What You Need To Know About Injuries And Getting Your Claim Moving Quickly
What You Need To Know About Injuries And Getting Your Claim Moving Quickly
Beginning January 1, 2027, The province of Alberta is moving forward with a no-fault insurance system branded as “care-first”. The Government is stating that the purpose is to provide injured Albertans with quicker medical treatment, rehabilitation, income benefits and other benefits while reducing the condition of lengthy legal disputes and alleged overcompensation. Albertan’s current Section B benefits known as “accident benefits”, already grant Albertan’s access to immediate treatment and access to income replacement.
For someone injured in a motor vehicle accident it is important that you fully understand what these changes are and how it may impact on any current claim you have against a negligent driver. It is pertinent that you take the right steps to protect your interests, ensure your claim is handled properly, and that you are properly compensated for your injuries.
What Is The Care-First Model?
Care-First is a no-fault insurance system. What this means is Albertans will no longer be able to pursue an Action against an at-fault driver for compensation. Instead, your own insurance company will provide you with compensation for your injuries and income replacement.
The principle behind the proposed system is to reduce litigation costs for insurers, increase how quickly claims are resolved, and reduce the strain on the Court system. It is being branded as a system that provides benefits based on the person’s injuries and needs of recovery instead of making an injured person proceed through the Court System to be compensated or access certain benefits.
The reality is the current system already provides immediate access to benefits through your Section B policy known as accident benefits. What the new Care-First model does is allow your own insurance company to determine what compensation for your injuries will be and remove your ability to challenge those decisions in the Court System with a handful of exemptions.
This means your own insurance company is compensating you rather than the at-fault driver’s insurance. Resulting in the at-fault driver no longer being held accountable.
So What Happens With The Care-First System When Someone Is Injured?
The Regulations are still being finalized, and no one knows how the system will function in reality. The current proposal has a number of major concerns including access to less treatment immediately following a car accident. Theoretically, nothing will change in the process immediately following a car accident because the current system already ensures Albertans has immediate access to treatment.
The draft Regulations strictly enforces people to contact their insurer as soon as possible and obtain an initial assessment from a health care physician. Currently, if you wish to access your Section B, accident benefits you would also contact your insurer, complete various forms with your physiotherapist or family doctor, and likely be placed on what is called the “Protocol” which provides 21 treatments immediately following an accident.
What Benefits Will Be Available?
The Government of Alberta has indicated there will be a range of benefits under the care-first system that is allegedly going to be broader and depending on the circumstances may include:
- Medical and rehabilitation services;
- Reimbursement for certain injury-related expenses;
- income replacement if an injury prevents someone from working;
- loss of studies benefits when an injured student cannot continue their education;
- caregiver support;
- help with activities of daily living; and
- permanent impairment benefits for injuries that qualify as permanent and lastly additional support for serious or catastrophic injuries; and
- the care-first model can provide a permanent impairment lump-sum benefit of up to approximately $298,520, subject to the rules and circumstances.
These are benefits or damages that are already available to Albertans under the current system but with much less restrictions on the individual benefits. The current system may require an injured person to pursue an Action through the Court system, but many claims resolve prior to an Action being filed and the only restriction on recovery for those damages is set by the Court rather than by your own private insurer typically resulting in better compensation for an injured person.
This means, if you have been or are involved in a motor vehicle accident before January 1, 2027. You should contact a lawyer to make sure your rights are properly preserved and maximize your recovery.
Does This Mean That You Cannot Sue?
Under the new system, it will be very difficult to pursue a lawsuit against an at-fault driver. The Government of Alberta has left a handful of circumstances where you may be eligible to pursue a claim but there will likely be other issues with respect to that.
Not every legal avenue is disappearing. In certain circumstances legal rights may still exist. The specific rules will depend on the nature of the accident, the injuries incurred, the applicable insurance coverage and the legislation and regulations in the force at time. The current proposal creates a tribunal for Albertans to appeal an insurers determination. However, in other Provinces these tribunals heavily favour insurance companies.
The insurance company categorizes your injuries based on regulations rather than impact. The category of your injury directly impacts your compensation entitlement. For individuals with serious injuries such as broken bones, major whiplash and/or neurological complaints or permanent (catastrophic) injuries such as quadriplegia, paraplegia and/or limb amputation it may not be a simple insurance claim and that it can be closed quickly. In certain instances, legal advice may still be necessary to determine whether additional compensation or legal remedies are required. You may also need to retain a lawyer to assist you with how your insurance company has categorized your injuries or if you are having difficulty accessing treatment. The difference now is you will likely need to pay your lawyer out of pocket on an hourly basis rather than when your claim is resolved.
This will be very challenging for many Albertans who have limited income because they are not working and will result in a lot of Albertans being unfairly compensated because they cannot access legal assistance.
I Was Recently in a Motor Vehicle Accident, What Should I Do?
After a vehicle accident one of the major concerns is how long it will take to receive treatment for injuries and benefits. Due to the branding of the Care-First Model, a lot of Albertans are correctly confused.
The good news is our current system already provides immediate access to treatment following a car accident. If you are injured in a car accident you should contact your insurance company to access your Section B, accident benefits, and schedule a doctor’s appointment with your family doctor.
Isn’t the Care First Model Going To Get Me Compensated Faster?
Not necessarily. One of the biggest reasons there are delays in Injury claims is because we cannot determine the range of a claim’s value until an injured person has fully recovered or reached maximum medical recovery.
Often our clients do not know the full scope of their injuries until 1.5 to 2 years after their car accident because the time for recovering from injuries like concussions, whiplash and other injuries are so varied. This delays our ability to move these matters to settlement because if our clients’ injuries become chronic the compensation assessment changes.
Once the injuries have crystalized, meaning we know whether there will be permanent impairments, the matters typically resolve quickly. Often only requiring litigation if the insurance company is disputing either liability (who is at fault) or the severity of the injury.
Under the new Care-First Model Albertans will likely have a similar issue and potentially face other issues like having their insurance company categorize their injury in a lower category. There will also be new challenges with access to treatment without the accountability measure the Court system currently provides.
The Bottom Line For Alberta Drivers
Alberta’s Care-First insurance is a major change that is coming into play on how motor vehicle accident injuries will be handled starting January 1, 2027. For an injured Albertan the most important steps are fairly straightforward and your immediate steps likely will not change:
- Seek medical attention;
- Report the accident;
- Notify your insurer;
- Complete any necessary forms; and
- Keep all records and preserve any evidence.
The most important thing is not to confuse a quick resolution with a fair resolution and if you were recently injured and are concerned you will not receive fair compensation as we transition to the new system. Contact one of our personal injury lawyers – we are always happy to help.
The information contained in this article is provided solely for general informational purposes and does not constitute specific legal or professional advice.