Major changes are coming to Alberta’s automobile insurance system. Scheduled to launch by January 1, 2027, the Alberta Care-First model will overhaul how people receive medical benefits after a motor vehicle accident in Alberta. Understanding this new system is crucial for anyone involved in a collision.
This guide breaks down the key features of the Care-First system, explaining the new care pathways, important deadlines, and support services available to Albertans. We will cover:
• The two main streams for receiving treatment.
• Critical timelines you must meet to secure your benefits.
• New services designed to support you and resolve disputes.
• Practical steps to take after an accident.
What is the Alberta Care-First Insurance System?
At its core, the Care-First system is Alberta’s version of no-fault auto insurance. This means that if you are injured in a motor vehicle accident in Alberta, you will have access to medical benefits and care, regardless of who was at fault for the collision.
The government’s goal is to ensure that everyone, including those in single-vehicle accidents or those deemed at-fault, can access expanded medical benefits beyond the current standard limits. The system is designed to provide timely, evidence-based care to help people recover more quickly and prevent long-term injuries.
Who is Eligible for Care-First Benefits?
If you are injured in a motor vehicle accident in Alberta after the system launches, you will be eligible for benefits under the Care-First model. This applies to drivers, passengers, and pedestrians, regardless of who caused the accident.
Your Path to Recovery: Program of Care vs. Treatment Plan
The Benefits, Treatment and Care Regulation establishes two distinct pathways for receiving medical care: the Program of Care and the Treatment Plan. Most people will begin their recovery journey in the Program of Care.
1. The Program of Care (PoC)
The Program of Care is a structured, evidence-based framework for treating common injuries. The government expects that up to 80% of injuries from auto accidents will fall into this category and can be resolved within this program if treatment begins promptly.
What it covers: The PoC focuses on common musculoskeletal injuries, including:
• Concussion
• Neck pain and associated headaches
• Shoulder pain
• Low back, mid-back, and chest wall pain
The main idea behind the PoC is that early and expert intervention leads to faster recovery and prevents minor injuries from becoming chronic problems. The fees for services provided under the Program of Care will be set by the Government of Alberta, which is working with healthcare providers and insurers to implement the system.
2. The Treatment Plan
A Treatment Plan is required in two situations:
• Your injuries do not fall under the Program of Care.
• You have completed the Program of Care, but your injuries are not fully resolved.
A registered healthcare practitioner must develop this personalized plan, which your insurance company must then approve. The Treatment Plan will outline your health goals, the specific strategies and interventions needed to achieve them, and an expected recovery timeline. Any modifications to the plan must be made by a healthcare practitioner and deemed necessary for your recovery.
Critical Deadlines and Compliance
The new system places a strong emphasis on timely action. Failing to follow the rules can have serious consequences for your benefits.
The 12-Week Submission Deadline
You must submit your claim for healthcare services to the insurance company within 12 weeks of the accident date.
If you miss this deadline, you may lose your entitlement to payment or reimbursement for your medical care. The regulation includes a “without reasonable excuse” clause, which means you might still be able to claim benefits if you can provide a valid reason for the delay. These situations will be assessed on a case-by-case basis.
The Importance of Compliance
Adhering to your prescribed care path is mandatory. If you fail to comply with the recommendations in your Program of Care or Treatment Plan, your insurance provider has the right to suspend or even deny your permanent impairment and income replacement benefits. Crucially, any benefits withheld during a suspension period cannot be recovered later.
New Services to Support Albertans
To ensure the Care-First system runs smoothly, the Government of Alberta is introducing three new services.
1. Comprehensive Medical Assessment (CMA)
A Comprehensive Medical Assessment is an independent medical review used to clarify a diagnosis, identify barriers to recovery, and provide expert treatment recommendations. It is similar to the Independent Medical Examinations (IMEs) used in the current system.
Key points about CMAs:
• Who performs it? An impartial assessor who has no prior history of treating you. Your family doctor cannot perform the CMA.
• Who can request it? Both you and your insurance company can request a CMA, especially if your recovery is not progressing as expected.
• Is it mandatory? Yes. Insurers must follow the recommendations in the CMA report. If you fail to attend a scheduled assessment without a reasonable excuse, your benefits can be suspended or terminated, and you may permanently lose them.
2. Consumer Support Service
This service will be your go-to resource for navigating the Alberta Care-First system. It will be responsible for:
• Answering your questions and addressing inquiries.
• Handling customer complaints.
• Developing educational materials to help Albertans understand their rights and the process.
• Collaborating with the dispute resolution system to identify and fix systemic issues.
3. Dispute Management Process
When disagreements arise between you and your insurance provider, a new dispute resolution system will provide a formal process for resolving them. The central body for this will be the Alberta Automobile Care-First Tribunal.
The tribunal’s substantive decisions on benefits and care will be final. While you can ask a court to review a decision, this judicial review is limited to procedural fairness. A successful review would only send the case back to the tribunal for a new hearing—it would not overturn the substance of the decision. This makes the tribunal a powerful and essential part of the new insurance landscape.
A Practical Checklist for Action After an Accident
Navigating a new system can feel overwhelming. Here is a simple checklist to help you protect your rights after an MVA under the Care-First model.
Your Quick Timeline Checklist:
• Immediately: Seek medical attention for your injuries.
• Within 12 Weeks of the Accident: You MUST submit your claim to the insurance company.
What Documents to Keep:
• Police or collision report number.
• Contact and insurance information for all parties involved.
• Photos of the accident scene and vehicle damage.
• All medical records, receipts, and notes from your healthcare providers.
• A journal of your symptoms and how they impact your daily life.
How to Start a Claim:
- Report the accident: Notify your insurance company about the collision as soon as possible.
- See a healthcare provider: Get an official diagnosis and begin your recommended Program of Care.
- Submit the required forms: Your healthcare provider and insurer will guide you on the necessary paperwork to officially open your claim.
Get the Legal Guidance You Need
While the Alberta Care-First system aims to simplify access to medical benefits, many details are still being finalized. The process can be complex, and the consequences of missing a deadline or failing to comply are significant. Understanding your rights and obligations from the start is essential.
If you have questions about how the upcoming no-fault auto insurance changes in Alberta might affect you, it is wise to speak with an experienced personal injury lawyer. David Sowemimo at Watchmaker Law has extensive experience with no-fault insurance systems and can help you navigate this new territory. An experienced lawyer can clarify your rights and determine how your specific case fits within the Care-First framework.
Contact Watchmaker Law today for a clear explanation of your options. Call us at 825-203-9801 or use the live chat feature on our website to speak with a lawyer right now.
