Section B Benefits
The first few moments following a car accident can often be a blur. The initial shock from the jolt of the impact, the acute pain from any injuries you’ve sustained, and the immediate concern that someone else could have been injured are enough to make anyone’s head swirl.
It’s only later, when you regain focus, that your mind turns to other important matters at hand, including: what medical treatment will I need as I recover, and who is going to pay for it?
If you’re injured in a motor vehicle accident in Nova Scotia – even if you were fully or partially at fault – you may be entitled to Section B benefits to assist in your rehabilitation and recovery; and Preszler Law is here to help you access them if you qualify. In Nova Scotia – every driver has to have mandatory coverage for automobile insurance through an insurer that meets minimum provincial regulations.
What are Section B benefits in Nova Scotia?
Section B benefits – also known as “first person” or “no fault” benefits – entitle anyone involved in a motor vehicle accident in Nova Scotia to receive coverage for any medically necessary treatments, rehabilitation costs and loss of income during periods of injury and recovery when they are unable to work. In an earlier blog post – we covered Section B Benefits and how can they help after you or a loved one have been involved in an accident.
Injured persons are eligible to receive up to $50,000 in coverage for medical and rehabilitation costs in the four years following an accident. Common medical rehabilitation treatments following a car accident include physiotherapy, chiropractic sessions and massage therapy. However, Section B benefits may cover any treatment your family doctor deems medically necessary for your recovery, including counselling, strength-training exercise programs, medical aids and prescription medications. Coverage typically includes ambulance bills, home modifications to accommodate disability, and travel and mileage expenses incurred during treatments or doctor’s appointments.
Income replacement payments – also called Weekly Indemnity benefits – cover 80 percent of an eligible accident victim’s lost net earnings to a maximum of $250 per week. This benefit continues for up to two years following an accident if a disability prevents you from returning to your job following an accident. After two years, if you cannot perform essential duties that permit you to return to any job for which you are qualified based on education, training and experience, the benefit will continue indefinitely. This designation can be much harder to obtain.
If an injured person is the principal unpaid housekeeper in their home and unable to fulfill their usual obligations, Section B benefits may also provide $100 per week for up to 52 weeks for housekeeping. In the event of a death resulting from injuries sustained in the car accident, Section B benefits provide $2,500 in funeral expenses, $25,000 in death benefits for the head of household or their spouse, and $5,000 in death benefits for dependents.
How do Section B benefits work in Nova Scotia?
If you were injured in a motor vehicle accident and require Section B benefits, you should not delay applying for Schedule B benefits and must apply promptly in accordance with the automobile policy in which you were a driver or passenger, and provincial regulations. If you were a cyclist or pedestrian who sustained an injury in the accident, you must apply for Section B benefits through the insurer or the “striking” vehicle or through your own automobile insurance provider if the driver is unknown.
The Section B insurer you contact will provide a form called the Accident Benefits Notice of Claim that you must complete and return promptly in order to begin receiving benefit payments and reimbursements for expenses. A Medical Form completed by your family doctor and an Employer’s Confirmation of Income and Benefits Payments Form completed by your employer must also be returned before you are able to receive payments. Section B insurers must make payments to reimburse you for expenses within 30 days upon receiving documentation.
To avoid unnecessary delays in receiving your Section B benefits, you should:
- ensure all forms are completed and returned as soon as possible;
- submit original documents to insurers and retain copies for your records;
- ask your doctor to note “motor vehicle accident” on any referral documents; and
- check with your private health insurance provider before submitting expenses to the Section B insurer. (This also allows you to get the most out of your benefits).
If you are missing work due to your injuries, you should also ask your doctor to estimate the date you will return to work or note when you will be returning to the doctor for reassessment. You must also apply for short-term disability benefits from your private insurer and/or Employment Insurance sickness benefits before you can access Section B income replacements.
What are treatment protocols?
In order to expedite treatment of common minor injuries from car accidents, Nova Scotia introduced the Diagnostic and Treatment Protocols for Minor Injuries. Accident victims with injuries that include Whiplash Associated Disorder I or II, or muscle sprains or strains have the option to seek immediate physiotherapy or chiropractic treatment without approval from the Section B insurer. They could also opt to use the normal Section B procedure.
If your injuries fall within the established protocols, the medical practitioner treating you will bill the Section B insurer directly. The number of treatments you are allowed under the protocols depends on the severity of your injuries; a first or second degree sprain or strain or Whiplash I diagnosis provides up to 10 treatments, while a third degree sprain or strain or Whiplash II diagnosis provides up to 21 treatments according to the protocols. These treatments must be completed within 90 days of the date of the accident and you normally have 10 days from the date of the accident to fill out the necessary documents .
What if I haven’t recovered after receiving treatment under the protocols?
Once your protocol treatments have been exhausted, you may still qualify for Section B benefits to cover additional treatments. In these cases, you must be reassessed by an injury management consultant (doctor, physiotherapist or chiropractor). They will need to explain why further treatments are still medically necessary.
How can Preszler Law help me with Section B Benefits?
In an ideal world, victims of accidents would always receive the benefits they are due in a timely manner and without any disruption. Unfortunately, insurance companies may deny or delay Section B benefits for a variety of reasons – and not all of them are fair or just.
A Section B insurance adjuster working on your file should be able to explain why your claim has been denied or delayed based on their policies. If you disagree with their assessment – particularly if your family doctor believes you require treatment – Preszler Law can examine your claim and help determine if you have a case. Certain benefit categories, such as the unpaid housekeeping benefit, are also fact specific; to access these benefits you may need to consult an experienced lawyer who knows what evidence is needed to build a strong case.
Sometimes an injured person will initially receive Section B benefits from an insurance provider on the basis of their family doctor’s recommendation; however, at any point during treatment the insurer may request an “independent medical exam” (IME). If a patient fails to attend this exam it constitutes breach of contract.
The insurer will choose a doctor to perform a one-time assessment based on a physical exam and review of your medical history. If this doctor determines you have recovered sufficiently, they can report to the insurer that you are no longer in need of treatment or other benefits; the insurer can immediately cease benefit payments. Given the importance of these IMEs, it’s often worth consulting a lawyer prior to the appointment to help you prepare. Preszler Injury Lawyers can explain what type of information you should bring with you to the appointment and offer tips on how to create a record of the exam in case you need it later. For example, bringing a friend or family member to witness the exam and writing down the questions you were asked can be useful if you need to challenge the IME report.
You may feel disheartened and defeated if you learn your benefits are being cut-off – particularly if you are still coping with the pain and disability brought about by injury or if you’re worried about your financial well-being if you still need treatments and/or cannot return to work. As your trusted advocate, Preszler Law can help you fight to reverse this decision by preparing rebuttal opinions from your doctor or other specialists to encourage the insurer to think twice about whether their IME will stand up in court.
When an injured person or their loved ones confront an insurance provider it can seem like a battle between David and Goliath. With Preszler Law on your side, we can help you to level the playing field and seek the benefits you deserve.
Section B benefits are an important part of an accident victim’s plan for rehabilitation and recovery; however, they are not your only avenue to access benefits and compensation for your pain and suffering. As a full service personal injury firm, Preszler Law is ready to work with you as you navigate the complicated world of insurance and tort claims. We not only help you access accident benefits for vital health care and treatment but also help you maximize any financial compensation you deserve for your accident injuries.
When applying for your benefits, be sure to contact your doctor, a treatment provider, and Preszler Injury Lawyers for a FREE initial consultation.
Contact us today to book your free conusltation with an injury lawyer who can advise you on Section B Benefits.