What are Section B Benefits - Edmonton Automobile Accident Injury Lawyer - Ranbir S. Thind
What Are Section B Benefits?
In Alberta, Section B Benefits are insurance benefits for people who are injured in automobile accidents, or who have loved ones who were injured or died in automobile accidents. Because these benefits comes from Section B of the Alberta Standard Automobile Policy, they are commonly known as Section B Benefits. Every Alberta automobile insurance policy must contain a Section B clause which is required by law.
Anyone's right to claim Section B Benefits does not depend on whether or not person was at fault for the automobile accident that caused that person's injuries. These benefits cover certain expenses related to medical treatments, disability, and death. These benefits are contractual, meaning that the owner of an Alberta automobile insurance policy had paid for Section B Benefits as part of his or her insurance premiums. If you have an Alberta automobile insurance policy, and were injured in an automobile accident, you are entitled to Section B Benefits. Your own automobile insurance company will typically, but not always, be the source of these benefits. There are many other scenarios where you may be entitled to Section B benefits. Even if the accident happened outside of Alberta, or if none of the vehicles involved in the accident are insured in Alberta, you may still be entitled to claim Section B benefits.
What is covered under Section B Benefits?
Generally speaking, Section B Benefits cover the expenses of certain medical treatments required to treat injuries caused by an automobile accident and provide limited disability coverage to injured person who is unable to work because of an automobile accident. The idea is that accident victims can quickly and easily access treatment without having to pursue or wait for the outcome of a personal injury claim.
Medical Benefits
Section B Medical Benefits may cover some costs such as an ambulance ride, acupuncture, dental treatment, chiropractic treatment, massage therapy, medication, physiotherapy, and psychological treatment. This list, however, is not exhaustive; if there are other medical services or supplies that are essential for injured person's treatment or rehabilitation they may also be covered. Section B Medical Benefits must be approved by the treatment providers, who must complete some forms during the treatment period. Section B Benefits are coordinated with your treatment providers, such as family physician, chiropractor, massage therapist, physiotherapist, psychologist or any other approved medical provider.
Section B Coverage Limit
The ultimate limit of Section B coverage for medical treatment in Alberta is $50,000.00 per person. That means that if there are three people who were injured traveling in the same car, and that car is insured in Alberta, each person is entitled to a maximum of $50,000.00 in Section B medical benefits. In practice, however, very few MVA injury victims ever approach the $50,000.00 limit. This is partly because the law requires a person to use up any personal health insurance benefits to which injured person is entitled to ahead of some types of Section B coverage. It is also partly because insurance companies are entitled to send injured person to a doctor of their choice to determine if ongoing treatment is required. If that doctor believes that the ongoing treatment is not medically essential (which is a very high threshold) additional Section B coverage will not be approvd. Finally, it is also partly because certain common treatments are limited to very small coverage amounts such as Acupunture expenses are only covered up to $250.00, Chiropractic expenses are covered up to $750.00 and Massage Therapy expenses are covered up to $250.00.
Disability Benefits
Section B Disability Benefits cover a maximum of $400.00 per week of lost earnings or 80% of your pre-tax average weekly earnings, whichever is lower. If an injured person's personal or work benefits that provide that person with disability coverage, that must be claimed first, and then claim the Section B Disability Benefit. In such cases, the amount of weekly benefit is determined by a formula set by law. Many rules and exceptions may apply to anyone's unique situation. If you have questions about your entitlement to Section B Disability Benefits, or the formula for calculating your Section B disability amount, please call or email us.
Qualification Criteria for Section B Disability Benefits
To qualify for Section B disability benefits the following criteria must be met:
1. An injury must be from an automobile accident. This includes car, motorcycle, bicycle, truck, bus, and pedestrian accidents.
2. There must be a Section B insurer to claim against.
3. Injured person must have been employed at the time of the accident or person must be at least 18 years old and have been actively employed for at least 6 out of the 12 months prior to the date of your accident. The 6 months of employment do not have to be consecutive.
4. The injuries caused by the automobile accident must prevent the injured person from performing all job duties within 60 days from the date of the accident.
5. If the Section B insurance company so chooses, a duly qualified medical professional, usually a doctor, must certify that an injured person disabled.
6. A person cannot claim Section B Disability Benefits unless that person is “wholly and continuously” disabled by the injuries from your automobile accident. This means that the disability must prevent from doing any and all the job duties.
7. If a person is off work due to disability and is collecting the Section B Disability Benefit, once that person goes back to work the benefit stops and cannot be restarted if case that person go off work again.
8. Section B benefits can't be claimed for the first 7 days of disability, so payment for that week is “lost” unless and until a person claims that back through a personal injury claim ending in settlement or trial, or by other means. Similarly, if the Section B Disability Benefit does not cover all the lost earnings, the difference is recoverable through a personal injury claim.
Deadlines related with Section B Benefits
Section B Benefits must be claimed within a specific amount of time after the automobile accident. Here are some important deadlines:
1. Must notify Section B insurance company of the accident within 30 days.
2. For medical benefits, injured must complete a Notice of Loss and Proof of Claim Form (AB-1 Form) for the Section B insurer within 90 days.
3. For disability benefits, injured must complete a Claim for Disability Benefits Form (AB-1A Form) for the Section B insurer within 90 days.
4. The ultimate deadline for all Section B benefits is 2 years from the date of the automobile accident. After 2 years, all Section B benefits end.
The Section B insurer will provide the right forms to fill out, and forms for the doctor or medical practitioner to fill out (AB-2, AB-3, and AB-4). Knowing what to do with these forms and how to fill them out can be difficult and confusing. If you have missed a deadline, do not panic, as you may still be able to receive benefits. At the earliest opportunity, contact the Section B insurer to notify them of the accident and try to open your medical or disability claim or both.
The insurance company is generally entitled to send the injured person to their own doctor or medical provider to verify the injuries and eligibility for either medical or disability benefits. If they ask to go, a person must go. This right is subject to restrictions based in part on how serious the claim is. If the claim is capped, the Section B insurer must wait 90 days to send the injured to their own doctor or medical provider to review the injuries for medical benefits. There is no such waiting period for disability benefits.
If a claim is capped, the injured will typically get faster access to treatment, and faster payment. In such cases, the Section B insurer may also lead the person to believe the amount of treatment under Section B medical benefits is limited to 21 treatments or less. This is not true. As mentioned above, Section B Medical Benefits may cover medical services or supplies that are essential for the treatment or rehabilitation, up to a limit of $50,000.00. If you have questions about whether or not your claim is capped and how that may affect your Section B Benefits, please call us at 780.784.1295 or email us at [email protected].
Death, Grief Counselling and Funeral Expenses
Section B provides some coverage related to the death of an individual in an automobile accident. This is a sensitive topic, and the following information may be upsetting to those who have lost a loved one in an automobile accident. The first type of coverage is called, rather insensitively, the “death benefit.” The coverage for the death benefit varies according to the age of the deceased, and the relationship of the deceased to the person or persons making the claim. It is also possible to claim funeral expenses for up to $5,000 for each deceased person, and $400 for grief counselling. The grief counselling benefit is $400 per family; if more than one family member has passed, it is possible to claim a grief counselling benefit for each deceased person. If you or someone you know are dealing with the loss of a loved one due to an automobile accident, and you or that someone need help with related Section B benefits, please call or email us for assistance.
Understanding Section B Benefits and Conclusion
Section B Benefits are complex and confusing, so much so that even insurance adjusters sometimes misunderstand or misapply the law. There are rules, deadlines, and exceptions that can make Section B Benefits inaccessible. Even if Section B Benefits are denied, they can be recovered (such as treatment costs, lost earnings, and compensation and other accident-related expenses) though a personal injury claim. We hope this article has been educational and useful, but we acknowledge that it is not possible to cover everything about Section B Benefits in one document. If you have questions about Section B Benefits, please feel free to give us a call at 780.784.1295 or send us an email at [email protected] to get advice, answers, and a peace of mind.
In Alberta, Section B Benefits are insurance benefits for people who are injured in automobile accidents, or who have loved ones who were injured or died in automobile accidents. Because these benefits comes from Section B of the Alberta Standard Automobile Policy, they are commonly known as Section B Benefits. Every Alberta automobile insurance policy must contain a Section B clause which is required by law.
Anyone's right to claim Section B Benefits does not depend on whether or not person was at fault for the automobile accident that caused that person's injuries. These benefits cover certain expenses related to medical treatments, disability, and death. These benefits are contractual, meaning that the owner of an Alberta automobile insurance policy had paid for Section B Benefits as part of his or her insurance premiums. If you have an Alberta automobile insurance policy, and were injured in an automobile accident, you are entitled to Section B Benefits. Your own automobile insurance company will typically, but not always, be the source of these benefits. There are many other scenarios where you may be entitled to Section B benefits. Even if the accident happened outside of Alberta, or if none of the vehicles involved in the accident are insured in Alberta, you may still be entitled to claim Section B benefits.
What is covered under Section B Benefits?
Generally speaking, Section B Benefits cover the expenses of certain medical treatments required to treat injuries caused by an automobile accident and provide limited disability coverage to injured person who is unable to work because of an automobile accident. The idea is that accident victims can quickly and easily access treatment without having to pursue or wait for the outcome of a personal injury claim.
Medical Benefits
Section B Medical Benefits may cover some costs such as an ambulance ride, acupuncture, dental treatment, chiropractic treatment, massage therapy, medication, physiotherapy, and psychological treatment. This list, however, is not exhaustive; if there are other medical services or supplies that are essential for injured person's treatment or rehabilitation they may also be covered. Section B Medical Benefits must be approved by the treatment providers, who must complete some forms during the treatment period. Section B Benefits are coordinated with your treatment providers, such as family physician, chiropractor, massage therapist, physiotherapist, psychologist or any other approved medical provider.
Section B Coverage Limit
The ultimate limit of Section B coverage for medical treatment in Alberta is $50,000.00 per person. That means that if there are three people who were injured traveling in the same car, and that car is insured in Alberta, each person is entitled to a maximum of $50,000.00 in Section B medical benefits. In practice, however, very few MVA injury victims ever approach the $50,000.00 limit. This is partly because the law requires a person to use up any personal health insurance benefits to which injured person is entitled to ahead of some types of Section B coverage. It is also partly because insurance companies are entitled to send injured person to a doctor of their choice to determine if ongoing treatment is required. If that doctor believes that the ongoing treatment is not medically essential (which is a very high threshold) additional Section B coverage will not be approvd. Finally, it is also partly because certain common treatments are limited to very small coverage amounts such as Acupunture expenses are only covered up to $250.00, Chiropractic expenses are covered up to $750.00 and Massage Therapy expenses are covered up to $250.00.
Disability Benefits
Section B Disability Benefits cover a maximum of $400.00 per week of lost earnings or 80% of your pre-tax average weekly earnings, whichever is lower. If an injured person's personal or work benefits that provide that person with disability coverage, that must be claimed first, and then claim the Section B Disability Benefit. In such cases, the amount of weekly benefit is determined by a formula set by law. Many rules and exceptions may apply to anyone's unique situation. If you have questions about your entitlement to Section B Disability Benefits, or the formula for calculating your Section B disability amount, please call or email us.
Qualification Criteria for Section B Disability Benefits
To qualify for Section B disability benefits the following criteria must be met:
1. An injury must be from an automobile accident. This includes car, motorcycle, bicycle, truck, bus, and pedestrian accidents.
2. There must be a Section B insurer to claim against.
3. Injured person must have been employed at the time of the accident or person must be at least 18 years old and have been actively employed for at least 6 out of the 12 months prior to the date of your accident. The 6 months of employment do not have to be consecutive.
4. The injuries caused by the automobile accident must prevent the injured person from performing all job duties within 60 days from the date of the accident.
5. If the Section B insurance company so chooses, a duly qualified medical professional, usually a doctor, must certify that an injured person disabled.
6. A person cannot claim Section B Disability Benefits unless that person is “wholly and continuously” disabled by the injuries from your automobile accident. This means that the disability must prevent from doing any and all the job duties.
7. If a person is off work due to disability and is collecting the Section B Disability Benefit, once that person goes back to work the benefit stops and cannot be restarted if case that person go off work again.
8. Section B benefits can't be claimed for the first 7 days of disability, so payment for that week is “lost” unless and until a person claims that back through a personal injury claim ending in settlement or trial, or by other means. Similarly, if the Section B Disability Benefit does not cover all the lost earnings, the difference is recoverable through a personal injury claim.
Deadlines related with Section B Benefits
Section B Benefits must be claimed within a specific amount of time after the automobile accident. Here are some important deadlines:
1. Must notify Section B insurance company of the accident within 30 days.
2. For medical benefits, injured must complete a Notice of Loss and Proof of Claim Form (AB-1 Form) for the Section B insurer within 90 days.
3. For disability benefits, injured must complete a Claim for Disability Benefits Form (AB-1A Form) for the Section B insurer within 90 days.
4. The ultimate deadline for all Section B benefits is 2 years from the date of the automobile accident. After 2 years, all Section B benefits end.
The Section B insurer will provide the right forms to fill out, and forms for the doctor or medical practitioner to fill out (AB-2, AB-3, and AB-4). Knowing what to do with these forms and how to fill them out can be difficult and confusing. If you have missed a deadline, do not panic, as you may still be able to receive benefits. At the earliest opportunity, contact the Section B insurer to notify them of the accident and try to open your medical or disability claim or both.
The insurance company is generally entitled to send the injured person to their own doctor or medical provider to verify the injuries and eligibility for either medical or disability benefits. If they ask to go, a person must go. This right is subject to restrictions based in part on how serious the claim is. If the claim is capped, the Section B insurer must wait 90 days to send the injured to their own doctor or medical provider to review the injuries for medical benefits. There is no such waiting period for disability benefits.
If a claim is capped, the injured will typically get faster access to treatment, and faster payment. In such cases, the Section B insurer may also lead the person to believe the amount of treatment under Section B medical benefits is limited to 21 treatments or less. This is not true. As mentioned above, Section B Medical Benefits may cover medical services or supplies that are essential for the treatment or rehabilitation, up to a limit of $50,000.00. If you have questions about whether or not your claim is capped and how that may affect your Section B Benefits, please call us at 780.784.1295 or email us at [email protected].
Death, Grief Counselling and Funeral Expenses
Section B provides some coverage related to the death of an individual in an automobile accident. This is a sensitive topic, and the following information may be upsetting to those who have lost a loved one in an automobile accident. The first type of coverage is called, rather insensitively, the “death benefit.” The coverage for the death benefit varies according to the age of the deceased, and the relationship of the deceased to the person or persons making the claim. It is also possible to claim funeral expenses for up to $5,000 for each deceased person, and $400 for grief counselling. The grief counselling benefit is $400 per family; if more than one family member has passed, it is possible to claim a grief counselling benefit for each deceased person. If you or someone you know are dealing with the loss of a loved one due to an automobile accident, and you or that someone need help with related Section B benefits, please call or email us for assistance.
Understanding Section B Benefits and Conclusion
Section B Benefits are complex and confusing, so much so that even insurance adjusters sometimes misunderstand or misapply the law. There are rules, deadlines, and exceptions that can make Section B Benefits inaccessible. Even if Section B Benefits are denied, they can be recovered (such as treatment costs, lost earnings, and compensation and other accident-related expenses) though a personal injury claim. We hope this article has been educational and useful, but we acknowledge that it is not possible to cover everything about Section B Benefits in one document. If you have questions about Section B Benefits, please feel free to give us a call at 780.784.1295 or send us an email at [email protected] to get advice, answers, and a peace of mind.