“If you’ve been involved in a motor vehicle accident then we will make sure you access the accident benefits from your own insurance company.”
Entirely apart from any claim that you may have based upon the liability of the driver or drivers involved in this accident, you may also be eligible for certain Benefits (called Section B or Accident Benefits), from the insurance company of the vehicle in which you were driving or were a passenger. If you were a pedestrian or cyclist who was struck by a motor vehicle, these Benefits are also available to you from the company that insures the vehicle that struck you.
You can apply for, and obtain payment of these Benefits without the assistance of a lawyer. However we will generally assist you in obtaining all of your Accident Benefits. You must apply as soon as possible, and in any event, no later than one year after the accident, failing which, you will be statute-barred, and unable to affect recovery thereafter. Accident Benefits include such items as lost income and medical expenses (including ambulance bills, physiotherapy charges, chiropractic fees, and medication).
TREATING MAJOR INJURIES
Medical and rehabilitation Accident Benefits have been increased from $10,000 to $50,000 to improve access to care and treatment. Several components of Accident Benefits have also now been pre-approved for treatments for more serious injuries.
You do not need a referral from a doctor or your insurance company’s approval to obtain initial access these benefits if you are seeking treatment related to your collision, though the pre-approval is subject to dollar limits.
If you require services beyond the dollar value set out, the services are available if you physician feels that they are necessary for your treatment. Your insurer can request a medical assessment prior to further treatment:
- Chiropractic services (maximum $750 per person)
- Psychological services ($600 per person)
- Physical therapy ($600 per person)
- Occupational therapy ($600 per person)
- Massage or acupuncture therapy (maximum $250 each per person)
- Grief counseling ($400 per family)
TREATING MINOR INJURIES
People who suffer sprains, strains and minor whiplash injuries (as defined in the regulations) can access 12 weeks of therapy. If treatment is required for more than 12 weeks, it would be available, however the insurer will likely request a medical assessment to make a determination.
Patients who are being helped through this new treatment process do not need prior approval from insurance companies to begin treatment, and they will not pay out-of-pocket for the treatments. The treatments are pre-approved, and care-providers directly bill the insurance companies.
Patients can choose their preferred medical doctor, chiropractor, or physiotherapist as their primary health care practitioner. The primary practitioner will diagnose the injury according to the diagnostic protocols, instruct the client in the treatment process, and follow the client’s therapy.
The primary health care practitioner will also provide the insurer with documentation of the diagnosis, planned treatment, and expected outcomes with the patient’s consent.
For a detailed description of the course of treatment under the regulation click here.
INJURY MANAGEMENT CONSULTANT
If recovery is not progressing as quickly as expected, the client would be referred by their insurance company to an Injury Management Consultant for further advice and treatment.
Injuries that have not resolved 12 weeks after the accident could also be referred to an Injury Management Consultant by the patient’s health practitioner. An Injury Management Consultant will be specially qualified and identified by the Colleges of Physicians and Surgeons, Chiropractors, and Physical Therapists of Alberta.
The consultant would provide an independent evaluation and consult on the original diagnosis, and the treatment and evaluation. The consultant can also recommend further therapy, or further evaluation.
Educating the injured person about how best to speed recovery is an important aspect of the new diagnostic and treatment process. Education would include encouraging early return to usual activities and work, explaining the nature and probable length of symptoms, reassuring the client of the injury’s nature, and advising how best to care for themselves.
AFTER 12 WEEKS
Following 12 weeks of therapy under the treatment protocols, sprain, strain or minor whiplash injuries that have not resolved would continue to be treated and covered by your Accident Benefits or compensation from the wrongdoer.