-Faith Claim

When an insurer refuses to pay your claim or protect you from the claim of others unreasonably or unfairly. It can also include a conscious wrongdoing or dishonest act operating within illegal or improper design.

Benefit

The various health care items or services that are covered under your health insurance or travel insurance plan. Your health insurance or travel insurance plan should outline the benefits that are covered, and which are excluded.

Burden of Proof

In civil court cases, the plaintiff is responsible for proving that the defendant is liable or legally responsible for your injuries or losses.

Case Manager (CM)

Case Managers are responsible for helping their patients understand their options concerning their specific situation. They act as a liaison between patients and their treatment options. Case Managers exist for mental health, rehabilitation, legal aid, medical health, and more.

Catastrophic Impairment

The most serious of personal injuries. Examples include paraplegia; tetraplegia; amputation; and brain injuries.

Causation

The relationship between the act or event and the result. It establishes the causal relationship between the defendant’s behaviour and the result (your injury).

Claim

A civil action brought forth by a plaintiff, due to the negligence of the defendant, resulting in physical or mental anguish or injury. It can also be a request made from a person to their insurance company requesting coverage and payment due to an injury or accident.

Complaint

The initial document filed with the court by either a person or entity claiming their legal right against another party. This initial document begins a lawsuit and includes the alleged wrongdoing of the defendant.

Contingency Fee

This is how many personal injury lawyers receive payment. The fee for services provided is only payable should there be a favourable result.

Damages

The losses a plaintiff and/or family has suffered because of a defendant’s misconduct. These losses can take many forms including compensation for pain and suffering; loss of past, present, and future income; past, present, and future health care costs.

Deductible

A deductible is a clause in an insurance policy that states how much the insured is responsible to pay prior to an insurer having to pay.

Defendant

A person and/or corporation that is being sued by a Plaintiff. Examples of a defendant include the driver of the car that struck you, 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.

Disbursement

Disbursements are fees and expenses incurred by the law firm/personal injury lawyer who has taken on your case. These fees include things like photocopying costs, mailing, and requesting clinical notes and records, private investigators, etc. 

Disclosure

At the beginning of a court case, each side is expected to release documents and other important information related to the case or requested by the opposing party, to the opposing party.

Examination for Discovery/Examination of Discovery

An important step in litigation, it is the process that allows each party to examine and question the opposing party before trial begins.

Expert Witness

Unlike a regular witness, an expert witness is qualified to speak with authority about certain subject matter. This includes professional matters, technical matters, and scientific matters. For instance, a specialized doctor being called to the stand to speak about a diagnosis given.

Health Care Expenses

A category of tort or contractual entitlements that includes such goods and services for medical expenses, rehabilitation, and attendant care.

Incurred Expenses

In most instances an “incurred expense” requires a claimant to actually pay or promise to pay for an expense and has received the goods or services.

Insurance Adjuster

A person who investigates and/ or adjudicates insurance claims on behalf of an insurance company.

Insurer Examination

In some states or provinces, insurers are allowed to appoint health care professionals of their choosing, to perform medical assessments in order to determine whether a benefit is claimable under the insurance policy.

Judgement

Judgements, also referred to as reasons for judgement, is the explanation given by the court at the conclusion of a hearing, that goes into detail why a certain order/ruling has been given.

Liability

A party can be held liable when they are held legally responsible for something. If a person or company is found liable, they then have a financial obligation to rectify the situation.

Licence Appeal Tribunal (LAT)

The Licence Appeal Tribunal is responsible for hearing appeals from previous decisions made and resolve disputes concerning compensation, claims, and licensing activities.

Limitation Period

When a person suffers an injury, every state and province have a specified time period in which a formal action must be brought in the courts. Limitations for various types of Torts and contractual claims vary from State to State to Province. If one does not file a claim or provide proper notice of an action, your right to compensation may be lost and/or statute barred.

Litigation

The act of pursuing a legal action or filing a lawsuit.

Loss

Loss covers all monetary value assigned to your injury or damaged property in a personal injury case. Loss includes medical bills, future medical care, at-home assistance, past and future income that may be missed, pain and suffering, as well as psychological damage.

Loss of Earnings

If you need to take time off work, quit working entirely, or change jobs due to your injuries, either physical or psychological. This loss of earnings will be calculated and put towards your total losses when making a claim.

Malpractice

Negligence or gross misconduct by a person working in a professional capacity. This includes doctors, surgeons, accountants, lawyers, and more. When they have failed to meet the set standard of care or conduct and injury or damages occur, they have committed malpractice. This includes injury/damages due to negligence, error, or intent.

Mediation

Negligence

In many personal injury cases, you must prove negligence. Negligence is the failure to use a reasonable degree of care or consideration under a set of circumstances. To prove negligence, you must prove that the defendant did not behave with the level of care that someone else would’ve under the same circumstances.

Occupational Therapist (OT)

Occupational Therapists are a form of health care, that works to help solve a person’s ability to do everyday activities. They work one-on-one with a patient to help them improve, recover, or develop the skills needed for daily living.

Optional Benefits

Additional benefits may be purchased to enhance a car insurance policy. This includes such things as increased accident benefits (PIP), family endorsements, underinsured and uninsured motorist coverage, increases in Personal liability coverage, etc. It is important to discuss your options with an Insurance Broker.

Paralegal

Paralegals often work alongside lawyers in law offices. They are professionals who have a deep understanding of the law and can perform tasks that require knowledge of legal concepts, that do not require the full expertise of a practicing lawyer.

Paraplegia

Paralysis of the lower body, including the legs, due to injury or disease of the spinal cord or brain.

Parties

Parties are the various organizations, businesses or people directly involved in a court case, agreement, contract, or other legal issue.

Personal Injury Law

The area of law that involves persons who have been injured in an accident. Accidents include motor vehicle, trucks, motorcycles, municipal claims, slip and fall, medical malpractice, dog bites, boating, assault, pedestrian, bicycle, etc.  

Plaintiff

A person who has sued another person, corporation, or insurer (the “defendant”).

Post-Traumatic Stress Disorder (PTSD)

After being involved in a bad accident or scary/dangerous event, many people experience a mental health condition called Post-Traumatic Stress Disorder. It is a natural, emotional response that can be triggered by many things and requires treatment.

Quadriplegia

Paralysis from the neck down, involving all four limbs, legs, arms, and torso.

Quality of Life

Quality of Life refers to the subjective well-being of the plaintiff. It looks at what their life and abilities previously were, versus what it is expected to be after the accident/injury.

Retrograde Amnesia

Usually affecting recently stored memories, retrograde amnesia is where you cannot recall memories that were formed just before the accident or injury but can still remember memories from years ago.

Settlement

A settlement is an agreement or resolution reached between the two disputing parties (plaintiff and defence) about the legal case. It can be reached either before court action begins or after. The settlement ends the dispute and results in a voluntary dismissal of any related litigation. The settlement can be monetary but doesn’t have to be.

A few examples are:

• two divorcing parties agreeing on how to divide their assets
• how much money an insurance provider will pay out a victim of a car accident.

Statement of Claim, Originating Action, etc.,

A document that is filed in the court in order to commence a lawsuit. It is a claim for “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

Subject to certain states and provinces car accident legislation one might have to have suffered certain types of injuries or financial losses in order to be allowed to sue a defendant. For example, levels of impairment or disfigurement a plaintiff has suffered.

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.

Traumatic Brain Injury (TBI)

A type of acquired brain injury that occurs from sudden trauma to the brain. The four types of traumatic brain injury are:

• Concussions
• Brain contusions
• Penetrating brain injuries
• Anoxic brain injuries

Trial

A court case where a judge or jury examines evidence put forth by the plaintiff and defendant to determine whether the defendant should be held legally responsible for damages alleged by the plaintiff.

Motor Vehicle Accident

Every state and province define what a motor vehicle is. This includes cars, trucks, motorcycles, and electric bikes. Some states exclude electric bikes and ATVs or have separate acts which define whether they are to be licensed and/or insured.

Underinsured and Uninsured Motorist Protection

Probably the most important provision in your own car insurance policy. Make sure your policy provides this coverage. If you are involved in an accident involving a car driver who caused the accident and is inadequately insured your own insurance company will step in and make up any financial shortfall (subject to certain limitations).

Verdict

The decision reached by the judge or jury on a matter submitted to trial.

Wrongful Death

A civil action brought forth in which damages are sought against a party for causing death. A family member of the deceased can bring forth a wrongful death claim if they believe that a person or company’s actions were responsible for the death of their loved one, through negligence or intentional action.