Tara A. Miller, Q.C. February 2021
Generally, anyone injured in a motor vehicle accident has a claim for accident benefits through Section B of their own automobile insurance policy. If you were a driver or passenger in a vehicle, then your claim for Section B benefits is made through the auto policy for the vehicle you were in. If you were a pedestrian or bicyclist hit by a vehicle, then you make your claim under that vehicle’s auto policy. You are entitled to Section B benefits regardless of whether you were at fault for the accident.
While Section B benefits provide a variety of benefits (https://www.mdwlaw.ca/personal-injury-what-are-section-b-benefits-who-is-entitled-to-them/) two key benefits are: 1) funding for immediate access to medical treatment; and 2) some income loss support. Understanding and accessing the benefits you are entitled to as quickly as possible after an accident will help set you up for as complete a recovery as possible. The automobile insurance company will provide you with information about the benefits available and assign a Section B adjuster to work with you through this process.
There are two scenarios for medical expense coverage:
- If you have a sprain, strain or whiplash associated disorder (WAD) injury grades I or II (soft tissues injuries), you can choose to be diagnosed and treated in accordance with either the Diagnostic and Treatment Protocols Regulations (https://www.novascotia.ca/just/REGULATIONS/regs/insdiagnostic.htm) (the “Protocols“) or the Nova Scotia Automobile Policy (https://www.novascotia.ca/finance/site-finance/media/finance/NS_Auto_Standard_Policy_Form1.pdf ) (“the NSPF#1“) Accident Benefits.
- If you do not have a sprain, strain or whiplash associated disorder (WAD) grades I or II (i.e., broken bone or concussion), then you will proceed under the NSPF#1.
- Under the Protocols, you can immediately access treatment through a chiropractor or physiotherapist as a primary health care provider. This means you do NOT need to first see a medical doctor to get a referral for a physiotherapist or chiropractor to start treatment. You can book an appointment at your local treatment clinic directly with a physiotherapist or chiropractor. That clinic will then bill the Section B insurer directly for up to 21 treatment sessions. You do NOT need to access your own private health insurance (Blue Cross or similar) during the Protocol period. If you continue to need treatment after 21 sessions, then you can continue to receive additional treatment provided your health care provider prescribes continued treatment.
- 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).
B) Nova Scotia Automobile Policy (NSPF#1)
- In this scenario, you must pay your treatment provider directly for treatment services, and then submit your expenses to your own private health care insurance (Blue Cross or similar). If your own private health care insurance provider does not cover your expenses, then you may submit your receipts (along with your explanation of benefits) to your vehicle insurer for payment.
- If you receive an ambulance bill, you must first submit this to your private health care insurance provider. If your extended benefits do not cover the full costs, then you may submit your invoice (along with your explanation of benefits) to your Section B vehicle insurer.
- If you do NOT have private health care insurance, then you can deal directly with your own Section B vehicle insurer to pay for treatment.
Unless under the Protocols, generally medical expenses must first be submitted through any available private coverage before the 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.
Your automobile policy provides coverage for income loss if a medical doctor determines you are totally disabled and unable to perform any aspect of your employment. You may be entitled to disability benefits for 2 years if you are unable to do your job. After 2 years, you will only receive this benefit 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 unable to 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 will be adjusted to reflect any other disability coverage you may carry (Short Term Disability or Long Term Disability) and any EI you receive.
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.
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 for a complimentary consultation.