Legal Terms Explained
Legal claims come with a language of their own. Insurance companies, adjusters, and lawyers use these terms every day. Most injured people are hearing them for the first time, often at the worst moment of their lives.
This glossary explains the terms you are most likely to encounter in an Ontario injury or disability claim, in plain English. It is general information, not legal advice about your situation. Deadlines, benefit amounts, and policy terms vary from case to case, so always confirm how the law applies to your specific circumstances.
A
Accident Benefits
Benefits available through auto insurance to people injured in car accidents in Ontario, no matter who caused the crash. Medical, rehabilitation, and attendant care benefits are included in every policy. For policies entered into or renewed on or after July 1, 2026, most other accident benefits, including income replacement, are optional coverages that must be purchased. Also called statutory accident benefits, or SABS.
Adjuster
The insurance company employee assigned to your claim. The adjuster investigates, decides what the insurer will pay, and negotiates on the insurer's behalf. The adjuster works for the insurance company, not for you.
Any Occupation
A definition of disability used in most long-term disability policies after the first two years of payments. Under this test, you are considered disabled only if you cannot do any job you are reasonably suited for by education, training, or experience, not just your old job.
Attendant Care Benefit
An accident benefit that pays for help with personal care, such as bathing, dressing, or supervision, when injuries leave you unable to safely care for yourself. The amount depends on your assessed needs and how your injury is classified.
B
Balance of Probabilities
The standard of proof in civil cases. You win if your version of events is more likely true than not. This is a much lower bar than the criminal standard of proof beyond a reasonable doubt.
C
Caregiver Benefit
An accident benefit for people who were the primary unpaid caregiver for someone in their household, such as a parent caring for young children, and can no longer manage those caregiving activities because of their injuries. It pays toward the cost of replacement care. For policies entered into or renewed on or after July 1, 2026, it is an optional coverage, and when purchased it is no longer limited to catastrophic injuries.
Catastrophic Impairment
A legal designation under Ontario's accident benefits system for the most serious injuries, including certain brain injuries, paralysis, amputations, and severe mental or behavioural impairments. A catastrophic designation unlocks much higher benefit limits, including up to $1 million for medical, rehabilitation, and attendant care combined.
Causation
The link between the wrongful act and your injury. To succeed, you must show the accident caused or materially contributed to your injuries. The usual test asks whether the injury would have happened anyway without the defendant's negligence.
Collateral Benefits
Money you receive from other sources for the same loss, such as short-term disability, long-term disability, or Employment Insurance sickness benefits. These payments can reduce what a defendant or insurer owes, which is why all of your benefits need to be coordinated carefully.
Contingency Fee
A fee arrangement where the lawyer is paid a percentage of the settlement or award, and only if the case succeeds. If there is no recovery, there is no fee. This is how most personal injury and disability cases in Ontario are handled.
Contributory Negligence
A finding that the injured person was partly at fault, for example by not wearing a seatbelt. It does not end a claim. Instead, compensation is reduced by the injured person's share of the fault.
Costs
Money a court orders one side to pay toward the other side's legal expenses. In Ontario, the losing party usually pays a portion of the winning party's costs.
CPP Disability Benefits
A federal benefit for people who contributed to the Canada Pension Plan and have a severe and prolonged disability that prevents them from regularly working. It is separate from long-term disability insurance, but most LTD insurers require you to apply for it and then deduct it from your LTD payments.
D
Damages
The money awarded to compensate for a loss. Damages can include compensation for pain and suffering, lost income, future care, and out-of-pocket expenses caused by the injury.
Death and Funeral Benefits
Accident benefits paid when someone dies in a car accident: fixed payments to a spouse and dependants, plus an amount toward funeral expenses. Under the old standard policy, these were $25,000 to a spouse, $10,000 to each dependant, and up to $6,000 for the funeral. For policies entered into or renewed on or after July 1, 2026, they are optional coverages with amounts set by what was purchased.
Deductible (Statutory)
In Ontario car accident lawsuits, a fixed amount set by regulation is subtracted from an award for pain and suffering. The deductible does not apply at all if the award exceeds a separate amount, also set by regulation. Both amounts are adjusted every year for inflation, and the deductible can significantly reduce smaller awards. It is one of the least understood features of Ontario car accident law.
Defendant
The person, company, or organization being sued.
Disbursements
The out-of-pocket costs of running a case, such as medical records, expert reports, and court fees. In contingency cases, the law firm usually pays disbursements as the case goes and is repaid from the settlement.
Discovery (Examination for Discovery)
A pre-trial step where each side answers questions under oath, with lawyers present and a transcript taken. It lets both sides learn the other's evidence and test the case. Many cases settle after discoveries.
Duty of Care
The legal obligation to take reasonable care not to harm others. Drivers owe it to everyone else on the road. Property owners owe it to people who come onto their property.
Duty to Mitigate
Your obligation to take reasonable steps to reduce your own losses, such as following medical advice and returning to suitable work when you are able. Failing to mitigate can reduce your compensation.
E
Elimination Period
The waiting period at the start of a disability claim before long-term disability payments begin, commonly in the range of 90 to 120 days. Sick leave or short-term disability benefits often cover this period.
Examination Under Oath
A formal interview where the insurance company questions you under oath about your accident benefits claim. You are entitled to have a lawyer present, and you should.
Expert Report
A written opinion from a qualified specialist, such as a doctor, engineer, or accountant, used as evidence. Serious injury and disability cases are usually built on expert reports.
F
Family Law Act Claim
A claim by close family members of an injured or deceased person, including a spouse, children, grandchildren, parents, grandparents, and siblings, for their own losses, such as loss of care, guidance, and companionship.
Functional Abilities Evaluation
A structured assessment, usually performed by an occupational therapist or physiotherapist, that tests which physical tasks you can safely perform. It is often used in disability and injury claims to measure work capacity.
Future Care Costs
Compensation for the treatment, equipment, medication, and assistance you will need going forward, not just what you have already paid for. In serious injury cases, this is often the largest part of the claim.
G
General Damages
Compensation for pain and suffering and loss of enjoyment of life. In Canada, general damages are capped by law, with the cap adjusted for inflation over time.
H
Housekeeping and Home Maintenance Benefit
An accident benefit that pays for help with household work you can no longer do, such as cleaning and snow removal. For policies entered into or renewed on or after July 1, 2026, it is an optional coverage. When purchased, it is no longer limited to catastrophic injuries, but for non-catastrophic injuries it ends 104 weeks after the disability begins.
I
In-Trust Claim
A claim for the value of care that family members provided to an injured person without pay, such as nursing, personal care, and extra housekeeping. The compensation is held in trust for the family members who did the work.
Income Replacement Benefit
An accident benefit that partially replaces income lost after a car accident, historically 70 percent of gross income up to $400 per week under a standard policy. For policies entered into or renewed on or after July 1, 2026, it is an optional coverage: existing policyholders keep their previous benefit on renewal unless they decline it in writing, while new policies include it only if purchased. Accidents before the change are governed by the old rules, so whether this benefit is available depends on the policy and the accident date.
Independent Medical Examination (IME)
A medical assessment arranged by the insurance company, or by the opposing side in a lawsuit, with a doctor of their choosing. Despite the name, the examiner is selected and paid by the insurer, so an IME should be treated as part of the claims process rather than as ordinary medical care.
Internal Appeal (LTD)
An insurance company's own review process for a denied long-term disability claim. Internal appeals do not pause the deadline for suing the insurer, and claims can expire while appeals go back and forth. A denial should be reviewed by a lawyer promptly rather than appealed indefinitely.
L
Liability
Legal responsibility for causing harm. Proving liability means proving that the other party was at fault for what happened.
Licence Appeal Tribunal (LAT)
The Ontario tribunal that decides disputes between injured people and their insurers about accident benefits. These disputes go to the LAT rather than to court.
Limitation Period
The deadline for starting a lawsuit. In Ontario, it is generally two years from the day you knew, or reasonably should have known, that you had a claim. Some claims also have much shorter notice deadlines, and the clock generally does not run while the injured person is a minor or lacks capacity. Missing a limitation period can end a claim permanently, so deadlines should be confirmed with a lawyer as early as possible.
Litigation Guardian
An adult who conducts a lawsuit on behalf of someone who cannot do it for themselves, such as a child or a person without mental capacity.
Long-Term Disability (LTD)
Insurance, often provided through work, that replaces part of your income when illness or injury keeps you from working. Most policies pay roughly 60 to 70 percent of pre-disability income after a waiting period.
Loss of Competitive Advantage
Compensation for the way an injury makes someone less able to compete in the job market over a working lifetime, even after returning to work. It recognizes things like lost promotions, reduced hours, and vulnerability if the current job disappears.
Loss of Income
Compensation for earnings lost because of an injury, covering both the past, from the accident until settlement or trial, and the future, where the injury reduces your ability to earn going forward.
M
Mediation
A settlement meeting guided by a neutral mediator who helps both sides try to reach an agreement. The mediator does not decide anything. Most Ontario injury and disability cases settle at or shortly after mediation.
Medical and Rehabilitation Benefits
Accident benefits that pay for treatment after a car accident, such as physiotherapy, psychological treatment, assistive devices, and medication. These benefits remain a mandatory part of every Ontario auto policy, and for accidents on or after July 1, 2026, auto insurance generally pays first, before employer or private health plans, for most of these expenses. The available limits depend on how the injury is classified.
Minor Injury Guideline (MIG)
A rule in Ontario's accident benefits system that limits medical and rehabilitation benefits to $3,500 for injuries classified as minor, such as sprains, strains, and whiplash. Whether an injury truly belongs in the MIG is one of the most commonly disputed issues in accident benefits claims.
Motor Vehicle Accident Claims Fund
A government fund of last resort that can compensate people injured by uninsured or unidentified drivers when no insurance coverage is available.
N
Negligence
Failing to take the care that a reasonable person would take in the circumstances. Negligence is the legal foundation of most injury claims.
Non-Earner Benefit
An accident benefit providing weekly payments to people who suffer a complete inability to carry on a normal life after a car accident but do not qualify for income replacement, such as students or people who were not working at the time. The standard amount was $185 per week. For policies entered into or renewed on or after July 1, 2026, it is an optional coverage, and the amount depends on what was purchased.
Notice Requirement
A deadline for formally warning a potential defendant that you may have a claim, separate from the limitation period. Two important Ontario examples: injuries on municipal property, such as sidewalks and roads, generally require written notice within 10 days, and slip and falls caused by snow or ice on private property generally require written notice within 60 days. Missing a notice deadline is not always fatal: courts can excuse late or imperfect notice where there is a reasonable excuse and the defendant is not prejudiced, so get legal advice even if a deadline has passed.
O
Occupier
Anyone with control over a property, including owners, tenants, and property management companies. More than one party can be an occupier of the same property at the same time.
Occupiers' Liability
The legal duty of those who control a property to keep it reasonably safe for the people who come onto it. This is the basis of most slip, trip, and fall claims in Ontario.
Offer to Settle
A formal written settlement offer made under the court rules. Turning down a reasonable formal offer and then doing worse at trial can carry serious costs consequences, which is what gives these offers real weight.
Optional Benefits
Auto insurance coverages that can be added to a standard Ontario policy. For policies entered into or renewed on or after July 1, 2026, most accident benefits, including income replacement, non-earner, caregiver, housekeeping, and death and funeral benefits, are optional. Existing policyholders keep their previous benefits on renewal unless they decline them in writing. These optional benefits apply only to the named insured, their spouse, their dependants, and drivers listed on the policy, so pedestrians, cyclists, and passengers without their own qualifying policy may not have access to them and may need to sue the at-fault driver instead.
Own Occupation
A definition of disability used in most long-term disability policies for the first two years of payments. Under this test, you are considered disabled if you cannot perform the essential duties of your own job. After two years, most policies switch to the stricter any occupation test, which is when many claims are cut off.
P
Pain and Suffering
Everyday shorthand for general damages: compensation for the physical pain, emotional distress, and lost enjoyment of life that an injury causes.
Plaintiff
The person who brings a lawsuit. If you were injured and are suing, you are the plaintiff.
Pre-Existing Condition
A health issue you had before the accident. It does not disqualify your claim. The law compensates you for how much worse the incident made things, and defendants must take injured people as they find them.
Pre-Judgment Interest
Interest added to compensation for the time between the injury and the judgment or settlement, recognizing that you went without money that was owed to you.
Prognosis
A medical opinion about how your condition is expected to progress over time. Prognosis evidence has a major influence on the value of injury and disability claims.
Q
Quantum
Lawyer shorthand for how much a claim is worth.
R
Recurrent Disability
When a disability returns after an attempted return to work. Many long-term disability policies treat a relapse within a set period as a continuation of the original claim, so no new waiting period applies.
Release
The document signed at settlement giving up the right to sue over the same incident, permanently, in exchange for the settlement funds. Settlements are final, which is why a case should not settle before the full extent of the injuries is understood.
Retainer Agreement
The written contract between you and your lawyer setting out the fee arrangement and each side's obligations. For contingency fee cases, Ontario law requires specific consumer protections to be included.
S
Settlement
An agreement to resolve a claim for an agreed payment without going to trial. The vast majority of injury and disability claims settle.
Special Damages
Compensation for measurable out-of-pocket losses, such as treatment costs, travel to medical appointments, and wages already lost. Keep every receipt.
Standard of Care
The level of care the law expects in the circumstances: what a reasonably careful driver, property owner, or professional would have done. Falling below that standard is negligence.
Statement of Claim
The court document that starts a lawsuit. It names the parties, alleges what happened, and states the compensation being sought.
Statement of Defence
The defendant's formal written response to a statement of claim, admitting, denying, or disputing the allegations.
Structured Settlement
A settlement paid as guaranteed, tax-free periodic payments over time instead of a single lump sum. Structured settlements are often used for large awards and for settlements involving children.
Subrogation
An insurer's right to step into your shoes and recover money it paid on your behalf from the party at fault. For example, OHIP may recover treatment costs from a negligent defendant as part of your claim.
Surveillance
Insurers sometimes hire investigators to observe and record claimants in public places. Surveillance is legal within limits, and it is one more reason to be consistent and honest about your abilities at every stage of a claim.
T
Threshold
In Ontario car accident lawsuits, compensation for pain and suffering is only available if the injury is a permanent and serious impairment of an important physical, mental, or psychological function, or a serious disfigurement. Whether an injury meets the threshold is a central battleground in these cases.
Tort Claim
The lawsuit against the at-fault party, as opposed to the accident benefits claim against your own insurer. After a car accident in Ontario, you may have both, and they run on separate tracks with separate rules.
Total Disability
The key test in most long-term disability policies. Despite the name, it rarely means being unable to do anything at all. What it actually requires depends on the policy wording, usually framed as an own occupation or any occupation test.
U
Uninsured and Unidentified Motorist Coverage
Coverage in your own auto policy that responds when the at-fault driver has no insurance or cannot be identified, as in a hit and run. Family protection coverage, known as the OPCF 44R endorsement, can provide additional protection where the at-fault driver is underinsured.
W
Waiver of Premium
A common feature of disability and life insurance policies that excuses you from paying premiums while you are disabled, keeping the coverage in force at no cost during that period.
Without Prejudice
A label on settlement discussions and letters meaning they cannot be used as evidence in court. It allows both sides to negotiate frankly without weakening their positions.
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