Tara Miller – October 2015
What are No-Fault Section B Benefits?
Generally, anyone injured in a motor vehicle accident is entitled to make a claim for no-fault accident benefits through Section B of their own automobile insurance policy. These benefits are no-fault, meaning they are available regardless of whether you were at fault for the accident in most circumstances. Many people mistakenly believe they only have access to these benefits if they did not cause the accident and often lose out on valuable resources for treatment and financial assistance in the aftermath of an accident.
A driver or passenger in a vehicle will advance a claim for no-fault benefits through the insurance policy covering the vehicle they were in. If you were a pedestrian or bicyclist hit by a vehicle, then you make your no-fault benefits claim under that vehicle’s insurance policy.
Section B no-fault benefits include:
- reimbursement for reasonable and necessary medical expenses incurred within 4 years from the date of the accident (up to a maximum of $50,000);
- a monthly disability payment for loss of income (up to a maximum of $250/week);
- weekly compensation for homemakers; and
- funeral, grief counselling and death benefits if a family member is fatally injured in a collision.
MEDICAL EXPENSES:
There are two situations for recovering medical expenses. If you have a sprain, strain or whiplash associated disorder (WAD) injury grades I or II, you may elect to be diagnosed and treated in accordance with either the Diagnostic and Treatment Protocols Regulations (Protocols) or the Nova Scotia Automobile Policy (NSPF#1) Accident Benefits. If you do not have a sprain, strain or whiplash associated disorder (WAD) grades I or II (ie., broken bone or concussion only), then you will proceed under the standard NS Automobile Policy Accident Benefits.
A) Protocols
- Under the Protocols, your primary health care provider (chiropractor, physiotherapist or medical doctor) may bill your insurer directly for approved treatment services. You need not access your extended health care benefits (Blue Cross or similar) during the Protocol period.
- It is recommended you attend an assessment with a primary health care practitioner within 10 business days from the date of the accident. Coverage for treatment in the Protocols expires no later than 90 days from the date of the accident.
- A Proof of Loss Form must be completed and submitted by you to your insurance company within 10 business days of the motor vehicle accident.
- If you decline to be treated under the Protocols, or your injury does not fall within Protocols, coverage may still be provided under the Nova Scotia Automobile Policy (NSPF#1).
- You must pay your treatment provider directly for treatment services, and then submit your expenses to your extended health care insurance (Blue Cross or similar). If your extended benefits do not cover your expenses, you may submit your receipts, along with your explanation of benefits, to your vehicle insurer.
- If you receive an ambulance bill, you must first submit this to your extended health care provider. If your extended benefits do not cover the full costs, you may submit your invoice along with your explanation of benefits to your vehicle insurer.
Unless under the Protocols, generally medical expenses must first be submitted through any available private coverage before the no-fault benefits through Section B are available. Treatment from physiotherapists, massage therapists, chiropractors, dental work, professional nursing care, and/or other treatments recommended by your doctor should be covered under Section B. You can also get reimbursed for accident-related medical expenses for things such as mileage to treatment, prescription drugs, medical devices, or ambulance bills.
DISABILITY COVERAGE:
Your automobile policy may provide coverage for income loss in the event you are totally disabled and unable to perform any aspect of your employment, as determined and documented by a medical doctor. You may be entitled to disability benefits for 2 years if you are unable to do your job. After two years, your insurance company will only pay you if you cannot do any job for which you are reasonably suited by education, training or experience.
There is no income benefit payable unless you are off work 7 out of the first 30 days after your accident. The maximum amount payable is 80% of your gross weekly income to a maximum of $250/week. This amount may be adjusted to reflect any other disability coverage you may carry (Short Term Disability or Long Term Disability).
In order to process your claim for income benefits, you will need to be organized and complete forms provided by the adjuster as quickly as possible. There are three forms to complete – one for you, one for your doctor and one for your employer. The quicker you complete the forms and provide necessary information such as a Record of Employment (ROE) and details about other coverage (private coverage, short term disability, EI sickness, etc.), the quicker the adjuster will be able to process your claim.
Individuals are typically able to handle their no-fault benefits claim on their own. The insurance company will assign a Section B adjuster who will work with you through this process. If you feel that you are not paid benefits to which you are entitled, or if you have any questions about Section B in general, then please consult a member of our personal injury team at MDW Law.