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Motor Vehicle Accident - Section B Benefits

Victor Lewin - Friday, July 31, 2015

What are Section B Benefits?

Every auto insurance policy includes no fault benefits, also known as Section B benefits. These benefits are available to the driver of the vehicle as well as any passenger injured as a result of an accident, regardless of fault.

What If I Wasn't In A Car At The Time Of The Accident?

Sometimes people are involved in motor vehicle accidents without even being in a car. This is the case if you are a pedestrian or on a bike at the time of the accident. You still have access to Section B benefits. In these situations, you are able to access Section B benefits from the insurance company of the car which hit you. If more than one vehicle is involved in the accident, it is the Section B policy of the car which physically comes into contact with your body (the "striking vehicle") that you may make a claim under.

What Medical Benefits Fall Under Section B?

Section B benefits include coverage for any necessary medical treatment required as a result of injuries sustained in a motor vehicle accident. Typically these include physiotherapy, massage therapy and chiropractic treatment, however benefits can include things such as psychological counselling, acupuncture, medical aids and strengthening programs through a community based exercise facility. If your family doctor deems a treatment to be necessary for your recovery, Section B has a duty to provide coverage.

Section B benefits also includes coverage for medication necessary as a result of the accident. This includes both prescription and non-prescription medications.

What If I Can't Work?

Section B also provides some income replacement if you are unable to work. These benefits are called Weekly Indemnity benefits and amount to 80% of your regular wages less any other income you receive, or up to $250 per week, whichever is less.

In order to qualify for Weekly Indemnity benefits, your doctor must have placed you off work for at least seven days within the first 30 days after the accident. In order to initially qualify and continue to qualify for Weekly Indemnity benefits, you must have written documentation from your doctor placing you off work as a result of the injuries sustained in the motor vehicle accident.

If you are entitled to Employment Insurance you must apply for sick benefits first.

How Do I Set Up My Section B Benefits?

The first thing you must do is report the accident your insurance company. If you were not the driver of the car, you must report the accident to the insurance company for the driver/owner of the car. The insurance company will then send you out forms to be completed. You must return these forms to the insurance company in order to access your Section B benefits.

What Is the Protocol and How Do I Know If I Fall Within It?

The Protocols refers to the Diagnostic and Treatment Protocols for Minor Injuries. These Protocols were put into place to assist individuals suffering from minor injuries in receiving immediate treatment. If you fall within the Protocols you have direct access to physiotherapy and chiropractic treatment without waiting for approval from the insurance company or obtaining a physician's referral.

Only injuries classified as minor can be treated within the Protocols. These injuries include sprains, strains and Whiplash Associated Disorder I or II. To find out whether your injuries fall within the Protocols, you should be assessed by a physiotherapist, chiropractor or your doctor.

Do I Have to Use My Private Health Insurance Benefits First?

Well, that depends. If you fall within the Minor Injury Protocols, you can simply attend the treatment facility of your choice, provide them with your insurance company name and policy number, and receive up to 21 treatments without using your private insurance.

If you do not fall within the Minor Injury Protocols, you must first use your private insurance.

You always have the option to opt out of the Minor Injury Protocols and go through your private insurance. In that case, your Section B benefits only kick in when you exhaust your treatment coverage. If you chose to proceed this way, you need a doctor's referral stating that the treatment is necessary in order to be covered by Section B.

What Happens When My Private Health Insurance Benefits Are Exhausted?

When your private health insurance is exhausted, Section B must take over funding your treatment, as long as the treatment continues to be necessary for recovery. Written documentation showing your private health insurance benefits are exhausted should be provided to your Section B adjuster.

How Long Can I Receive Section B Benefits?

Section B benefits for medical treatment max out at $50,000 worth of treatment or 4 years after the date of the accident, whichever comes first.

Weekly Indemnity benefits are different; they continue until you are able to return to work on an 80% basis. If you are not able to return to work they continue indefinitely. There is one caveat. For the first 104 weeks (two years) after the accident, the question is whether you are able to return to your pre-accident employment. After the first 104 weeks (two years), the question then becomes whether you are able to engage in any employment for which you are qualified, based on your age, education and experience. This may sound confusing, and it usually is. It is best to consult a lawyer if this becomes an issue for you.

What Happens If I have Difficulty Accessing My Section B Benefits?

Section B benefits are contractual benefits; i.e. they arise as a result of your contract of insurance. Therefore, in order to be available to you, you must be in compliance with the contract. The Section B adjuster assigned to your file should be able to assist you with any questions or concerns. If you are unsatisfied with the service you receive, you may ask for a copy of the policy for review.

If, after reviewing the policy, you are still unhappy, you have the option of bringing a bad faith claim for a breach of contract. Essentially, this would be suing your insurance company for failing to uphold their end of the contract. In order to be successful with such a claim, it is not enough that the insurance adjuster was "mean" or hard to deal with; you must be able to point to something in the contract they your Section B adjuster failed to do. If you find yourself in this position, you should seek the advice of a lawyer.

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