After an accident, everything can be a blur. An injured party may immediately require medical treatment, and the thought of incurring significant interim expenses can be stressful. However, that is where Section B benefits, or “Accident Benefits,” kick in. Section B benefits are available to individuals in order to help provide some financial relief to cover certain prescribed medical treatments, disability, and death, after an accident.
Section B benefits are a mandatory component of the standard insurance policy in Alberta, under “Section B“. These benefits are considered “no-fault” benefits, meaning that eligibility to receive these benefits is not determined by whether the party caused the accident or not. These benefits are also available to an individual even if the other party involved in the accident is uninsured. The primary purpose of Section B benefits is to help ensure that injured individuals can immediately access treatment to help them focus on their recovery without experiencing a significant financial strain or waiting for the outcome of their personal injury claim.
Eligibility for Section B Benefits
Section B benefits are available to anyone involved in an accident. Aside from the insured driver, the driver’s child or spouse, another passenger in the vehicle, or a pedestrian struck by a vehicle may also be eligible to claim these benefits.
Individuals who were not in their own vehicle at the time of an accident, or were uninsured at the time of the accident, may be eligible to claim Section B benefits through another driver’s insurance, depending on the circumstances.
A pedestrian or cyclist who was struck and injured by a vehicle must apply for Section B benefits through the insurance of the vehicle that struck them or through their own automobile insurance if the driver is unknown. Even if an accident occurs outside of Alberta, individuals may still be eligible for Section B benefits.
What Do Section B Benefits Cover?
Section B benefits provide a variety of coverage for medical benefits, disability benefits, and death benefits to individuals injured in car accidents.
Section B benefits are most often used to cover an injured party’s medical treatment and rehabilitation expenses. Uninsured medical treatment such as physiotherapy, massage therapy and chiropractic care are all eligible to be covered by Section B. Additional expenses such as dental treatment, medication, exercise program, and counselling services may also be eligible for coverage.
There is a total limit to the amount of coverage available to each individual involved in the accident, and certain types of treatment may also have a prescribed coverage limit. Generally, the amount of benefits depends on the extent of the injuries and the appropriate treatments for recovery. The Section B insurer will coordinate treatments and coverage with the injured party’s treatment providers. It will often rely on progress reports and treating physician reports to provide an analysis of an individual’s recovery prognosis to help determine their ongoing benefit coverage entitlement.
Section B benefits provide medical coverage for up to two years following the date of the accident, with a maximum of $50,000 in medical coverage, whichever expires first. After the initial injury diagnosis, the initial treatments which occur under protocol will be covered by direct billing. Afterwards, it is likely that the individual will be required to pay for these treatments upfront and will subsequently be reimbursed by the insurer; therefore, it is important to keep all recipes and treatment records.
Disability/Income Replacement Benefits
An injured party may not be able to work following an accident. Therefore they may seek disability benefits through Section B. These limited disability benefits can act as a temporary income replacement which can provide an individual who is “wholly and continuously” disabled with a weekly benefit being the lesser of either $600 or 80% of their average gross weekly earnings. In order to be eligible for disability benefits, the disability may need to be certified by a qualified medical practitioner. Under the Income Tax Act, income replacement benefits are not considered taxable income.
It is important to note that an individual applying for disability benefits through Section B must have either been employed at the time of the accident or worked for the minimum required time during the year leading up to the accident. Individuals are unable to claim disability benefits for the first seven days after the date of disability, and if approved, payments will not exceed 104 weeks.
Individuals 18 years of age or older who are not employed but are incapacitated insofar as they are unable to perform their daily household activities may be eligible to receive $200 per week for up to 104 weeks to cover housekeeping expenses.
If an individual loses a loved one as a result of a motor vehicle accident, Section B benefits may be payable to a survivor. The death benefit amount will depend on the deceased’s age and household status at the date of the accident. Additionally, Section B benefits will cover funeral expenses of up to $6,150 for the death of one person and grief counselling expenses of up to $500 per family member.
The Process of Applying for Section B Benefits
An injured party must comply with several important deadlines and forms when making a claim for Section B benefits. First, the individual must notify their insurance company within 30 days of the accident. Depending on the benefits sought, that person must complete either a Notice of Loss and Proof of Claim Form (AB-1 Form) or a Claim for Disability Benefits Form (AB-1A Form) within 90 days. As a claim progresses, the Section B insurer will provide the party with the necessary forms for both the individual and their treatment team to complete and return to the insurer.
Complexities can arise for a variety of reasons, such as a deadline being missed, treatments not being followed, or a claim being deemed to be capped by the insurer, making Section B benefits appear less accessible. Speaking with a personal injury lawyer is important to obtain guidance on your unique circumstances and benefit entitlements.
Contact Personal Injury Lawyers at Cuming & Gillespie in Calgary for Assistance with Section B Benefits
The personal injury lawyers at Cuming & Gillespie represent those injured in a motor vehicle or pedestrian accident. Our experienced and knowledgeable lawyers are committed to helping clients obtain fair and necessary compensation after an accident to help them rebuild their lives. Located in downtown Calgary, our office proudly serves clients throughout Alberta. If you or a loved one have been injured in an accident and have questions regarding the benefits you may be entitled to, please contact us online or call us at 403-571-0555.