Section B – Accident Benefits Overview (Medical Coverage)
By: Nushka Blais, Associate Lawyer
The first three forms provided to you by your insurance company to open a Section B claim are the Automobile Accident Proof of Claim form, a form to be completed by your Attending Physician, and an Employer’s Confirmation form. You will be assigned an adjuster and claim number for Section B specifically and can correspond with that adjuster. Note that you can always ask your lawyer for assistance if there is any issue with having treatments covered.
If you have access to any private medical insurance, you will be required to claim for treatments through your private insurance first. The remainder of the treatment payments in a situation of co-pay or limit overage can then be claimed through Section B.
Section B medical benefits are available for 4 years post motor-vehicle accident or up to $ 50,000.00, whichever comes first. If you require more benefits than those available through Section B and any private insurance you may have, those can be claimed against Section A.
In order to have treatments, prescriptions, necessary medical aids or devices covered by Section B, you will need a medical practitioner to prescribe the treatment as being necessary due to the motor vehicle accident. Section B will not cover treatments that are not associated to the motor vehicle accident.
Section B may request that you attend an independent medical evaluation. This will be scheduled and paid for by them. The independent medical evaluation report can provide opinions with respect to your diagnoses, prognosis, treatment needs and working abilities so that Section B can better identify the support you will need and the benefits they will need to offer you.
You can claim mileage for any appointment that is directly linked to the accident. Your adjuster can provide you with a mileage claim sheet. The necessary information is the distance travelled, and the reason for the travel. The treatment provider or physician will have to sign the claim sheet or provide a printout confirming your attendance at their office. This does not include grocery store trips, regular family doctor appointments or appointments with your lawyer, as they are not for the purpose of treatments required due to the injuries sustained in the motor vehicle accident.
At home assistance
If you require assistance with chores and home maintenance, then it may be covered. There are principal unpaid housekeeper benefits available in some circumstances. It is always a good idea to keep track of any spending that would not have been necessary had it not been for the accident. Note that if these services were already part of your expenses prior to the accident, they will likely not be covered.
Your immediate medical needs and your recovery from the accident are important. As a plaintiff in an action, there is a duty to mitigate which means you are responsible for making improvements and any action taken that would be willfully worsening your situation may have a negative effect on your claim. If any issue occurs in relation to coverage or independent medical evaluations, you can always ask your lawyer for assistance. As always, anything that you had to do but were not reimbursed for by Section B should be kept on record as you may be able to incorporate it into the Section A claim. For loss of income and the weekly indemnity benefits, please refer to other posts on our blog.
DISCLAIMER: The publications on this website are intended to provide information of a general nature and not legal advice. The information contained in this publication is current to the date of the publication and may be subject to change following the publication date.