Overview of Section B
After a motor vehicle accident in Alberta, one of the coverages you should get access to are No-Fault Accident Benefits. The details of the Accident Benefits coverage are included in Section B portion of the Insurance Policy. This section of the policy outlines the coverage of medical expenses resulting from a motor vehicle accident. Its primary goal is to ensure that injured individuals receive timely and appropriate care. Additionally, it outlines specific rules based on the type of injury and its treatment.
What is covered under Section B?
Section B of the Owner’s Automobile Policy entitles a person injured in a car accident to accident benefits. These benefits, including medical expenses, loss of income, and death benefits, are collectively known as no-fault benefits. This system is designed to ensure fairness and provide unwavering support to all parties involved, regardless of fault, instilling a sense of reassurance and security.
Medical Expenses
Injuries caused by a motor vehicle accident can vary in severity from minor to serious, and the benefits entitled to the injured person depend on the severity of the injuries. For minor injuries, the Diagnostic and Treatment Protocol may be applicable should the injured person wish. However, the benefits under the Diagnostic and Treatment Protocol are a combined total of 21 physical therapy, chiropractic, and adjunct therapy visits within 90 days of the accident.
Where an injured person is covered by the Diagnostic and Treatment Protocol, but chooses not to follow the Protocol or where the protocol no longer covers the treatment or where the injury is serious or not covered by the Diagnostic and Treatment Protocol, the person injured in a motor vehicle accident is entitled to medical expenses benefits under Section B. The insurance company must cover all expenses incurred by an injured person within two years of the accident date, up to a maximum of $50,000.
Medical expenses of the person injured in a motor vehicle accident for the maximum of Medical Expenses covered by Section B include:
• Medical treatment,
• Surgery,
• Chiropractic treatment,
• Dental care,
• Psychological treatment
• Physiotherapy,
• occupational therapy,
• massage therapy,
• acupuncture,
• professional nursing services
• ambulance services, etc.
Although the maximum amount of coverage for the two years is $50,000, there are some services with their specific cap, for instance:
• Chiropractic care: Max $1,000 per person
• Massage therapy: Max $350 per person
• Acupuncture: Max $350 per person
Death Benefits
Motor vehicle accidents can lead to more catastrophic consequences, such as death. While the pain of losing a loved one cannot be compensated, the grieving family is entitled to some financial support, which includes:
• Funeral expenses of up to $6,150 for each deceased person,
• Grief counselling of up to $500 per family for each deceased person.
• The death benefit varies in amounts determined by the age of the deceased person and their status in the family at the time of death. The amount is calculated using a formula that takes into account the deceased’s age and their relationship to the primary policyholder.
Total Disability Benefits
Section B also covers total disability benefits, providing financial support when an insured person becomes completely disabled due to a motor vehicle accident and is unable to work.
To be eligible for disability benefits, the injured person must be:
• Employed at the time of the accident and
• The injury must have prevented them from performing duties or functions relating to the person’s occupation/job within 60 days of the accident.
The injured person is entitled to weekly benefits for a maximum of two years or 104 weeks from the day of the accident. However, it is worth noting that no benefits are paid for the first 7 days of disability.
Weekly Benefit Amount: For individuals entitled to disability benefits, the weekly benefit is the lower of $600 per week or 80% of the person’s average gross weekly earnings. For instance, if 80% of a person’s gross weekly earnings is $480, the entitled benefit will be $480; however, if 80% of the gross weekly earnings is $720, the benefit will be $600.
It should be noted that where an injured person claims disability benefits through another source outside Section B and the total benefits payable to the person exceed the person’s average gross weekly earnings, the amount to be received will be calculated by the insurance company. This means that if you are receiving benefits from another source, the insurance company will adjust your Section B benefits accordingly to prevent overcompensation.
In a situation where the insured person is unemployed, 18 years or older, and unable to perform any household duties, the injured person will be entitled to $200 per week for up to 104 weeks, or 2 years.
It is essential to note that for a person entitled to this benefit, the disability must be certified by a qualified medical practitioner, if the insurance company requires it. This means that if the insurance company requests it, you will need a doctor’s confirmation of your disability to receive benefits.
Who is covered under Section B?
- The named insured person driving the vehicle described in the insurance policy
- The insured person’s spouse or adult interdependent partner, and dependent relatives living in the same home, when they ride in the car covered under the policy.
- Occupants of vehicles not used regularly by the occupants.
- Pedestrians or cyclists struck by a car.
When Coverage Doesn’t Apply
Even the most comprehensive policies have exceptions where coverage is denied, and section B exclusions are designed to protect insurance companies from bearing costs in high-risk or inappropriate scenarios. These exceptions are:
- Any injury resulting from suicide or attempted suicide, irrespective of mental state.
- Work-Related Injuries
- Injuries sustained during races or speed tests
- Any injury while using the vehicle for illegal activities
- Claims arising from accidents where the driver is convicted under impaired driving laws, underage, or unauthorized to drive.
Processing a Claim under Section B
The process for submitting a claim under Section B is as follows:
Timeframe for Filing: the insured person must deliver a completed claim form (AB-1: Notice of Loss and Proof of Claim Form) to the insurance company’s head office or local agency within 30 days of the accident and where filing within the 30-day deadline is not reasonable because of the severity of the injury severity, hospitalization, or other extenuating circumstances, it should be filed “as soon as practicable”.
Methods of Delivery: the claim must be delivered by Personal delivery, mail, fax, or email if mutually agreed.
Contents of the Form: The claim form must contain a detailed account of your injury and a clear description of the accident, based on your firsthand knowledge.
Medical Documentation and Examination Rights of the Insurance Company
Section B grants the insurance company certain rights to verify the legitimacy and extent of your injuries:
• When a claim is pending, the insurance company may request examinations by a medical practitioner of their choice.
• In the unfortunate event of death, the insurance company may conduct an autopsy under local legal parameters.
• However, the insurance company does not have a right to the medical report in situations including but not limited to injuries treated under the Diagnostic and Treatment Protocol within the protocol period of 90 days.
Payment of Benefits: Timelines and Conditions
Section B specifies deadlines for payments once a claim is approved:
• Non-Disability Benefits: All non disability benefits must be paid within 60 days of receiving your completed claim form.
• Loss of Time (Disability) Benefits: Initial payments are made within 30 days of receipt of the form; subsequent payments are made at 30-day intervals, payable upon proof of ongoing disability.
It is also worth noting that before issuing payment, the insurance company can require a release form from the insured person, releasing both parties from further liability up to the paid amount.
Taking Legal Action
If a claim dispute arises, Section B outlines strict legal timelines:
• Two-Year Limitation: An insured person who wants to bring a lawsuit to recover benefits under section B must do so within two years from the accident. Failure to do so within this time will result in the loss of the right to sue to recover the benefit.
• Pre-Action Requirements: For an insured person to sue to recover benefits under section B, a completed claim form must have been submitted to the employer, and the loss must have been determined.
Key Takeaways
• Medical Expenses: Each person injured in a motor vehicle accident is entitled to up to $50,000 per person for two years for treatments such as surgery, physiotherapy, and professional nursing, with service‐specific caps for chiropractic treatment, massage therapy, and acupuncture.
• Disability (Loss of Income) Benefits: A person suffering from total disability because of a motor vehicle accident that affects their ability to do their job can claim disability benefits for available for up to 104 weeks after a seven‐day waiting period
• Disability (Housekeeping) Benefits: An unemployed person suffering from total disability because of a motor vehicle accident that affects their ability to do their housework job can claim disability benefits available for up to 104 weeks after a seven‐day waiting period.
• Death Benefits: The family members of a person who dies because of a motor vehicle accident are entitled to death benefits, funeral expenses, and grief counselling.
• Exclusions and Insurance company Rights: Section B does not cover injuries from suicide, racing, illegal use, impaired or unlicensed driving, or work‐related accidents.
If you have sustained injuries in a motor vehicle accident or slip and fall incident, our lawyers are available 24/7 to review the facts of your specific case and provide information to you on the options available to you, including assistance with your Accident Benefits claim.
Watchmaker Lawyers can be reached at 825-203-9801 or chat live a member of our legal team now on our home page.
