Scenario: You are standing by your car in a parking lot, another driver loses control of his vehicle and drives his vehicle right at you. You suffer serious injuries and impairments, and are taken to the hospital via ambulance. Will your Insurance Company cover the costs of your medical and rehabilitative treatment?
Simple answer: YES, your treatment will be covered by your Insurance Company, but, APPROVAL WILL NOT BE EASY.
Law: Motorists, cyclist and pedestrians injured in a motor vehicle accident, with a valid Insurance Policy at the time of the accident, are entitled to benefits through their own auto insurance company, referred to as the Accident Benefits Claim. This is irrespective of whether that person was at-fault for the accident.
An Accident Benefit’s claim will include medical benefits, rehabilitation benefits, attendant care benefits, housekeeping and home maintenance benefits, income replacement benefits, case manager services, together with reimbursement for the cost of examinations and medical reports.
The Statutory Accident Benefits Schedule, entitles individuals injured in an accident suffering from a predominantly minor injury to claim up to $3,500 in medical benefits, if under the Minor Injury Guideline, OR if deemed out of the Minor Injury Guideline up to $65,000 in medical benefits for up to five years.
For the Insurance Company to approve your eligible coverage, it comes down to their interpretation of your accident. Section 3(1) of the Statutory Accident Benefits Schedule—Effective September 1, 2010, O. Reg 34/10, defines accident as follows:
3.
(1) “accident” means an incident in which the use or operation of an automobile directly causes an impairment or directly causes damage to any prescription eyewear, denture, hearing aid, prosthesis or other medical or dental device.
A look at Court cases and tests applied by the Courts, shows that Courts favor the victims of accident, when they are able to establish that:
- The accident resulted from the ordinary and well-known activities to which automobiles are put; and
- There is some nexus or causal relationship (not necessarily a direct or proximate causal relationship) between the victim’s injuries and the ownership, use or operation of his vehicle.
If your Insurance Company has refused to open an Accident Benefits claim for you or has denied you eligible benefits, contact us immediately!
At JEWELL RADIMISIS JORGE LLPwe support your Accident Benefits claim and will help you apply the legal interpretation of “accident” to your individual scenario.