Navigating Section B Medical Benefits
Every car accident injury victim in Nova Scotia is entitled to certain insurance benefits regardless of who was at fault. This blog post is intended to answer some common questions about section B medical benefits.
Nova Scotia has a standard form automobile insurance policy. The basics of this policy apply to every insured driver in Nova Scotia. Under section B of this standard policy you are entitled to up to $50,000.00 in medical expense coverage if you are injured in a car accident, even if you’re the one at fault. This medical benefit coverage lasts for up to 4 years (private insurance will need to be accessed if your medical or treatment expenses go beyond 4 years, or over $50,000). If someone else is at fault for the accident that caused your injuries, you can bring a claim against that person’s insurance for medical costs over and above what is covered by your section B policy.
What is Section B?
Benefits that are described in Section B of the standard automobile policy of Nova Scotia. Generally, such benefits will help cover the immediate needs of someone injured in a car accident. There is no need to prove that anyone was in the wrong in order to access these benefits. Section B benefits can include coverage for all medical expenses that you have as a result of the car accident.
Section B benefits can include:
- Medical Costs
- Medical Equipment
- Rehabilitation Costs
- Loss of income
- Death and funeral expenses
- Nursing care (including dressing changes)
- Prescription drugs
- Physiotherapy
- Medical and/or rehabilitation equipment (such as neck braces, crutches, wheelchair)
- Monthly income replacement benefit (up to a maximum of $250/week); including weekly compensation for injured homemakers
How do I access my Section B benefits?
You, or your personal injury lawyer, should contact your insurance company or the company linked to the vehicle involved in your accident. They will give you information about your eligibility and provide you with documents to complete in order to access these benefits.
When should I apply?
If you’re injured in a car accident, you should contact your insurance company and open a claim as soon as possible. Generally, a Section B claim should be opened within 30 days of the date of the accident; however this is usually not a strict deadline. If you are admitted to hospital because of a car accident and think you will need medical benefits upon your release, you should not wait until after you are discharged home from hospital before contacting your insurance company.
What are “the treatment protocols” all about?
The treatment protocols are intended to create a simplified, streamlined process by which injured car accident victims can access medical treatment. They are optional if you have been diagnosed with a car accident related sprain, strain or whiplash associated disorder (WAD) injury grades I or II.
If you have been diagnosed with any of the above, you have the choice on whether to receive medical benefits through the treatment protocols or through the traditional Automobile Section B Policy.
The treatment protocols are more “user friendly”. Your primary health care provider (chiropractor, physiotherapist or medical doctor) may bill your insurance company directly for treatment. Unlike the traditional route, you do not need to access any private insurance immediately to pay for this treatment.
Importantly, coverage for treatment under the protocols expires 90 days from the date of the accident. It is therefore important that you attend to your family doctor and discuss treatment options as soon as possible after the accident. Generally, you need to complete certain documents within 10 days of the car accident.
You are entitled to a pre-set number of treatments if you proceed under the protocols. This number depends on the diagnosis made by your main health care practitioner (usually your family doctor). A 1st or 2nd degree strain or sprain allows injured persons 10 treatments, while a 3rd degree diagnosis allows for a maximum of 21 treatments. The same allotment applies for Whiplash I (10 treatments) and Whiplash II (21 treatments). Again, all of these treatments must be completed within 90 days of the date of the accident. The treatments are paid for directly by the insurance company and the insured person does not have to pay out of pocket or process it through their private insurance policy.
What if I haven’t recovered after receiving treatment under the treatment protocols?
If you have completed your pre-set treatments but your injury remains, you may be seen by an injury management consultant (approved doctors, chiropractors and physical therapists) who can offer a second opinion to the originating health care practitioner. In the event that you continue to suffer from injuries after exhausting all the benefits under the treatment protocols, you may be able to access the usual Section B benefits. A lot will depend on the recommendations you receive from your health care providers.
