Glossary of Terms

Adjuster

A person who investigates and makes decisions on insurance claims on behalf of an insurance company.

Arbitration

A legal process for the resolution of disputes outside the courts. Both parties refer their case to an independently appointed arbitrator (or arbitration panel). The arbitrator’s decision is binding – in other words, all parties have to abide by that decision.

If your insurance company cuts off your benefits or refuses to pay for certain goods or services, an arbitration is one of the final stages of the appeal process (after the DAC process and mediation).

Catastrophic Designation

This is the insurance term for the most serious personal injuries. People with catastrophic injuries are entitled to significantly increased benefits, payable over their lifetime. You may be designated catastrophic if you:

• Are paraplegic (paralyzed from the waist down) or quadriplegic (paralyzed from the neck down)
• Have had both arms or both legs, or an arm and a leg, amputated
• Are brain injured with a score of 9 or less on the Glasgow Coma Scale
• Have extreme mental or behavioural impairment  
• Have a severe disability or brain injury
• Have any of the above, or an impairment of 55 per cent of your body function, three years after the incident

You will need to meet face-to-face with an adjuster or other insurance representative to be considered for the catastrophic designation.

Costs Endorsement

A court decision in which one party is ordered to pay some or all of the legal costs of the other party.

DAC Process

If you make a claim for benefits and your insurer wants to find out if those benefits are necessary, you will be asked to attend a Designated Assessment Centre (DAC). This is the nearest assessment centre to your house. You will be seen by an impartial expert in the relevant field, who will say whether or not they think the benefits or expenses are necessary. If they are, the insurance company will pay for them. If not, the insurance company will refuse to pay and your case will go to mediation.
Defendant (Recent Decisions. The Process)

The person, people or corporation being sued. Most defendants in personal injury lawsuits are insured, and their insurer will usually appoint a lawyer to act on their behalf.

Fiduciary Duty

The legal duty to act in the best interests of another party. Fiduciary duty is part of any relationship of trust and responsibility – between, for example, a teacher and student, a doctor and patient, and an employer and employee.

Glasgow Coma Scale

A scale that is used to test the extent of a brain injury, based on response to stimulation in three areas: opening the eyes, giving a verbal response, and giving a motor (movement) response. The lowest score is 3 and a normal score is 15.

Liability

The legal responsibility for an injury done to someone, whether through negligence (not shoveling a sidewalk so someone slips, for example) or direct action (like punching someone in the face).

Mediation

A legal process for the settling of disputes before they come to trial. This is a voluntary process that all parties agree to attend (unlike arbitration, the decisions made at mediation are non-binding). Each party discusses their view of the case, and you will have an opportunity to talk about your injury and how it has affected your life.

Successful mediations often end with a cash settlement paid to you by the defendants, and I will be able to advise you and negotiate the best deal possible.

Mediation has many advantages. It is:

• Voluntary - you can end the mediation at any time
• Confidential – nothing you (or the other parties) say in a mediation can be used against you later on, for example at trial
• Quicker than a trial – mediations can be over in days, while cases take years to get to court
• Cheaper than a trial

Proof

Different degrees of proof are required for different types of legal case. For criminal cases, the defendant’s guilt must be proved ‘beyond a reasonable doubt’. Most civil lawsuits require a lesser degree of proof – liability must be proved ‘on the balance of probabilities’ (more probable than not).

Plaintiff

The person or people who are suing another person, people or corporation.

Threshold

This is the test a car crash victim must meet to succeed, or have a chance of succeeding, in a personal injury lawsuit. The injury must be either a permanent and serious disfigurement (burns or scars, for example), or a permanent, serious impairment of an important physical, mental or psychological function, usually affecting the victim’s day-to-day activities.