Soft tissue payout from insurance

[zyzz]

A few months ago my girlfriend and I were involved in a pretty bad crash. The other driver ran a stop sign and we ended up slamming into the side of their car. Our car is a write off. We've already been given the 21 sessions (used 19) and they have helped, our dr says we will probably need more however. At this point what happens? I've read about a payout of 4000 for pain and suffering, can we get more sessions? Not sure what happens and I don't wanna get messed around with from insurance

[burn_this_city]

I believe the $4,000 is a payout for your pain and suffering and the cost for physio is above and beyond that amount.

[Osker]

My girlfriend was in 2 crashes in a year span, neither her fault. What luck huh? She did the 21 physio sessions both times and received similar payouts for each. They were both around $4500.

[zyzz]

Originally Posted by Osker

My girlfriend was in 2 crashes in a year span, neither her fault. What luck huh? She did the 21 physio sessions both times and received similar payouts for each. They were both around $4500.

Did the insurance just pony up the money or did she have to see a lawyer to get it?

[Osker]

No lawyer necessary. Insurance should issue the cheque. The protocol is different between companies I think. I seem to recall one of the cheques being mailed to her while she had to pick up the other from their office. State Farm and Co-operators were who she dealt with but I can't remember who made her pick up. Each cheque was 1-2 months after completing physio.

[Maritime Q-Scout]

I don't know how things work in Alberta, here in NS everything you mention is legislated. I'd assume it's the same in Alberta.

That said call a lawyer. Ask if they'd give a free consultation and they should be able to answer your questions without a second thought.

I don't want to comment further as I really don't know Alberta's rules and regulations.

[110%]

Honestly, I would follow up with your insurer to see what exactly is going on. $4000 may be a lump sum for everything, or it could be just for your damages. Also, $4750 is the maximum you can receive for a "minor injury". If you are having continual difficulties with your injuries then I would seriously consider speaking with a lawyer. You could be entitled to further funds if this has affected your work, your work potential in the future or if you are going to have significant costs to manage your symptoms in the future. I'd get the whole picture explained to you from your insurer then speak with a lawyer. I know personal injury lawyers often do free initial consults, so that would be a good avenue to explore if you still have questions.

[jayswin]

Originally Posted by 110%

Honestly, I would follow up with your insurer to see what exactly is going on. $4000 may be a lump sum for everything, or it could be just for your damages. Also, $4750 is the maximum you can receive for a "minor injury". If you are having continual difficulties with your injuries then I would seriously consider speaking with a lawyer. You could be entitled to further funds if this has affected your work, your work potential in the future or if you are going to have significant costs to manage your symptoms in the future. I'd get the whole picture explained to you from your insurer then speak with a lawyer. I know personal injury lawyers often do free initial consults, so that would be a good avenue to explore if you still have questions.

Are you 100% sure about that?

[kipperfan]

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.

[Titan]

Consult a lawyer that does this work. Vladtheimpaler is one option.

[Gundo]

Originally Posted by Titan

Consult a lawyer that does this work. Vladtheimpaler is one option.

I had no idea Vlad was a lawyer, he always dropping porn innuendos so I thought he was a Pornologist.


I would consult with a lawyer there is no harm in it.

[Cheese]

Originally Posted by Gundo

I had no idea Vlad was a lawyer, he always dropping porn innuendos so I thought he was a Pornologist.


I would consult with a lawyer there is no harm in it.

Lawyers are "pornologists". They #### you out of your money.

[InSutterWeTrust]

Originally Posted by zyzz

A few months ago my girlfriend and I were involved in a pretty bad crash. The other driver ran a stop sign and we ended up slamming into the side of their car. Our car is a write off. We've already been given the 21 sessions (used 19) and they have helped, our dr says we will probably need more however. At this point what happens? I've read about a payout of 4000 for pain and suffering, can we get more sessions? Not sure what happens and I don't wanna get messed around with from insurance

My wife was in a car accident in August and our car was written off, took the insurance a month to determine it was a right off. My wife went through the 21 sessions and her physio, Chiro had recommended she get some more. She contacted our insurance had to request more and I think she was given another $750 to cover more treatments, between the span of insurance giving approval for more and the 21 running out we had to use our work benefits to cover those costs. One thing people have told us, is when the insurance is offering the payout the $4000 or $5000, whatever the limit is, do not accept it if you are still needing treatments. Once the insurance give you your payout and you accept, you now have to pay for any of your treatments you still might need.

[troutman]

http://www.millerthomson.com/assets/...egulations.pdf

Three sets of comprehensive regulations come into force in Alberta as of October 1st 2004. These new regulations will radically change the compensation system for accident victims.

Personal injury lawyers need to review and understand these changes. Now more than ever
accident victims will require excellent legal representation to ensure that their rights are
protected. The regulations are intended to reduce the amount paid out by insurers to accident
victims for soft-tissue injuries. This will occur. It is our duty to ensure that all accident victims
are aware of their rights and are dealt with fairly.

Insurers will be tempted to declare claimants as healed after submitting to the Treatment
Protocols and will likely be reluctant to pay for further treatment.

Insurers will also be tempted to over-classify injuries as minor due to the lower non-economic
damages pay-out. As in Ontario there will need to be several court decisions regarding the
definition of minor injury in order to clarify what type of cases will be capped.

It will likely be uneconomical, at current contingency fee rates, to represent accident victims
whose claims are subject to the minor injury cap. However, if an accident victim has other non-
minor injuries or other pecuniary losses, the case may be economical despite the cap on non-
economic damages. Case selection will be critical but will lead to fewer accident victims being
represented. Whether these regulations lead to lower insurance rates for most Albertans
remains to be seen

Early cases offer some guidance as to when a claim will fall within the cap in Nova Scotia, Alberta, New Brunswick and Prince Edward Island.
http://www.claimscanada.ca/issues/ar...aid=1000405449

The truth about insurance caps
http://www.theglobeandmail.com/globe...rticle1376575/

[undercoverbrother]

I have said it before, I will say it again. The Cap is bull####.

[TheSutterDynasty]

Originally Posted by zyzz

A few months ago my girlfriend and I were involved in a pretty bad crash. The other driver ran a stop sign and we ended up slamming into the side of their car. Our car is a write off. We've already been given the 21 sessions (used 19) and they have helped, our dr says we will probably need more however. At this point what happens? I've read about a payout of 4000 for pain and suffering, can we get more sessions? Not sure what happens and I don't wanna get messed around with from insurance

As far as the treatment session go, your physio or chiro will talk to you about it. If they/you feel like you need further treatment they submit a form to insurance. We're lucky in Alberta that there's usually no issue with obtaining further treatment if it's needed.

[Rathji]

The insurance company paid me the cap + a bunch for 'transportation expenses' for my 50 or so appointments when I was in my accident about 18 months ago.

In my case, when I (my chiro) requested additional treatments, they had no issues, but possibly it was because I wanted to do Physio and was willing to go to 'their' physiotherapist, because it was closest to my house anyway. They extended it again when the physiotherapist requested some more.

The next time I figured it needed to be extended, they made me fill out a bunch of paperwork, which I had to take to my family doctor.

Every case is different though.

[1stLand]

I was involved in a similar situation last year. I used VLADTHEIMPALER and I was very happy with his services.

I highly recommend him.

[VladtheImpaler]

Under no circumstances should you accept less than "cap". And there are many ways around it (i.e to more money). Obviously, if you are fine after 3-4 months, the "cap" amount is all you are really entitled to. PM me if you have any questions. You can also check out my website for additional info - www.zhivovlaw.ca.

P.S. Ah the salad days of pornology - it's amazing how much free time you have when you are an employee. Now that I am the boss, porn is just a fond memory...

[Rathji]

Originally Posted by VladtheImpaler

Under no circumstances should you accept less than "cap". And there are many ways around it (i.e to more money). Obviously, if you are fine after 3-4 months, the "cap" amount is all you are really entitled to. PM me if you have any questions. You can also check out my website for additional info - www.zhivovlaw.ca.

P.S. Ah the salad days of pornology - it's amazing how much free time you have when you are an employee. Now that I am the boss, porn is just a fond memory...

Just wanted to do a shout out here for you, Vlad.

Your advice you gave me when I was in my accident allowed me to be comfortable accepting the cap offer from my insurance. It did go a little longer than the 3-4 months, but I blame the quack of a chiropractor I went to before physio.