WHAT HAPPENS WHEN YOUR INSURANCE COMPANY DENIES YOUR BENEFITS AFTER AN ACCIDENT? WHAT CAN YOU DO?

 

In Alberta, every auto insurance policy includes Section B benefits that can be claimed after you are in an accident, whether you are at fault or not. However, there are circumstances where your insurance company can deny your claim for benefits. This blog will discuss the instances where your insurance company can deny your claim, and what you can do about it.

What are Section B benefits?

Briefly, your Section B benefits will cover certain expenses associated with treatments and disability payments after you are in a car accident. A full description of your Section B benefits can be found in this blog post.

When can your insurance company deny your claim for Section B benefits?

There are certain deadlines that you need to meet in order to claim your Section B benefits:

 

  • Your insurance company must be notified of your car accident within 30 days of the date of the accident
  • You must complete an AB-1 Form and submit it to your insurance company within 90 days of the accident in order to access your medical benefits
  • You must complete an AB-1A Form and submit it to your insurance company within 90 days of the accident in order to access your disability payment benefits

Your insurance company can deny your claim for Section B benefits if you do not meet the above deadlines.

Your Section B benefits are also only available for 2 years from the date of your car accident. This means that after the 2 years pass, your insurance company will deny any further claims for Section B benefits.

Further, your insurance company can require you to attend an Independent Medical Examination (IME). This will involve submitting to an examination done by an independent, third-party medical professional, who will determine the extent of your injuries, and your entitlement to continued benefits. If the IME doctor is of the opinion that you no longer require benefits, your insurance company is then entitled to cut you off from accessing your Section B benefits moving forward.

What can you do when your insurance company denies your claim for Section B benefits?

If you have been cut off from your Section B benefits by an unfavorable IME report, you can try to attend upon your own treating doctor and ask them to prepare a rebuttal report. This report will be submitted to your insurance company as an argument supporting your continued need for benefits.

Another option available is to file a complaint. All insurance companies must have a formal complaint process available, whereby you may direct your complaint directly to your insurance company. You may also contact an independent ombudservice to assist in resolving your dispute.

After exhausting your other options, you can also contact a lawyer who specializes in contract law, who can assist in suing your own insurance company for failing to abide by the terms of your insurance contract by improperly cutting you off from your Section B benefits.

However, one of the best ways to avoid having your claim for benefits denied in the first place is to get in touch with an experienced lawyer early on after you have been injured in a car accident. A lawyer will be able to give you all the information that you need to help you deal with your insurance company and make sure that you understand your rights to benefits from the beginning.