This article is a general overview of Section B benefits in Alberta, and is not a substitute for high-quality legal advice from the experienced personal injury lawyers at Litwiniuk & Company. The law is complex, there are exceptions to the rules, and every automobile accident is different. If you have been injured in an automobile accident, we are here to help. Call or email us now; there may be very important deadlines that you cannot afford to miss.
Introduction to Section B Benefits in Alberta
In Alberta, Section B Benefits are insurance benefits for people who are injured in automobile accidents, or who have loved ones who were injured or killed in automobile accidents. Automobile insurance companies often refer to them simply as Accident Benefits, but because they come from Section B of the Alberta Standard Automobile Policy, they are commonly known as Section B Benefits. By law, every Alberta automobile insurance policy must contain a Section B clause.
Section B benefits are known as “no-fault” benefits, meaning that your right to claim them does not depend on whether or not you were at fault for the automobile accident that caused your injuries. These benefits cover certain expenses related to medical treatments, disability, and death. They are contractual, meaning that the owner of an Alberta automobile insurance policy had paid for Section B Benefits as part of his or her insurance premiums.
If you have an Alberta automobile insurance policy, and were injured in an automobile accident (car, truck, motorcycle, etc.), you are entitled to Section B Benefits. Your own automobile insurance company will typically, but not always, be the source of these benefits. Here are some accident scenarios that show which insurance company will pay these benefits:
Example 1 – The Typical Situation.
You are stopped at a red light and are rear-ended by another driver. Both of you are injured, and both of you have Alberta automobile insurance. In this scenario, you can claim Section B Benefits from your insurer, and the other driver can claim Section B Benefits from his insurer.
Example 2 – The Pedestrian.
You are jaywalking across a busy road and are hit by a car with Alberta insurance. You can claim Section B Benefits from the driver’s insurance company, regardless of who was at fault for the accident.
Example 3 – No Insurance.
You are driving an automobile with no insurance and are hit by a driver who ran a red light. You have no insurance coverage and therefore no coverage for Section B Benefits. You may still be entitled to Section B coverage through other means; please call or email us for more information.
Example 4 – The Passenger.
You are a passenger in an Alberta-insured car turning left at an intersection. When the driver makes her left turn, she is hit by an oncoming car. You can claim Section B Benefits through your driver’s insurance company.
Example 5 – The Bus.
You are on a Calgary city bus, and the bus is involved in an accident. Regardless of who was at fault for the accident, if you were injured in the accident you can claim Section B Benefits through the City of Calgary.
There are many other scenarios where you may be entitled to Section B benefits. Even if the accident happened outside of Alberta, or if none of the vehicles involved in the accident are insured in Alberta, you may still be entitled to claim Section B benefits. If you have any questions about your entitlement to Section B benefits, call or email us now.
What Do Section B Benefits Cover?
Broadly speaking, Section B Benefits cover the expenses of certain medical treatments required to treat injuries caused by an automobile accident, and provide limited disability coverage if you are unable to work because of an automobile accident. The idea is that accident victims can quickly and easily access treatment without having to pursue or wait for the outcome of a personal injury claim.
Section B Medical Benefits may cover some costs such as an ambulance ride, acupuncture, dental treatment, chiropractic treatment, massage therapy, medication, physiotherapy, and psychological treatment. This list, however, is not exhaustive; if there are other medical services or supplies that are essential for your treatment or rehabilitation they may also be covered. Section B Medical Benefits are coordinated with your treatment providers, which may include your family physician, chiropractor, massage therapist, physiotherapist, psychologist or any other approved medical provider. Treatments must be approved by your treatment providers, who must fill out certain forms during your treatment period. If you have questions about your Section B Medical Benefits coverage, please call or email us.
How Much Section B Coverage Do I Get?
The ultimate limit of Section B coverage for medical treatment in Alberta is $50,000 per person. That means that if there are four injured people traveling in the same car, and that car is insured in Alberta, each person is entitled to a maximum of $50,000 in Section B medical benefits. In practice, however, few injury victims ever approach the $50,000 limit. This is partly because the law requires you to use up any personal health insurance benefits you are entitled to ahead of some types of Section B coverage. It is also partly because insurance companies are entitled to send you to a doctor of their choice to determine if you require ongoing treatment. If that doctor believes that the ongoing treatment is not medically essential (which is a very high threshold) you will not be approved for additional Section B coverage. Finally, it is also partly because certain common treatments are limited to very small coverage amounts:
Section B Disability Benefits cover a maximum of $400 per week of lost earnings OR 80% of your pre-tax average weekly earnings, whichever is lower. If you were earning less than an average of $500 per week, before taxes, at the time of the accident, you will be entitled to less than $400 per week in Section B disability benefits. Here is an example:
Scott and Emma are in an automobile accident and have an Alberta insurance policy. Both are unable to work because of the accident, and both have no disability coverage through work or any other benefit plan. Before taxes, Scott earns $300 per week and Emma earns $800 per week. Under Section B, Scott can receive $400 per week in disability coverage OR 80% of his pre-tax weekly earnings. 80% of $300 is $240, which is less than $400, so Scott is entitled to $240 per week. Emma can receive $400 per week in disability coverage OR 80% of her pre-tax weekly earnings. 80% of 800 is $640, which is more than $400, so Emma is entitled to $400 per week.
If you have personal or work benefits that provide you with disability coverage, you must claim those benefits first, and then claim the Section B Disability Benefit. In such cases, the amount of your weekly benefit is determined by a formula set by law. Here is an example:
Joe earns $1,000 per week at his job and is injured in an automobile accident in Alberta. He cannot work at all because of the injuries caused by the accident, so his benefits at work pay him $800 in disability. According to the formula, Joe would be entitled to $218.18 per week in Section B disability benefits, on top of the $800 he receives through his work benefits.
Many rules and exceptions may apply to your unique situation. If you have questions about your entitlement to Section B Disability Benefits, or the formula for calculating your Section B disability amount, please call or email us.
How Do I Qualify For Section B Disability Benefits?
To qualify for Section B disability benefits you must meet the following criteria:
- You must have been injured in an automobile accident. This includes car, motorcycle, bicycle, truck, bus, and pedestrian accidents.
- There must be a Section B insurer for you to claim against.
- You must have been employed at the time of the accident OR you must be at least 18 years old and have been actively employed for at least 6 out of the 12 months prior to the date of your accident. The 6 months of employment do not have to be consecutive.
- The injuries caused by your automobile accident must prevent you from performing ALL of the duties of your job within 60 days from the date of the accident.
- If the Section B insurance company so chooses, a duly qualified medical professional, usually a doctor, must certify that you are disabled.
You cannot claim Section B Disability Benefits unless you are “wholly and continuously” disabled by the injuries from your automobile accident. This means that the disability must prevent you from doing any and all of your job duties. If you are off work due to disability and are collecting the Section B Disability Benefit, once you go back to work the benefit stops and cannot be restarted if you go off work again. You cannot claim Section B benefits for the first 7 days of your disability, so payment for that week is “lost” unless and until you are able to claim it back through a personal injury claim ending in settlement or trial, or by other means. Similarly, if the Section B Disability Benefit does not cover all of your lost earnings, you may be able to recover the difference through a personal injury claim.
Deadlines and Other Important Information
Section B Benefits must be claimed within a specific amount of time after your automobile accident. Here are some important deadlines:
You must notify the Section B insurance company of the accident within 30 days.
For medical benefits, you must complete a Notice of Loss and Proof of Claim Form (AB-1 Form) for the Section B insurer within 90 days.
For disability benefits, you must complete a Claim for Disability Benefits Form (AB-1A Form) for the Section B insurer within 90 days.
The ultimate deadline for all Section B benefits is 2 years from the date of the automobile accident. After 2 years, all Section B benefits end.
The Section B insurer will provide you with the right forms to fill out, and forms for your doctor or medical practitioner (physiotherapist, chiropractor) to fill out (AB-2, AB-3, and AB-4). You can find all the forms here. Knowing what to do with these forms and how to fill them out can be difficult and confusing. If you have missed a deadline, do not panic, as you may still be able to receive benefits. At the earliest opportunity, contact the Section B insurer to notify them of the accident and try to open your medical or disability claim or both. If you need any help with any of these forms or deadlines, or with opening a Section B claim before or after the deadlines, please call or email us.
The insurance company is generally entitled to send you to their own doctor or medical provider to verify your injuries and eligibility for either medical or disability benefits. If they ask you to go, you must go. This right is subject to restrictions based in part on how serious your claim is. If your claim is “capped” or even initially believed to be capped the Section B insurer must wait 90 days to send you to their own doctor or medical provider to review your injuries for medical benefits. There is no such waiting period for disability benefits.
If your claim is capped or even initially believed to be capped you will typically get faster access to treatment, and faster payment. In such cases, the Section B insurer may also lead you to believe the amount of treatment under Section B medical benefits is limited to 21 treatments or less. This is not true. As mentioned above, Section B Medical Benefits may cover medical services or supplies that are essential for your treatment or rehabilitation, up to a limit of $50,000. If you have questions about whether or not your claim is capped and how that may affect your Section B Benefits, please call or email us.
Death, Grief Counselling, and Funeral Expenses
Section B provides some coverage related to the death of an individual in an automobile accident. This is a sensitive topic, and the following information may be upsetting to those who have lost a loved one in an automobile accident.
The first type of coverage is called, rather insensitively, the “death benefit.” The coverage for the death benefit varies according to the age of the deceased, and the relationship of the deceased to the person or persons making the claim.
It is also possible to claim funeral expenses for up to $5,000 for each deceased person, and $400 for grief counselling. The grief counselling benefit is $400 per family; if more than one family member has passed, it is possible to claim a grief counselling benefit for each deceased person. If you are dealing with the loss of a loved one due to an automobile accident, and you need help with related Section B benefits, please call or email us and know that you have our sympathies.
Understanding Section B Benefits
Section B Benefits are complex and confusing, so much so that even insurance adjusters sometimes misunderstand or misapply the law. There are rules, deadlines, and exceptions that can make Section B Benefits inaccessible. Even if you are denied Section B Benefits, you may be able to recover treatment costs, lost earnings, and compensation for many other accident-related things though a personal injury claim. We hope this article has been educational and useful, but we acknowledge that it is not possible to cover all the ins-and-outs of Section B Benefits in one document. If you have questions about Section B Benefits, please feel free to give us a call or send us an email to get advice, answers, and peace of mind. We have over 40 years of experience as Alberta personal injury lawyers, and our consultations are free and without obligation.
i. Automobile Accident Insurance Benefits Regulations, http://www.qp.alberta.ca/1266.cfm?page=1972_352.cfm&leg_type=Regs&isbncln=0779751140