Q: My car was hit when another driver ran a stop sign. Now I need physiotherapy to help with my neck injury, but when I contacted the other driver’s insurance, it told me my insurance would pay for the treatments. Is this right?
A: If you have private medical insurance through your work or school (or through a relative’s insurance), it is considered to be the “primary” insurer and you would use that coverage until it is exhausted.
Most private medical insurance policies have annual limits in the range of $500 for physiotherapy (and similar limits for massage and chiropractic treatments), and cover only 80 per cent of the cost of a treatment.
Assuming you opted to have an accident benefits endorsement (often called Section “B” benefits) added to your automobile policy when you insured your vehicle, your automobile insurer would pay the remaining 20 per cent outstanding until your private coverage was exhausted for a given year. After you had gone over the coverage limit (i.e., $500 for physiotherapy, if that was your limit) in a year, your Section B provider would begin to pay 100 per cent of the cost of your physiotherapy until your private coverage renewed at the beginning of the next year.
Section B will pay up to $25,000 per person for personal medical expenses (such as physiotherapy, massage, chiropractic treatments and drugs) incurred within four years of an accident.
Unfortunately, if you didn’t opt to have Section B coverage, you may have to pay out of pocket until you settle your claim for injuries (after you exhaust any private coverage you might have). I’d contact your automobile insurer to check if you are unsure if you have it.
If you have no coverage, there are other ways we can try to get you the treatment you need until your claim is resolved.
I hope this clarifies the situation. If you have any questions, feel free to call.
For more information, contact Poole Althouse.
