This post is for the many people who ask me what to do when they are injured in a car accident.
Understanding your rights could be the difference between having access to the care you need for a speedy recovery and suffering with chronic pain the rest of your life.
There is no doubt that experiencing a motor vehicle accident (MVA) is tedious enough, but when you’re injured in the accident, the results can be life changing. There are a few common injuries that you can experience in an MVA and many of them we treat regularly at the The Spine & Sports Clinic, these include: Whiplash, sprain/strain, low back and wrist injuries, fractures, shoulder impingement, etc.
Typically whenever I see a patient who has been injured in an MVA, my first objective is to render an accurate diagnosis of their injuries; then I establish a treatment plan tailored to their needs; finally, I provide them with the following information form, so that they understand their rights and access to care; and finally I help them accurately complete the necessary paperwork to have their access to care accepted by the insurance company.
MOTOR VEHICLE ACCIDENT INJURY INFORMATION FORM
Dear Valued Patient,
As you may have heard, on September 1, 2010 the Statutory Accidents Benefit Schedule has changed in Ontario. The new regulation limits the maximum medical and rehabilitation benefits to accident victims to $50,000.00 for all related medical expenses (medications, physiotherapy, Chiropractic, Massage, Assistive devices, etc.) However, in order to benefit from such coverage you must:
- Have suffered a fracture
- Have neurological signs/symptoms (numbness and tingling)
- Have psychological conditions (new or pre-existing)
- Have a pre-existing medical condition that will limit your ability to fully recover from your injury under the Minor Injury Guideline.
Moreover, your insurance company will require “compelling medical evidence” if you have any of the aforementioned conditions. This evidence consists of, but is not limited to: diagnostic imaging reports (i.e. x-ray, MRI, ultrasound, CT-scans, etc.), list of medications with prescribing practitioner names, letters and referrals by any medical practitioner, and/or a list of pre-existing conditions and date of diagnoses by family physician or regulated medical practitioner.
Furthermore, depending on your insurance policy, you may qualify for additional services:
- Income Replacement: this allows for financial compensation if you cannot work as a result on injuries sustained in your accident.
- Non–Earner Benefit: this allows for financial compensation to those that do not work and can no longer carry out normal activities due to injuries sustained in your accident.
- Attendant Care: this allows for an aide or attendant to help you if you are no longer capable of caring for yourself as a result of injuries sustained in your accident.
- Caregiver Benefit: this allows for financial reimbursement if you are a primary caregiver and can no longer fulfil the responsibilities required as a result of injuries sustained in your accident.
- Other Expenses Benefit: this allows for financial reimbursement if you sustained financial losses as a result of the injuries sustained in your accident.
- Death and Funeral Payments Benefits: a lump sum payment to the survivors of a person that was killed as a result of a motor vehicle accident.
If you do not have any of the previously stated symptoms, under new legislation, your injuries will fall under the Minor Injury Guideline (MIG) and your medical and rehabilitation benefits are covered up to $2,200.00 over a 12 week period, to a maximum total of $3,500.00 after the initial 12 weeks; this includes all associated goods and services (medications, physiotherapy, Chiropractic, Massage, Assistive devices, etc.)
- $215.00 Initial Examination and Completion of Forms (OCF-23)
- $775.00 MIG Block 1 (minimum 1 treatment a week for 4 weeks)
- $500.00 MIG Block 2 (minimum 1 treatment a week for 4 weeks)
- $225.00 MIG Block 3 (minimum 1 treatment a week for 4 weeks)
- $400.00 Goods and Services (Massage, Assessments, Acupuncture, Assistive Devices, etc.)
- $ 85.00 Discharge Report (OCF-24)
The remaining $1,300.00 must be requested after the 12 week treatment phase has expired, or can be used for additional assessments that may be required to obtain compelling medical evidence that may withdraw you from the MIG.
Note: If you have Extended Health Coverage (EHC), please be aware that the Legislation requires that the funds available in your EHC account be used to pay for treatments prior to your automobile insurance paying for any treatments required as a result of your automobile accident.
In some cases, your healthcare provider will try to obtain various assessments to provide your insurance company with the “compelling medical evidence” they require, helping you get the additional benefits you may require. These assessments include, but are not limited to:
- Neurological Assessments
- Psychological Assessments
- Orthopaedic Assessments
- Chronic Pain Assessments
- Dental/Oralmaxofascial Assessments
- In-home Assessments
If your insurance company refuses to pay for your treatments you still have options and it’s time to consider obtaining legal counsel:
- Negotiate: have your legal advisor notify your insurance company that you will be disputing the insurer’s decision and attempt to resolve the dispute.
- Mediation: if you cannot resolve your dispute with the adjuster then you can file for Mediation, where a mediator is appointed to your file by FSCO Dispute Resolution Services.
- Legal: if the mediation failed, then you may file for Arbitration, Lawsuit or Evaluation.
Time Limit: you have a maximum of 2 years to file for Mediation and/or Arbitration, Lawsuit or Evaluation form the date that the insurance company refused to pay.
If you have any additional questions regarding the Injury Claims Process, please do not hesitate to ask your health provider, or visit: http://www.fsco.gov.on.ca/en/auto/Pages/default.aspx
I sincerely hope that you found this information useful. There are many motor vehicle accidents daily and people are frequently injured; it’s important to understand your rights and that injuries are not always apparent right away, they can takes days, even weeks to appear. So be sure to visit us if you were or suspect your were injured in a motor vehicle accident, ignoring your pain could lead to chronic dysfunction. Remember, there’s no obligation to you, most insurance companies will cover the cost to have you examined!