Accident Benefits Claims — Owen Sound

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A car accident generally triggers two types of claims: one against the “at fault” driver and a second against your own insurer for accident benefits. If you don’t have insurance yourself, the accident benefits would be paid by whatever insurance company is most closely connected to you in the accident (your parent’s insurer or the other driver’s, for instance).

No matter whose fault the accident is, the accident benefits insurer must pay some of the following kinds of benefits:

• Income Replacement Benefits (IRB)

• Non-Earner Benefits (NEB)

• Caregiver Benefits

• Medical Benefits

• Housekeeping Benefits

• Rehabilitation Benefits

• Loss of Education Benefits

• Attendant Care Benefits

• Travel Expenses for Family

• Death Benefits

• Funeral Benefits

Some of these benefits are payable only rarely. For instance, only if you have purchased enhanced insurance can you receive caregiver and housekeeping benefits. And if you have breached a relevant law (example: driving without insurance), you will not be entitled to income loss or non earner benefits.

These benefits are capped at a certain amount, and they are usually time limited. There are also a variety of factors that influence a potential car accident settlement and how it may ultimately be reached.

There are three categories of injuries (minor, catastrophic and everything in between) which determine how much and for how long the benefits might be paid. We may not agree with the insurer as to what is necessary. In such cases, we dispute the benefit through a formal arbitration process. Let’s review a number of these benefits. 

 

Income Replacement Benefits and Non Earner Benefits (IRB) 

IRB benefits are in place to supplement the income which you were receiving at the time of the accident. No benefits are paid for the first 7 days following the accident. Income replacement benefits pay a maximum of $400.00 weekly to replace the income that you were receiving before the accident. This may not be much if you were a high earner, but it is something. If you did not earn income pre-accident, then the non-earner benefit is available if your injury is causing a complete inability to engage in daily life.

 

Medical and Rehabilitative Benefits

Your accident benefits provider is responsible to pay for medical and rehabilitative treatment which is “reasonable and necessary”. If you have private or collateral coverage (through your own or your spouse’s work benefits) then you must first exhaust those benefits and then seek for the costs of additional treatment to be paid for by your accident benefits provider.

 

Kinds of Med-Rehab Benefits

Medical and rehabilitative benefits can cover pay for such things as:

• chiropractic care

• massage therapy

• physiotherapy

• prescription drugs

• vocational therapy

• occupational therapy

• tutoring

• counselling

 

Attendant Care Benefits

If the injury which you sustained is so restrictive and impairs you so significantly that you cannot carry out your own personal care (or you require supervision for safety) then you may be entitled to attendant care benefits.

These benefits, aimed at covering day-to-day expenses such as housekeeping and common errands, are very difficult to access and are not available if a loved one provides the care – unless that loved one has given up their job to provide the care. Similar to Medical Rehabilitative Benefits, attendant care benefits only cover expenses that can be deemed “reasonable and necessary”. To better understand what expenses qualify as reasonable and necessary when seeking medical, rehabilitative or attendant care benefits, read this article.

 

Catastrophic Determination

We are entitled to make an application to the insurer if we suspect a catastrophic injury has been suffered. Catastrophic injury is a narrow legally defined term. It requires proof of a very serious brain injury, massive orthopedic injuries or, in rare cases, psychiatric disability. Those who are found to be catastrophically injured can be entitled to up to $1,000,000 in combined med/rehab and attendant care benefits over the course of their lifetime. For older accidents, this value can reach up to 2 million dollars.

 

Travel Expense for Family Members

If you or someone you know in Collingwood, Owen Sound or Port Elgin is injured in a MVA, certain costs will be incurred by family members who need to travel to be with the injured person while they are in hospital. These expenses should be submitted in a clear manner to the insurance company using OCF-6 Application for Expenses. The items should be clearly described in order to ensure they can be processed efficiently.

 

Some Practical Advice

When you claim is denied by your insurer it can be very frustrating. Similarly, so can an insistence on paperwork. But remember that your adjuster is a person just like you on the other end of the line. Please give him or her time to return your calls and deal with them respectfully. It will pay dividends. You have the right to dispute every single decision your insurance company makes. Our team routinely disputes denials.

 

Lumping out your Accident Benefit Claim

What is a lump out? Sometimes an insurance company will be open to the option of ‘lumping out’ the entire file. This means that the insurance company will agree to pay a one time lump sum and in exchange for such you will sign off on your future rights to access future benefits. No more treatment plans to complete. No more insurance company sponsored doctors to meet with. No more denials. No more arguments with the insurance company. We do not have a crystal ball and we can not see into the future to know whether your injuries will deteriorate or improve. If you lump out, then you are no longer able to apply for any benefits, no matter if your condition worsens. Still, in many cases it is possible after a year or so to make an intelligent guess about your future and to negotiate a fair deal.

 

 

What will be the amount?

Clearly we will negotiate the most possible. That said, it all depends on how many benefits you are entitled to and how much has been paid out to date. If you have, for instance, used very few benefits in the first year following the accident, it will be that much more difficult to negotiate a high settlement. In accident benefit cases the work can be substantial. An accident benefits file must be audited to ensure appropriate benefits have been applied for and received. Quite frequently the work completed to obtain benefits is substantial and that time will never be billed for by our firm.

 

Legal Costs

Once we negotiate a lump out, we render an account based on 30% of the total compensation on what we collect, plus HST and out of pocket monies being reimbursed. For more information on the subject of how we, as a firm, get paid, check out this brief video.

 

Concluding Comment

It takes hard, dedicated work to press for maximum accident benefits. We get results because we are well known in the industry. When dealing with the team at Tamming Law, you are dealing with people who, by virtue of ongoing training and hundreds of AB files per year, are on the cutting edge of accident benefit developments. We know how large the envelope can be expanded. We look forward to assisting you in obtaining all of the income replacement and rehabilitation benefits to which you are entitled.