Motor Vehicle Accident Claims

Accident Benefit insurer

The insurance company

Tort Insurer

The insurer of the vehicle, your own insurer (if other driver impaired or unlicensed or no other insurance available)

they are the insurer in a lawsuit

Priority dispute

when there are multiple motor vehicle liability policies which might respond to an accident benefit claim made by an individual involved in a motor vehicle collision

MVACF

Motor Vehicle Accident Claims Fund - made to provide compensation to people injured in accidents who do not qualify as an insured person under any other policy

Income replacement benefits

employed or self-employed person cannot return to work due to their injuries sustained in the accident

70% of gross weekly employment income to 400 max

Childcare or other caregiver expenses

if a stay-at-home parent or other caregiver cannot care for a child or other person that they had previously been the caregiver to, due to the accident;

250 per week for the first person and 50 for additional people

Non-earner benefits

unemployed person who cannot go on due to accident

185 per week (not payable for first 4 weeks or injured people under 18, not payable after 104 weeks 2 years after the accident

LAT

License Appeal Tribunal Automobile Accident Benefits Service - when insurer’s exam report received and treatment not reasonable you can apply this to dispute the denial

must be filed within 2 years from the date that the income company denied the benefit(s)

Case Conference

Takes an hour - used so that parties can meet LAT Adjudicator, via phone call - supposed to take 45 to 60 days of the Response being received - injured party and insurance company must both participate

Case Conference Summary

e-filed at least 10 days in advance of case conference and provided at the same time as Notice of Case Conference to AABS- this is called disclosure

Hearings

held within 60 to 90 days after conference and only mandatory if conference did not result in a settlement agreement between the parties - not recorded (no transcript) unless requested

MIG

Minor Injury Guideline - the sum of medical and rehab benefits payable in respect of an injured person who sustains a minor injury shall not exceed 3500 for any one accident less the sum of all amounts paid in respect of the injured person

CAT

Catastrophic Impairment - significant change to how we define catastrophic impairment

 When a Treatment and Assessment Plan (OCF-18) is submitted by a regulated health professional, how long does the adjuster have to respond with either an approval or denial?

Within 10 days, if they don’t respond within that time limit it is deemed approved