If you are injured in a car accident you are likely to find yourself in need of medical care. Getting traditional health insurance to pay for your medical care and treatment can be difficult and time consuming. If your accident involved another driver, and that driver was negligent in causing the accident, you may want him or her (or his or her insurance) to compensate you for medical bills and other expenses. Getting that driver to accept responsibility and pay your bills caused by the accident can take time, however.
A Quicker Way to Get Insurance Benefits
Nova Scotia’s Section B benefits under existing insurance laws provide a solution for those in need of immediate medical attention.
Section B benefits can provide access to needed funds no matter how the accident occurred. Nova Scotia implemented Section B benefits out of a recognition that even those who may be at fault for a car accident still need to be able to pay for medical care. Even accidents that only involve one vehicle, such as a car driving off the road, can result in the need to obtain medical treatment.
In cases in which an accident is caused by a negligent driver, you may need to resolve a dispute over who caused the accident before getting the other driver or his or her insurance to pay damages to you. This can take a significant amount of time. People injured in accidents cannot sit around waiting for their case to resolve in order to get needed medical treatment. In fact, newly enacted laws require accident victims to obtain medical attention as quickly as they can, and can hold those drivers responsible for injuries that are caused by, or made worse by, the failure to get immediate and appropriate medical attention.
Section B insurance is available to victims regardless of fault and regardless of how the accident happened or who caused it. You do not need to prove anything (other than the fact you were actually in a car accident) before being able to access the benefits. This is why Section B is often called “no fault insurance.” Think of the insurance as an immediate “fund” that a victim can use to at least get preliminary medical attention.
Who is Insured by Section B Benefits?
Section B benefits do not only insure the driver or owner of the vehicle involved in the accident. The insurance will cover any person occupying the vehicle.
The insured’s Section B will also cover pedestrians (including cyclists) that the insured driver may hit, as well as members of the insured’s family, if they are pedestrians hit by another car, if that car owner or driver doesn’t have insurance. The law defines family as those who reside with the insured.
If you are in a car accident in your vehicle (whether you are the driver or the passenger), your own Section B benefits will pay whatever benefits you are determined to be entitled to under the policy. However, if you are in someone else’s car and are injured in an accident, you will look to their Section B policy to make payments to you. If they do not have Section B benefits, you would then look to your own insurance.
In cases in which there are multiple insured parties, figuring out which person’s Section B benefits will provide for your expenses can be a complex question. A lawyer from Preszler Injury Lawyers can help you navigate these scenarios so that you can get the medical attention that you need as soon as possible.
Section B Medical Expenses
Section B benefits cover a wide variety of medical treatments. Hospital treatment, ambulance, chiropractic care, dental work, necessary surgeries, nursing care and service, and medical supplies can all be covered by Section B benefits. Supplies that in the opinion of medical providers are necessary for rehabilitation, therapy including occupational and physical therapy, and even job/professional retraining are included.
Courts have required Section B to pay for things like tools to clean teeth when a patient’s jaw was wired shut, traveling expenses to get to medical providers, eyeglasses, and modifications to a victim’s home to accommodate disabilities caused by an accident.
Your Section B benefits will cover all of these expenses incurred for up to four years, to a limit of $50,000. This maximum is for all Section B benefits, excluding lost wages.
In cases where emergency surgery is needed immediately following an accident, that amount may be used up after just a few weeks. With other injuries, which may require extended medical care, multiple smaller surgeries, or other ongoing therapy, it may take a few years to hit the $50,000 maximum.
However, after four years, your Section B medical benefits will no longer be available. This means that your benefits will terminate after four years, even if you have not yet hit the $50,000 mark.
Accidents can put their victims out of work for extended periods of time. Victims can be left with no way to pay their household bills while they recover from their injuries. Section B benefits can provide assistance with these lost wages.
Lost wages after an accident that causes injury in Nova Scotia can be obtained so long as the victim was employed at the time of the accident, or employed for six of the previous 12 months. Those seeking lost wages must show that they have suffered a “substantial inability” to perform their job for at least seven days.
Lost wages can only be received for a maximum of 104 weeks, but there is an exception to this maximum. Victims who can show that they cannot engage in any job that they are trained to do or capable of doing, can receive continued lost wages.
So, for example, if you are a nurse and cannot go back to patient care after 104 weeks, but you could work in a medical job where you analyze medical records from a desk, you would not get benefits. However, if you were a trucker, and there are no other driving jobs that you can apply your knowledge or training toward, you may be able to continue to receive benefits.
Section B unfortunately does not pay all of your lost wages, but rather, will pay 80% of your wages to a maximum of $250 per week. In some cases, Section B will pay less, if your lost wages are being paid by another source, such as separate insurance or salary continuation plans. Those who have additional wages than the $250 weekly maximum, and who would like protection, can add traditional employment disability insurance to assist them along with the Section B benefits.
If you were unemployed at the time of the accident, you still may benefit from the lost wages part of your Section B policy. If you do not claim lost wages because you were unemployed, and you were a homemaker—say, for example, a stay at home mother or father—you can opt to receive benefits for housekeeping services.
The payments are a bit less than they would be for lost wages — $100 per week — but that money can assist you in utilizing outside help or services to do things like take care of the lawn or do household chores and only available for 52 weeks.
This is very fact specific and you should consult a Preszler Injury Lawyer as soon as possible.
Death and Burial Expenses
Section B will also pay for funeral and burial expenses, if necessary. In these cases, families may also be entitled to death benefits. Insurance will pay a cash benefit of $25,000 either to the deceased, or the spouse of the deceased. Even those who are not married, but who have lived with the deceased for at least one year prior to the accident/death, can receive the benefits. Dependants can be paid $5,000.00. There is also an increase in the amounts when more than one dependant or survivor exists.
The funeral expense payable is $2,500.00.
Giving Timely Notice
Many kinds of insurances have strict notice periods where the insured must tell the insurer of the loss in order to get benefits, and Section B is no different. Notice of a claim must be made within 30 days of the accident (or as soon as practicable, in cases where someone is unable to give notice sooner).
Another benefit of quickly notifying your insurer (or the insurer that is responsible for paying the benefits, if not yours), is that Nova Scotia allows doctors treating injury victims to provide treatment without getting prior approval from the insurance company for certain categories of injury. Injuries like sprains, strains, whiplash, and similar injuries can be treated by your doctor immediately so long as your insurance company has been notified of the accident.
Cutting Off Benefits
If you start to receive Section B benefits, there may come a time when the insurance company wants to check your progress, to see if you still are in need of medical care and treatment. Although this seems innocent, insurance companies regularly abuse this process.
At any point, the insurance company may send you for what is known as an independent medical exam (IME). Despite the name, these examinations are anything but independent.
An IME is when the insurance company sends you to one of their chosen doctors for a one-time independent evaluation of your medical condition, to see if you have healed, or at least, to see if you have stabilized to the point that continuing benefits are no longer needed. The insurance company chooses the doctor, who of course does not know as much about you or your medical history as your own doctors.
The doctor will conduct a medical examination on you and take a verbal medical history from you. Based on this examination, the doctor will report to the insurance company that you either are in need of further medical care (and thus continuing benefits), or that you are not. As you may have guessed from the fact the doctor is sharing your report with the insurance company, there is no doctor-patient confidentiality, the way there is between you and your own treating doctors.
You must attend the IME. Failure to do so will be considered a breach of your insurance contract, and the insurance company can terminate your Section B benefits, regardless of your injuries or medical condition.
The problem—and why these examinations are not exactly “independent”—is that many of these doctors make a lot of money off of these exams from the insurance companies. They may be biased towards cutting off your benefits, as the insurance company’s payments for these exams can make up a large part of a doctor’s income. It is not uncommon to see even the most catastrophically injured accident victims with IME reports that say that they are fine, or stable, or healed enough that further benefits are no longer needed.
There are rules about what must be in an IME report, and how it can be used against you in a trial. There are also rules that permit rebuttal opinions from your own physicians.
A lawyer from Preszler Injury Lawyers can help prepare you for your IME. Doing things like bringing a friend or family member, writing down what was asked and noting the time and duration of the exam, can all be helpful down the road and can help you continue to receive the benefits that you paid for under your policy.
The experienced lawyers at Preszler Injury Lawyers can help you with insurance problems after an accident and can explain how to make insurance companies and negligent drivers compensate you for injuries that you may have suffered. Call today to speak with one of our lawyers.