Just got into a car accident?

Once you have been in a motor vehicle accident, a claim needs to be made to your motor vehicle insurer. Post-accident, you are required to call your insurance company to file a claim and inform them that you have sustained bodily injuries from the accident as well. The insurance company will assign you an adjuster that will be with your health claim, who will be separate from your vehicle damage adjuster. If you have not done this yet, not to worry. You have up to 2 years to make a health claim due to injuries sustained from a motor vehicle accident. Once an adjuster has been assigned to you, they will provide you with a package of forms (if they do not, we can provide you with the required documents). The main form that is required to start your health claim process is an Application for Accident Benefits (OCF-1) form. The patient is to fill this form out and bring it with them to their first initial assessment & treatment. If you feel you cannot fill it out yourself – no worries! Just let us know ahead of time so we make sure we reserve adequate time before your initial assessment to help you fill them out. We can also send this form on your behalf to your insurer.

There are 3 categories you may be classified under when you have been injured in a motor vehicle accident: 1. Minor Injury Guideline (MIG): Sprain or Strain Whiplash Injury Whiplash Associated Disorder Partial Dislocation of a Joint Laceration Contusion 2. Non-Catastrophic (Non-CAT): Pre-existing medical condition that may delay recovery Fracture Bone break Full Bone Dislocation Psychological disorders associated to the accident Was not able to recover within the MIG 3. Catastrophic Impairment (CAT): Amputation of a limb Severe paralysis Spinal cord injuries Severe head injuries Severe brain injuries Severe burns Blindness Deafness Other injuries that are so severe that you are permanently unable to work or perform activities of daily living

Minor Injury Guideline: $3500 limit (including $400 for rehabilitation products) Non-Catastrophic: $50,000 limit (including rehabilitation products) Catastrophic Impairments: $1,000,000 limit (including rehabilitation products) Please note, these are limits. They do not indicate that funding is automatically approved. Treatment plans always require submitting and approval by the insurer for any coverage to occur. When you have been in an accident, you are automatically pre-approved for $2200 of medical rehabilitation coverage. Once those are exceeded, treatment plans need to be submitted and approved by your insurer. Also please note, if you have private health care coverage, the guidelines require you to exhaust them first before your motor vehicle insurer begins coverage. If you are only covered up to a certain percentage by your private health insurer, your motor vehicle insurer will cover the remaining percentage until exhausted, in which they will then begin to cover the full price of the treatments.

If you’ve exhausted your full $3500 and require more treatment, unless already moved out of the minor injury guideline for any of the reasons listed under the non-catastrophic or catastrophic injuries, we will require to submit a treatment plan outlining what further treatment is required. Your insurer will automatically decline the treatment plan, in order to have you attend an insurer examination by a physician of their choosing. It is important if being moved out of the MIG, to retain legal counsel.

Some cases are simpler than others to move clients out of the MIG. A client who sustained a break or a fracture for example with documentation (such as an x-ray), will be easier to move out of the Minor Injury Guideline then one who is required to move out due to a brain injury, as this requires a longer process and several insurer examinations. If our medical professionals determine that you qualify to be moved out of MIG, we will refer you to one of our legal partners to seek legal advice and representation. We will work hand in hand with your legal representative to achieve a higher status of injury. Our legal partners are highly equipped to deal with minor and major cases and will be able to potentially help you get the coverage and benefits you require to fully recover, continue on the path to recovery, and potentially receive income replacement benefits if you cannot work due to your injuries.

Seeking legal representation would be best in cases of treatment plans or benefits being declined. Personal injury lawyers are experts in this field and would devise a strategy to appeal the decline of your treatment plan and push to get it approved. *Please note: You are not always guaranteed approval for treatment coverage after the initial pre-approved $2200 coverage. We do our best to help all our clients receive coverage, but ultimately if the insurance denies your claim, it is the responsibility of the client to settle any outstanding balances such as client requested assessments.