Judge Rules Injury Settlement Does Not Impact Injured Person's Ongoing Right to Section B Medical and Rehabilitation Benefits

In a Court Decision released earlier this month, Justice Beveridge of the Nova Scotia Supreme Court held that a woman's settlement of her injury claim had no bearing on her right to ongoing benefits from her Section B Insurer. The case was Humphrey v. Portage La Prarie Insurance.

Essentially, the insurance company was trying to limit its obligation to pay medical and rehabilitation expenses submitted by the Ms. Humphrey. Under the terms of the standard automobile policy in Nova Scotia and Prince Edward Island, Auto Insurers have to pay up to a maximum of $25,000 for medical and rehabilitation expenses related to injuries suffered in a car accident

This case represents a victory for injured persons and automobile insurance policyholders in Nova Scotia.

Nova Scotia Government releases second edition of "Consumer's Auto Insurance Guide"

The Nova Scotia government publishes a guidebook called A Consumer's Auto Insurance Guide, 2nd ed. It is easy to read and answers many basic questions about auto insurance, including how to choose an insurance company, the different types of coverage, what to do if you want to file a claim, and what to do if you want to file a complaint against your insurance company.

Auto Accident Benefits - Don't miss the deadlines for applying for benefits

In previous articles I have discussed that people injured in automobile accidents are entitled to certain accident benefits (also called Section B benefits), regardless of whether they were a driver or a passenger, regardless of whether they owned the vehicle or not, and regardless of who was at fault for the accident.

However, please be advised that there are deadlines for applying for auto accident benefits. In Nova Scotia, if you are injured in an car accident and want to access accident benefits (e.g., for rehabilitation or loss of income payments) you must notify the Insurance Company, in writing, of your intent to make a claim within 30 days of the accident and provide them with proof of your claim within 90 days of the accident, or as soon as is practicable after that time.These deadlines apply to all automobile insurance policies in Nova Scotia and read as follows:

(4) Notice and proof of claim
The insured person or his agent, or the person otherwise entitled to make claim or his agent, shall,

(a) give written notice of claim to the Insurer by delivery thereof or by sending it by registered mail to the chief agency or head office of the Insurer in the Province, within 30 days from the date of the accident or as soon as practicable thereafter;

(b) within 90 days from the date of the accident for which the claim is made, or as soon as practicable thereafter, furnish to the Insurer such proof of claim as is reasonably possible in the circumstances of the happening of the accident and the loss occasioned thereby;

(c) if so required by the Insurer, furnish a certificate as to the cause and nature of the accident for which the claim is made and as to the duration of the disability caused thereby from a physician.

It is easy to miss these deadlines, especially if your injuries take months to appear. Also, it is easy for passengers to forget because they don't own the car and the insurance company may not contact them directly.

If you miss the notice/proof of claim deadlines, the courts will look to when your "became aware" or "discovered"  that you suffered injuries in the accident. They will take all the circumstances into account in deciding whether you notified the insurance company as soon as was reasonably possible. In some situations, the court may allow your claim to go forward even if you did not notify the Insurer as soon as was reasonably possible.

If an Insurance company denies your claim for Section B benefits on the basis that your failed to notify them within the 30 and 90 day deadlines outlined above, you should consider speaking with a lawyer experienced in personal injury and insurance law. Depending on your circumstances, there may be several ways to get around missed deadlines, and preserve your right to accident benefits.

Do you have "enhanced" automobile insurance benefits coverage? You should.

As someone who has worked with injured persons and persons with disabilities for the past decade, I cannot stress how important it is that you have private health insurance if you become seriously injured or disabled. You may think, "it won't happen to me." You may think the public health care system or social services will take care of you. You couldn't be more wrong.

If you talk with some who has experienced a serious injury or disability you will find out that people (and their families) are largely left to fend for themselves. Its too late to buy insurance once you become disabled - your disability will be a pre-existing condition that the insurer does not have to cover. Also, there are lengthy waits for public-sector rehabilitation services. The only way to get timely rehabilitation is to attend a private clinic. Unlike other provinces, the Nova Scotia government does not pay for wheel-chairs, home renovations, and other technical aids or assistive devices (unless you and your family have no income and are on social assistance).

The chances of you suffering an injury are greater than you think. Each year, approximately 30,000 people are involved in automobile accidents in Nova Scotia. Of these 30,000 people, approximately 3,000 will suffer moderate to serious injuries. If you are one of these 3,000 people, it is extremely important that you have the best insurance protection that you can afford. One of the simplest ways you can protect yourself is to buy "enhanced" automobile accident benefits from your automobile insurance company.

Automoble accident benefits are also called "Section B" benefits. Please see my earlier post on no-fault auto accident benefits  for a full discussion on this topic.

Why would you want "enhanced" automobile accident benefits? Two words - financial security.

The enhanced benefits provide up to $50,000 for rehabilitation, as apposed to the $25,000 on the regular accident benefit plan. You may be thinking, well I have rehabilitation coverage through my work group benefits plan, so why do I need enhanced rehabilitation benefits? Good question, but you need to be aware that most group health benefits plans have a maximum number of visits (per year) that you can attend for rehabilitation (physiotherapy, chiropractic, and massage therapy). If you are seriously injured, you will easily exceed these limits very quickly. If you have extended section B coverage, you would then have a maximum of $50,000 to spend on rehabilitation in private clinics.

However, in my mind, the greatest benefit of the enhanced section B coverage is that you can get up to $250 per week in income replacement payments if you doctor says you are unable to return to work because of your injuries. If you do not have a group disability plan through your work (and most Nova Scotians do not) then these weekly payments are extremely important. They will help pay for the rent, mortgage, groceries, whatever, for the time you are unable to earn income. If you have the general section B coverage, you could only get a maximum of $140 per week.

You may be worried that your insurance rates will go up if you use the accident benefits. This is a valid concern. It is often difficult to predict what will cause your insurance rates to go up. However, one thing is clear. If the accident (that caused your injuries) was not your fault, then your insurance company cannot raise your rates because you use your accident benefits for rehabilitation and income replacement. The Government passed a law banning this practice back in October 2003.

I urge you to consider buying enhanced section B coverage. I recently bought it when I called my auto insurance company to report a change of address. I think it raised my monthly premium by a couple of dollars per month, but the security it provides is well worth it.

Overview of No-Fault Auto insurance Benefits for People Injured in Car Accidents in Nova Scotia

If you are injured in an automobile accident, then you may be entitled to benefits from your own automobile insurance company, or from the automobile insurance policy of a vehicle involved in the accident, no matter who was at fault for the accident.

You may qualify for the following benefits:

Medical and Rehabilitation Benefits

Your accident benefits insurer may be required to pay for a wide range of medical and rehabilitation services up to a maximum of $25,000*, including physiotherapy, occupational therapy, massage therapy, psychology, and chiropractic. Your insurer may also be required to pay for medical expenses related to the accident, such as corrective shoes, hand splints, drugs, gym memberships, and mobility aids (wheelchairs, canes, etc). If your injury prevents you from returning to work, then your insurer may be required to pay for vocational rehabilitation, work hardening programs, jobsite assessments, and modifications to your workstation or workspace.

Weekly Loss of Income Payments

If your injuries prevent you from working, you may qualify for weekly loss of income payments. These payments are 80% of your gross weekly income or $140* per week, which ever is less. Generally speaking, in order to qualify for weekly loss of income payments, you must meet the following criteria:

1. You were "employed" at the date of the accident;
2. During the 30 days after the accident you suffered a "substantial inability to perform the essential duties of your occupation or employment" for at least 7 days; and
3. You are unable to work because of injuries you suffered in accident.

Housekeeping Expenses

• $70 per week for not more than 12 weeks*

Funeral Expenses

• $1,000* for funeral expenses

Death Benefits

• $10,000* to the victim's spouse
• $2,000* to each of the victims dependants

* These figures are the most common amounts. However, you may be entitled to more benefits if you have "supplementary benefits" coverage. To determine if you have supplementary benefits coverage read your policy, or ask your insurance broker, your insurer, or your lawyer.

If you have questions about whether your right to automobile accident benefits, contact a Nova Scotia personal injury lawyer. He or she will explain your rights.