Accident benefits – an overview

Alex Mlynek
by Alex Mlynek September 27, 2019 / No Comments

If you’ve been injured in a truck or automobile accident, whether as a driver, passenger, pedestrian or cyclist, you could receive accident benefits, which may cover such things as medical treatment or rehabilitation, income replacement, death benefits, and attendant care. 

What are accident benefits?

Accident benefit coverage is required as part of auto insurance in all provinces and territories, with the exception of Newfoundland and Labrador, according to the Insurance Bureau of Canada 

These benefits are designed to help people who’ve been hurt in an accident get the medical treatment they need and get back on their feet, or pay for funeral expenses or death benefits. 

Who pays?

It depends where you live. Many places in Canada have what’s called no-fault insurance, which means that each person goes through their own insurance company for payment, regardless of who is at fault. 

If you don’t have automobile insurance — say you’re a pedestrian, a cyclist, or a passenger who doesn’t drive their own vehicle — you’re covered by the driver’s insurance company.

Some provinces, like BC, and Newfoundland & Labrador allow people who are injured to sue for financial compensation. While other places, like Saskatchewan, give you the option to select either no-fault coverage or tort coverage when you sign up for auto insurance. The latter gives you a lower level of defined benefits, but allows you to sue the person who is found to have caused the accident for certain expenses, as well as for pain and suffering.

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Filing a car accident insurance medical claim

The process may differ slightly depending on where you live. But once you reach out to the relevant car insurance company, they will send you a number of forms to fill out that will help them understand your injuries, your medical team’s treatment plan, as well as the kinds of benefits you want. 

You’ll need to specify which benefits you want because, in some cases, there are options that suit you better. Meghan Walker, an associate with Will Davidson LLP in Ontario, represents clients in personal injury cases. She helps clients make these decisions. For example, deciding between income replacement benefits or caregiver benefits, because, in Ontario, you can’t have both. “Oftentimes we have to look at how much money that person was making and how much their caregiving expenses will be to determine what is the more appropriate option,” she explains.

A bodily injury claims adjuster will then look at all of this information.  They may include assessments from your doctor, other medical practitioners, and potentially consult with the insurance company’s own medical experts.  Once completed, the adjuster decides what kind of benefits they will pay you. 

What happens if there’s a dispute about the types of benefits offered?

There are sometimes discrepancies between what you and your medical team deem important and what qualifies as necessary with your insurance company. Disputes can also arise in terms of how they classify your injury. For instance, your doctors may say your injuries are catastrophic, but the insurer may disagree. This determination could have major financial consequences.

How this is sorted out varies from place to place. With Ontario car insurance, for instance, a dispute with an insurance company over the types of benefits they are willing to pay is adjudicated through a government body called the Licence Appeal Tribunal, specifically, a section within that called the Automobile Accident Benefits Service. Other provinces or territories may deal with these disputes through the courts.

The Bottom Line

Now that you know a bit about accident benefits, if you need to make a claim, check with your province or territory’s governing body to see how long you have to do so. In some instances, waiting too long can mean you could lose out on these benefits.

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Sources for story:

  •  https://www.sgi.sk.ca/basic-auto-injury-insurance
  • https://www.fsco.gov.on.ca/en/auto/brochures/pages/brochure_claims.aspx#accident
  • https://www.iban.ca/automobile-insurance-faq.html#what-is-third-party-liability-insurance
  • https://www.icbc.com/claims/injury/Pages/Settling-your-claim.aspx
  • http://www.ibc.ca/mb/auto/auto-insurance/
  • https://saaq.gouv.qc.ca/en/traffic-accident/public-automobile-insurance-plan/in-brief/