SHARE PERSPECTIVES – Autumn, 2009 1

issue 15, Autumn 2009

This Issue:

a newsletter forclients and friends ofDavid Share Associates,Lawyers

We make a personal injuryand disability claim aspainless as possible.

In This Issue:Life Insurance disputes

In Person:the Ibrahim family . . . . . . .1

Team Profi le: Emily Rimes . . . . . . . . . . . . . .2

Did You Know:four expert tips about disability insurance . . . . . .2

Ask a Lawyer: about life insuranceclaims . . . . . . . . . . . . . . . . . . .3

. . . see Page 2

Free Disability BookletFor your free copy of

‘Benefi ts Denied -What To Do When

Your Insurance CompanyDenies Your Disability Claim’

call 416 488-9000

IN PERSON:

The Ibrahim Family,Survivors of Deceased Drywaller

Mohammed Ibrahim was the owner of a small drywall company. He started the

business before either of his sons was born and took great pride in its success and the success of his family. So, when his eldest son became a father, Mohammed was delighted to say the least. He even smoked a cigar to celebrate the arrival of his fi rst grandchild. Little did anybody know that this gesture would come back to haunt him.

insured with good intentionsBecause his family was so important to him, Mr. Ibrahim had purchased a $250,000 life insurance policy to provide for them in the event of his death. While at work on one of the hottest days of the year, at age 53, he died from a heart attack. When his wife and sons claimed the benefi t, the claim was denied.

non-smoker’s policyMr. Ibrahim had purchased the policy at age 50. His application disclosed no prior medical problems, except elevated blood pressure. Of particular note, the policy was issued with a non-smoker provision. He clearly stated on his insurance application that he did not smoke.

denial based on misrepresentationAfter his wife and sons submitted a claim for the benefi t, the insurance company took six months to investigate. It then wrote a letter denying the claim based on misrepresentation. Because more than two years had passed since the policy was issued, the insurance company would have to prove that the misrepresentation was fraudulent to void the policy and deny the claim.

history as a smokerThrough its investigation, the insurer discovered a photo on one of Mr. Ibrahim’s sons’ MySpace pages showing Mr. Ibrahim smoking a cigar at a party celebrating the birth of his grandchild. The investigators also secured medical records indicating that he had a history of cigarette smoking. The medical information was inconclusive about whether he was still a regular smoker, or had smoked at all since getting insured – other than the cigar at the party.

got counsel on referralThe Ibrahim family heard about the law fi rm of David Share Associates (DSA) through friends who had got help with a disability insurance claim. They engaged the DSA legal team to pursue the claim. DSA felt that the matter could be pursued to success.

trial would result in all or nothingA case like this requires a thorough review of medical records and any evidence that could determine whether the case could be settled or would have to proceed to trial. It was understood that, at trial, the outcome would be “all or nothing”. That is, the benefi ciaries would either recover the entire life insurance benefi t, or the case would be dismissed.

total certainty elusiveAfter reviewing the evidence and the

SHARE PERSPECTIVES – Autumn, 20092

. . . from Page 1 IN PERSON: Ibrahim Family

TEAM PROFILE

Emily Rimes

litigation process, DSA recommended that they try to settle the case through mediation. The case had strengths, especially that proving fraud is diffi cult. The case also had weaknesses. Fairly certain that Mr. Ibrahim had quit smoking years earlier, the family were not sure whether he might have snuck a smoke here and there. The insurance company also could not be certain.

one cigar not proof of fraudNevertheless, the one instance of celebratory cigar-smoking would not be enough to satisfy the court that Mr. Ibrahim was a smoker,

much less that he intentionally committed fraud in purchasing a non-smoker’s life insurance policy.

settled for 75%At mediation, a settlement was achieved. The family received 75% of the life insurance proceeds, plus interest and a contribution toward their legal costs. The Ibrahims found this outcome acceptable and were pleased that the money would enable them to move forward with their lives – including care for Mohammed’s grandchild.

“Tough times never last. Tough people do.”

– Robert Schuller

Emily with her man, Justin.

Meet Emily Rimes, a legal assistant who knows how to take care of business. She requests records from insurance companies, employers, and medical care providers as well as assisting with new client inquiries and opening new fi les.

Emily earned a Certifi cate in Dispute Resolution from Durham College of Oshawa in 2006. She then graduated from Durham College’s Legal Administration program in 2007. In the same year, Emily completed a fi eld placement (co-op) with David Share Associates and became an offi cial member of the staff.

In her two years of service with DSA,

Emily has often found that, when taking new calls from prospective clients, previous clients have referred them “because they were so happy with our service.” Some calls come from past clients, “who need our help again and know how much we can do for them.”

Knowing how much DSA helps people whose insurance claims have been denied gives Emily a satisfying sense of meaningful contribution. She enjoys “speaking with clients and hearing how much they appreciate the work we do for them.” Emily does not just hear client testimonials; she reads them too. She says, “I like seeing how much we as a team have affected our clients’ lives for the better. We do good work.”

Did You Know . . . Five Expert Tips about Disability Insurance 1. Don’t sign anything from the insurance company without carefully reviewing it fi rst. It could possibly be used against you later.

2. Don’t let too much time go by. There is a statute of limitations on all claims.

3. Don’t engage in activities in public that could be construed as proof that you are not disabled. An insurer could document this, even on video, to use it against you.

4. Don’t fi le one claim at a time. If you have been disabled in more than one way, insurers might tell you that you can only fi le one claim at a time. Your policy covers your entire body and potentially all of the ways you can be disabled.

5. Don’t cut back your working hours. By working fewer hours because of your disability, you could inadvertently disqualify for your disability insurance benefi ts.

SHARE PERSPECTIVES – Autumn, 2009 3

“It’s not the strongest of the species that survive, nor the most intelligent, but those most responsive to change.” – Charles Darwin

Ask A LawyerQ: What if the life insurance company denies our claim based on a non-smoker celebrating a birth or wedding by smoking a cigar?

A: Denial of a claim based on the insured smoking a cigar at a celebration should be reviewed by a lawyer with expertise in life insurance. The cliché, “Where there is smoke, there is fi re” seems appropriate in these circumstances, as the insurance company might not be disclosing the whole reason for denying the claim. Even so, if that is the only basis for denying the claim, then it would seem spurious and should be challenged.

Q: What if we applied for life insurance and completed the application simply unaware of some information that our doctor did not share?

A: This problem usually arises only when a claim has been submitted and the clinical notes and records provided by your doctor do not match the information you may have given on the insurance application. When applying for life insurance, you should review your records with your doctor to ensure that you do give accurate answers to

the medical questions. Once the claim is denied, it could still be possible to pursue it, even if your answers were incorrect, if it can be shown that you really were not aware of a medical condition. A thorough review of all of the evidence by a qualifi ed lawyer would be the place to start to see if there is any hope of succeeding.

Q: When I expected to receive life insurance benefi ts after my husband’s death, the insurance company instead returned the premiums and said thatmy husband did not qualify forcoverage. What can I do now?

A: The fi rst thing you should do is to consult with a lawyer with expertise in life insurance to determine whether the denial of the claim has any chance of being challenged. Also, the cheque refunding premiums should not be cashed. The insurer might construe that as an acceptance of their decision to void the policy.

Share Perspectives readers are invited to write in with questions for Ask A Lawyer. Watch future issues for questions from your fellow readers. One question per person. Send your question to AskALawyer@sharelawyers.com.

Laugh: A String of Bizarre AccidentsFour people were injured in a string of bizarre accidents. Sheri Bauer was admitted to hospital with a head wound caused by falling masonry. Tim Vanegas was diagnosed with mild whiplash and contusions on his chest, arms, and face. Bryan Corcoran suffered torn gum tissue, and Elizabeth McKenzie’s fi rst two fi ngers of her right hand were bitten off. Bauer had just dropped off her husband for his fi rst day of work at a new job. In addition to a good-bye kiss, she fl ashed her breasts for him. She said later, “I was really close to the car, so I didn’t think anyone would see. Besides, it couldn’t

have lasted more than two seconds.”Tim Vanegas saw. The taxi driver lost

control of his car, went over the curb, and ran into the corner of the Johnson Medical Building. Inside, McKenzie, a dental technician, was cleaning Corcoran’s teeth. The crash of the taxi into the building made her jump, causing a tear in Corcoran’s gums with a cleaning pick. In shock, Corcoran bit down and severed two fi ngers from McKenzie’s hand. A falling piece of the medical building caused Bauer’s head wound. All received medical treatment. Mister Bauer only learned of the incident later that day.

SHARE PERSPECTIVES – Autumn, 20094

Thanks!David Share Associates (DSA) is a leading Toronto personal injury and disability claim law fi rm. DSA concentrates on serious injuries, death claims, insurance disputes, and disability coverage disputes in Ontario. Following an accident or illness, DSA helps people to get the support they need and deserve.

We care enough to stand by you through

your claim and after your settlement. Share Perspectives is one way we keep in touch.We also respect your confi dentiality. If you want us to add or remove your name and address from the Share Perspectives mailing list, then send e-mail to newsletter@sharelawyers.com. When you recommend DSA, that is our best advertising.

Head Offi ce:David Share Associates3442 Yonge St.,Toronto, Ontario, Canada, M4N 2M9

Phone: 416-488-9000

Toll-Free Phone: 1-888-784-3529

E-mail: legal@sharelawyers.comwww.sharelawyers.comwww.sharedisabilitylaw.com

LaughAttorney: “Now doctor, isn’t it true that when a person dies in his sleep, he doesn’t know about it until the next morning?”

Witness: “Did you actually pass the bar exam?”

From Disorder in the American Courts: actually spoken in court, taken down by court reporters.

You Said It!“Excellent experience! From the bottom line to the top, everyone was amazing and respectful. Steven Muller – wow! Shira Bernholtz – great! Volker – very friendly and helpful. Thank you.” – Greg Norwood , long-term disability claim

“I wish I would have called you fi rst, when the insurance company and my employer started to harass me and denied me my benefi ts. Mr. Share, you have my utmost respect and gratitude, along with your staff as well.” – Chriag Gupta, long-term disability claim

Shira’s warm, understanding manner, as well as the professionalism with which she draws on her in-depth experience. This year, Shira reaches the twenty-one year mark in her service with DSA. David Share and the fi rm celebrate with her.

Profi led in the Autumn, 2006 issue of Share Perspectives, Shira Bernholtz works as a Client Services Lawyer with DSA. Clients often meet her when she provides support explaining the legal process, or when she gives counsel about settlements. Many appreciate

Shira Bernholtz Achieves 21 years withDavid Share Associates

Shira and family at home.