Who pays for treatment after a car accident injury in Ontario?
I am often asked about how the priority of payments works for treatment costs incurred after a car accident injury. People often have accident benefits through their own car insurance company, perhaps they are named under another car insurance policy, maybe they were also an occupant of a car that had a car insurance policy too, and maybe they even had extended health coverage under theirs or a related person’s health insurance/work insurance plan.
It gets confusing for people to understand where they should apply and to who they should apply first. Here is a quick summary of the rules (don’t rely on it for any specific situation – call me for a free consultation about your specific situation instead – its tough to beat free after all):
1. The Insurance Act gives you the right to apply to any insurance policy that could cover you for accident benefits (even if there is more than one). It is then up to the insurers to figure out who should pay. I have, in the past, seen insurance companies refuse to pay benefits to an insured person because they say that the insured should apply to someone else. That is not the correct procedure – the insurance company should be paying you if they are anywhere on the list of available insurers and they should then be seeking to get payment from, and dispute priority, with the other insurer. It’s not your job. However, its usually easiest to get some advice about the right insurer to apply to.
2. You are required to access extended health benefits before you access your MVA insurance accident benefits from your car insurer in Ontario. As a for instance, I have a client in Whitby Ontario who sustained injuries in a car accident and I am acting as his personal injury lawyer – he has coverage for chiropractic and physiotherapy with Manulife up to $500 per year at 80% coverage. He is required to apply to Manulife for payment up to the $500 limit each year before the car insurer kicks in to start covering the full treatment costs. That being said, the 20% short-fall on the Manulife policy amounts should be paid by the car insurer provided that they deem it to be reasonable and necessary. You just have to apply to Manulife first, get the 80% from them and then apply to the car insurer for the additional 20%. Beyond the $500 per year, you just apply to the car insurer.
Most of the licensed clinics know how to do this and will help in preparing the forms and submissions. When my firm is acting as the car accident injury lawyer, we will typically also assist people in making sure that they are getting payments for the benefits owed to them.
There are some newer extended health and disability policies offered by employers that have exclusions for car accident related injuries. I am starting to see this more and more. If there is an exclusion, then its important to bring that to the attention of the car insurer right away.
Please feel free to call me if you have any questions about who pays for treatment after a car accident injury. I am available in Whitby, Oshawa and Ajax at 905-409-2438 (and at 105 Consumers in Whitby, between brock and hopkins) and at 416-601-2355 in Toronto.
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