View Single Post
Old 11-12-2013, 05:49 PM   #9
kipperfan
Franchise Player
 
kipperfan's Avatar
 
Join Date: Feb 2004
Location: Brisbane, Australia
Exp:
Default

The cap depends on the year the accident occurs. For 2013 losses the cap is $4725.00, for 2012 $4641.00 and a bit less each year further into the past. With regards to if you'll be offered the cap maximum and at what point you would be offered it, it really does depend on the insurance company you're dealing with and with some companies, the specific adjuster/analyst that is handling the claim. As a general guideline, if you treat for 3+ months and take 21+ treatments you're entitled to the cap max, some companies with offer it to you at that point if you want to settle, other companies will try and play hardball and won't offer cap unless you treat for 6+ months.

With regards to obtaining more treatment, that is a different claims process. The claims process described above is bodily injury and handled through the at fault insurance company. Getting more treatment would be done through your insurance company (or the insurance company of whomever owned the car, if that wasn't you) under the Accident Benefits or Section B portion of the policy. After the first 21 are completed you are entitled to additional treatment for up to 2 years post MVA if it is being recommend by a doctor, but will likely have to start paying out of pocket for said treatment and submitting the costs first to extended health care (if applicable) and then back to your insurance company.

Hope that helps.

Edit: I will also mention if you keep treating and you get 2 years down the lines and the symptoms have not gone away (very unlikely) then you could possibly obtain a lawyer, have him/her have you see some specialists and try and build a case for "chronic pain" as a result of the accident related injuries. That is a hard case to make and the issuance company would fight back very hard with doctors of their own, but that could potentially move the injury outside of the cap and bring the compensation into the tens of thousands of dollars, for pain and suffering alone.
__________________
"Man, so long as he remains free, has no more constant and agonizing anxiety than to find, as quickly as possible, someone to worship."

Fyodor Dostoevsky - The Brothers Karamazov

Last edited by kipperfan; 11-12-2013 at 05:53 PM.
kipperfan is offline   Reply With Quote