While you may already know that the at-fault driver’s insurance company should eventually pay you for the damages caused by their negligent driver, you may not know that other insurance benefits are available to help you recover.
Section B is one of those sets of benefits. They come from your own automobile policy and are a standard part of every legal insurance policy sold here in the province. These benefits are guaranteed by the Alberta Automobile Accident Insurance Benefits regulations and so work basically the same way from policy to policy.
What do section B benefits cover?
Section B benefits are used for medical treatment costs, and will often pay medical costs that your personal injury settlement doesn’t cover, or will cover costs before your settlement gets paid.
Section B can also cover limited disability coverage. This means you’ll get some percentage of your weekly wage up to the preset limit (80% of your wages to a maximum of $600 a week) if you are unable to work while recovering from your accident. Note that the other benefits you might be eligible for are factored into this payment. For example, if you have group accident insurance and disability insurance then they will factor these payments in and reduce your Section B disability payment accordingly.
Section B covers $50,000 in medical coverage per person injured in the accident. This means if four people get injured in the accident each of them can access $50,000 in Section B benefits.
If the accident resulted in the wrongful death of your loved one Section B can provide some coverage for up to $6150 in funeral expenses and up to $500 per family for grief counseling, as well as an additional benefit amount based on the age of the deceased and their relationship to the claimant. The death of the family breadwinner, for example, would result in a larger death benefit payout than the death of a child, because it is recognized that the loss of the head of household has a severe economic impact on the family.
How do I qualify for Section B disability and medical benefits in Alberta?
Section B benefits are “no-fault” benefits, which means you can make a claim against these benefits regardless of how your accident actually occurred. This means you don’t have to wait for a determination of fault to claim them, don’t need to worry about contributory negligence derailing them, and that they are not contingent upon how your personal injury case resolves itself.
The accident may even take place outside of Alberta or when you are a pedestrian.
You qualify if you were:
- Injured in an automobile, truck, motorcycle, bicycle, bus, or pedestrian accident.
- You have an insurance policy that includes Section B benefits.
- You were employed at the time of your accident, or you were at least 18 years old and actively employed for 6 out of the 12 months preceding your accident (for disability benefits only).
- Your injuries must keep you from performing all the duties of your job within sixty days from the date of the accident (disability only).
- The Section B medical provider must usually certify that you are “wholly and continuously disabled” as a result of your automobile accident (disability only).
Some of these requirements can get quite complicated. For example, you can’t claim benefits for the first 7 days of your disability, which means you’ll lose a week’s pay no matter what. You can get that amount back through your personal injury settlement, but this unfortunate policy may still cause a hitch in your ability to pay your bills.
These costs can include:
- Ambulance bills.
- Dental treatment.
- Chiropractic care.
- Massage therapy.
- Acupuncture therapy.
- Medication.
- Diagnostic imaging.
- Laboratory testing.
- Specialized testing.
- Surgery.
- Physical therapy.
- Medical supplies.
- Psychological care.
- Medically necessary home modifications.
- Medically necessary vehicle modifications.
Some of these costs are limited. For example, you can only receive up to $1000 in chiropractic care coverage, only $350 for massage therapy services, and only $350 for acupuncture services. In addition, you should expect that your insurance company will send you to the medical providers of their choice, rather than the provider you might usually see.
These benefits give you the opportunity to access treatment and to continue paying your bills quickly. Alberta law is well aware of the fact that personal injury cases can take up to 18 months to resolve.
Can self-employed people receive Section B benefits?
This is a complex area of the law.
To receive Section B benefits, the independent contractor, freelancer, or business owner must prove that they were “actively engaged in an occupation, for-profit,” at the date of the accident or for six months in the 12 months proceeding the accident.
This means the business owner:
- Earned profits over and above the cost of running the business (even if they work from home).
- Been compensated in cash, so that the Section B disability compensation amount may be properly calculated.
- Section B uses your tax returns to determine what your average weekly earnings look like for the purposes of calculating a disability benefit.
Why must a self-employed person earn profits? Simply put, if you weren’t earning profits you don’t have any actual loss for the insurance to compensate. Disability insurance never functions as a windfall, merely a replacement of what you lost due to the fact that the accident has taken place.
This can be a tough problem for self-employed individuals, who may need to be up, about, and working to keep their business functional, but who may lose the ability to do so as a result of their accident. These sorts of losses may need to be addressed by their lawyers as they seek to put together an injury settlement with the at-fault driver’s insurance company.
Will my insurance rates go up after using Section B benefits?
No. Using these benefits does not count as a “claim” in your insurance history, which means your insurance company is not permitted to raise your rates just because you make this claim.
What is the deadline for applying for Section B benefits?
All parts of your personal injury case will include deadlines you’ll have to pay attention to, and your Section B benefits are no exception. You must notify your Section B carrier within thirty days of the accident unless you’re in a coma or have some other extenuating circumstance.
You have 90 days to complete a Claim for Disability Benefits.
All benefits end within two years after the accident, which is the same statute of limitations you’re operating under when you are dealing with your personal injury case.
Note that you may want to get your lawyer’s help making your Section B claim. Your Section B insurer is like any other insurance company. They remain profitable by denying as many claims as possible. Working with your personal injury lawyer to get these forms filled out and taken care of correctly can help ensure that your claim is approved and that your benefits flow to you in a timely fashion.
How do section B benefits intersect with your personal injury case?
Your Section B benefits will usually pay out long before you receive your personal injury settlement.
Nevertheless, getting those benefits isn’t always easy. At times the application process is confusing. At times the Section B insurer looks for reasons to deny benefits, or to pay fewer benefits than they’re contracted to pay.
It is wise to have your personal injury lawyer deal with the Section B insurer just as it is wise to have them deal with the at-fault driver’s insurance company.
Does Section B cover property damage?
Section B does not cover the damage sustained to your vehicle. That requires the optional Section C coverage, which comes in several parts.
Collision coverage pays for vehicle repair or replacement.
Specified perils cover fire, theft, and storm damage, while comprehensive and all perils coverage covers the vehicle against other threats.
You’ll usually choose this coverage when you purchase your insurance policy. It will come with a deductible which you’ll have to pay before insurance will pay the claim. Usually, you’ll recover that deductible as part of your personal injury settlement. If you’ve been in an at-fault accident your lawyer may be able to get your insurance company to waive the deductible, as they know they’ll be able to recover any payouts they make from the at-fault party’s insurer. Speak to your lawyer to get help with this.
What is SEF 44 coverage?
SEF 44 Family Protection is an important part of your policy that you usually have to opt-out of. We recommend that you go ahead and keep this coverage because it can be incredibly helpful in the event that you are injured by an uninsured or underinsured motorist.
While you can recover from the Alberta Motor Vehicle Accidents Claims program, they only compensate you up to $200,000. In the event that $200,000 is not enough to cover your losses the SEF 44 protection kicks in to pay the difference on your losses.
What can I do when Section B disability coverage runs out?
You’ll only have access to Section B disability benefits for two years. After the two-year period, the benefits run out, even if you can’t work.
You’ll have a few options at that point, options you can often claim for regular monthly income even if you receive a personal injury settlement.
Option #1 is your employment insurance’s disability benefits. Option #2 is the Canada Pension Plan disability benefits.
For most Alberta residents Option 3, the Assured Income for the Severely Handicapped (AISH) may be the course of the best resort. This program pays you a monthly living allowance, covers medical and dental care, and provides other benefits as well. There are also specific provisions in AISH regulations that discuss how you can handle a personal injury settlement without losing your benefits.
Note that if you’ve truly lost the ability to work your settlement should also include an amount known as a “loss of earning capacity” amount. This amount would take the number of working years you would have been expected to work if you hadn’t been in the accident and multiplies them by the amount of salary you would have been expected to receive during those years.
This amount can be somewhat subjective, as it’s difficult to say what promotions or advancements would have been available to any given worker, as well as how much longer any given worker would have worked. It’s one reason why it’s so important to have a savvy negotiator on your case. You need someone who can make a good argument for a truly helpful and reasonable amount.
Most individuals who have been completely disabled after their accident may need to combine some of these benefits and amounts to make ends meet after their accident. It’s important to know, understand, and explore all of your options so you can live as comfortably as possible after your injury.
Need help with your personal injury case?
Do you want a firm that will help you deal both with your own insurance company and the at-fault driver’s company?
Do you want a firm that cares about you enough to help you navigate the labyrinthine process behind disability benefits?
Work with our team. We have decades of experience helping Edmonton residents navigate their personal injury cases and take on the insurance companies. We’re responsive, caring, and dedicated to protecting you and your best interests.
Calling us is risk-free. We don’t get paid until we bring your case to a successful conclusion. Our contingency fees are fair and reasonable. With our help, you’ll obtain far more compensation than you would have obtained on your own, even after those fees are accounted for.
Set up your first appointment today. Call (780) 413-9777 to get started. You don’t have to do this alone.
