If you are injured in a motor vehicle accident in Alberta, you are likely entitled to no-fault treatment and disability benefits commonly referred to as your “Section B” policy (as such coverage is found under Section B of your standard automobile insurance policy). These benefits are available to you regardless of who caused the accident.
Who is Responsible for Providing Coverage?
Typically, the automobile insurer of the motor vehicle you were an occupant (i.e. as a driver or passenger) is responsible for providing Section B benefits to you. However, if you were a pedestrian or cyclist, the automobile insurer of the motor vehicle that struck you is responsible for providing such benefits to you.
How Do I Access My Benefits?
To access your treatment benefits, it is advisable to see your Primary Health Care Practitioner (usually a physiotherapist, chiropractor, or physician) as soon as possible. It is important that you truthfully report all your symptoms so your Primary Health Care Practitioner can properly assess and treat your injuries. Your Primary Health Care Practitioner will subsequently complete a Treatment Plan (Form AB-2)and submit it to your automobile insurer for approval. You must also complete a Notice of Loss and Proof of Claim (Form AB-1) and submit it to your automobile insurer. If your injury is diagnosed as a sprain, strain, or whiplash associated disorder grade I or II, you should submit this form within 10 days of the accident. If you have other types of injuries or choose not to access the accident benefits described as the Diagnostic and Treatment Protocols (see below), you should submit this form within 30 days of the accident.
To access your disability benefits, you need to visit your attending physician in order to complete a Claim for Disability (Form AB-1A). Thereafter, you are required to submit this form to your automobile insurer.
After being notified of the accident, your automobile insurer should provide you with the appropriate forms to be completed. However, these forms can also be easily found online.
What Treatment Coverage Am I Entitled To?
Section B provides treatment coverage for “all reasonable expenses” incurred within two (2) years from the date of the accident to the limit of $50,000 per person. This includes “necessary” medical, surgical, chiropractic, dental, hospital, psychological, physical therapy, occupational therapy, massage therapy, acupuncture, professional nursing, and ambulance services; and, in addition, for other services and supplies that are, in the opinion of your attending physician and your automobile insurer’s medical advisor, “essential” for treatment or rehabilitation. However, out-of-protocol (see below) expenses payable in respect to chiropractic services are limited to $750, and massage therapy and acupuncture services are limited to $250 each.
If your injury is initially diagnosed as a sprain, strain, or whiplash associated disorder grade I or II, you may choose to be treated in accordance with the Diagnostic and Treatment Protocols. If so, your automobile insurer will authorize 10 or 21 treatment visits (depending on the specific diagnosis) with direct billing (ie. your automobile insurer will directly pay your treatment provider for such treatment). After you have completed such treatment, but still require ongoing care, you may be treated outside of such protocols (see below).
Other types of injuries including whiplash associated disorder grade III or IV are treated outside of the Diagnostic and Treatment Protocols. In such circumstances, you must first submit your receipts to your extended healthcare provider(s) for reimbursement. If you do not have or have exhausted your extended healthcare benefits, you may submit your receipts to your automobile insurer for reimbursement of any outstanding amounts.
What Disability Benefits are Available?
If you are wholly and continuously disabled whereby within sixty (60) days from the date of the accident “such injury prevents you from performing any and every duty pertaining to your occupation or employment”, you may be entitled to a maximum weekly disability benefit of $400 after seven (7) days of such disability for up to 104 weeks.
If you are not working at the time of the accident, but are completely incapacitated and unable to perform any of your household duties, you may be entitled to receive $135 per week for not more than 26 weeks.