Navigating the system after an accident can be confusing, especially when you’re trying to access treatment through Section B. While Section B Benefits offer vital coverage, up to $50,000 for medical expenses, regardless of fault, it’s the Section B protocols that really determine how and when your treatment is approved.
You need to understand these protocols because they could impact the speed of your recovery, the timeline of your claim, and even its success. Let’s break down what you need to know about accessing care and making sure your claim moves forward smoothly.
- Section B benefits in Nova Scotia provide up to $50,000 for medical expenses, lost income, and other related costs, regardless of fault. This coverage extends to the policyholder, drivers, passengers, pedestrians, and dependents in other vehicles.
- Minor injuries, such as sprains, strains, and whiplash, are covered by Section B protocols, allowing direct treatment without insurer approval. There are treatment limits, like up to 10 visits for minor injuries and 21 visits for more severe cases.
- Claims for minor injury treatments must be submitted within 10 days of the accident. If additional treatment is needed, a reassessment by an injury management consultant is required to extend coverage under Section B.
Who Is Covered Under Section B Benefits?
- The policyholder
- The driver of the insured vehicle
- Any passenger in the insured vehicle
- Pedestrians who are hit by the insured vehicle
- Dependants and family members who were occupants of other vehicles
To expedite the treatment of minor injuries and compensation for property damage caused by automobile collisions, Nova Scotia introduced Section B Automobile Accident Diagnostic and Treatment Protocols for Minor Injuries. Section B Protocols are optional for accident victims diagnosed with a car accident-related minor injury.
What Are Section B Treatment Protocols?
Treatment protocols are intended to streamline the process for car accident victims to access medical treatment for minor injuries. If your injuries are classified as minor, you have the option to seek immediate treatment from a medical practitioner without approval from your insurer. Unlike the traditional route of an insurance company reimbursing your medical expenses, your primary healthcare provider (chiropractor, physiotherapist or medical doctor) can bill your insurance company directly.
What Type of Injuries Can Be Treated Within the Protocols?
Under the Nova Scotia Insurance Act, the legal definition of a minor injury is a “sprain, strain or whiplash-associated disorder”. Under subsection 5(3) and Section 159 of the Insurance Act, the definition of injuries that can be treated within the protocols are as follows:
“Sprain” means an injury to one or more tendons, to one or more ligaments, or to both tendons and ligaments.
“Strain” means an injury to one or more muscles.
“Whiplash-Associated Disorder Injury” means a whiplash-associated disorder other than one that exhibits one or all of the following:
- Neurological signs that are objective, demonstrable, definable and clinically relevant;
- A fracture to the spine or dislocation of the spine.
A whiplash-associated disorder (WAD) is when the force of an automobile collision injures connective tissue or muscles in the neck. There are four levels of WAD injuries, also referred to as grades. WAD grades 1 and 2 are considered minor injuries and covered under treatment protocols. Symptoms include neck stiffness, pain or tenderness, and reduced motion. WAD grades 3 and 4 are more severe and not covered under Section B protocols. They involve signs of neurological decline presented in reduced reflexes or loss of feeling, in addition to any fracture or dislocation of the spine.
How Do I know If My Injuries Fall Within Section B Protocols?
If your injury meets the definition of a minor injury outlined in the Automobile Accident Minor Injury Regulation of the Insurance Act, your injuries will fall within Section B protocols. However, an injury is no longer considered minor if it results in a serious impairment.
According to the regulations under the Insurance Act, a serious impairment must be ongoing since the accident and not expected to improve, resulting in a substantial inability to perform the following:
- The essential tasks of regular employment, occupation or profession, despite reasonable efforts to accommodate the impairment.
- The essential tasks of training or education in a program or course that the injured person was enrolled in or had been accepted for enrollment at the time of the accident, despite reasonable efforts to accommodate the impairment.
- The normal activities of daily living.
A healthcare practitioner must use the criteria outlined in the Insurance Act to diagnose and determine the severity of an injury. Authorized treatment plans are also outlined in the Insurance Act as a way to promote healthier outcomes by providing consistent, quality care for minor injuries.
How Many Treatments Will I Receive if I Choose the Treatment Protocols?
You are entitled to a pre-set number of treatments from your primary healthcare provider or adjunct therapist (massage therapist, acupuncturist or an occupational therapist) if you proceed under Section B protocols. The number of treatments you are entitled to will depend on how severe your injury is.
A 1st or 2nd degree strain or sprain provides up to a combined total of 10 visits, while a 3rd degree strain or sprain allows for a maximum of 21 visits. The same number of visits apply to whiplash injuries grade 1 (10 visits) and grade 2 (21 visits).
Patients with multiple injuries from a single accident are eligible for a combined total of 10 visits to treat two or more injuries diagnosed as 1st or 2nd degree strains or sprains, and a grade 1 whiplash injury. A maximum of 21 visits is available to treat one or more 3rd degree strains or sprains and a grade 2 whiplash injury.
How Long Can I Receive Treatments Under Section B Protocols?
Coverage for treatment under Section B protocols expires in 90 days from the date of the accident. A patient or health care practitioner cannot submit an insurance claim for treatment protocols until the patient has completed the prescribed claim form for the injury. This form must be sent to the insurer no later than 10 business days after the accident.
An insurance provider must respond with a decision within 5 business days of receiving a completed prescribed claim form. The decision must either approve or refuse the claim.
Reasons a Treatment Protocol Claim May Be Denied
- The person who was injured does not meet the definition of “patient”.
- The insurer is not liable to pay due to an exclusion set out in Subsection 3 – Special Provisions, Definitions and Exclusions of this Section of the Section B benefits.
- There is no existing contract that applies to the person who was injured.
- The injury was not caused by an accident involving the use or operation of an automobile.
If an insurer does not send a decision notice back to the applicant within the time limits set out in the Insurance Act, then the claim is considered approved. However, even if an insurer approves a claim for treatment protocols, they may later refuse the claim by sending a written notice to the patient and each person that the patient is authorized to visit for treatment.
If you’ve been involved in a car accident, it’s crucial to understand your rights. Valent Legal is here to guide you through the process and help you secure the compensation you deserve.
What if I Haven’t Recovered After Receiving Treatment Under the Protocols?
Suppose you have completed your pre-set treatments and have not recovered from your injury. In that case, you may be eligible for Section B benefits to cover additional treatments. An injury management consultant must reassess your injuries and provide a referral to explain why further treatments are still medically necessary.
All medical treatments and associated services deemed necessary by the injured person’s physician should be covered under Section B. You can also seek reimbursement for prescription and non-prescription medication used to treat or manage injuries and related pain caused by the car accident.
Medical Expenses Covered by Section B:
- Ambulance services
- Surgical treatment
- Chiropractic treatment
- Dental reconstruction
- Hospital fees
- Psychological counselling
- Physical therapy
- Occupational therapy
- Message therapy
- Medication
- Acupuncture
- Nursing care
- Funeral expenses
- Death benefits
- Medical equipment
If you chose to proceed with treatment protocols, coverage under Section B will only kick in after your initial treatment coverage has been exhausted. Your medical expenses under Section B will be covered up to $50,000 or four years after the accident, whichever comes first. If someone else is responsible for causing the car accident, you can file a claim with their insurance provider to pay for medical expenses beyond the Accidents Benefits coverage in your auto insurance policy.
Step-by-Step Guide to Accessing Section B Protocols
Getting the treatment you need after an accident is possible, but it requires understanding and following the right steps under Section B protocols.
- Report the accident: Notify your insurer as soon as possible, detailing the accident and injury.
- Seek initial medical assessment: Visit a healthcare provider for an initial evaluation of your injury.
- Confirm eligibility under protocols: Your injury must meet criteria to qualify for Section B coverage.
- Complete and submit required forms: Prepare necessary documentation, for example, your treatment plan, and submit to your insurer.
- Understand Insurer approval and timelines: Wait for insurer approval, which can take several days to weeks depending on the complexity of the claim.
- Begin treatment: Once approved, start your treatment.
Be mindful of potential delays like missing forms or requests for additional information. To avoid these, double-check your submissions and stay in contact with your insurer to ensure everything is on track.
Section B Protocols FAQS
How Do I Appeal a Denied Section B Claim in Nova Scotia?
If your Section B claim is denied, the first step is to request an internal review from your insurer. If the decision isn’t reversed, you can escalate the matter by filing a formal dispute. You may also explore mediation or arbitration as alternative resolution methods.
Throughout this process, it’s crucial to keep thorough documentation and be aware of timelines to ensure your appeal remains on track. If needed, consider seeking legal support to navigate complex disputes effectively.
Where Can I Find the Prescribed Claim Form for Section B Protocols?
You can find the prescribed claim form for Section B protocols through the Nova Scotia Superintendent of Insurance’s official website or TDI form listing. Typically, you’ll need to submit the initial claim form along with a treatment plan form to begin the process. Make sure to use the most up-to-date forms to avoid delays in your claim.
What Is the Maximum Monetary Limit for Section B Coverage Beyond the Initial Protocols?
The standard monetary limit for Section B coverage is up to $50,000 for medical benefits. Once this limit is exceeded, you may be able to access additional coverage, but it requires further approval from your insurer and medical justification. You’ll need to provide supporting documentation to demonstrate the necessity of continued treatment beyond the initial protocol limits.
What Is the Difference Between Section B Protocols and Section B Benefits?
Section B protocols refer to the structured treatment pathway for specific injuries, guiding the approval and process of medical care. In contrast, Section B benefits are the broader coverage categories available under Section B, such as medical expenses, income loss, and housekeeping costs, which apply to a range of accident-related needs.
Should I Always Opt for Section B Protocols, or Are There Situations Where the Traditional Insurance Claim Route Is Better?
Section B protocols are ideal for straightforward injuries where a clear treatment path is required. However, for more complex or severe cases that fall outside the protocols, the traditional insurance claim route may be more appropriate. The treatment approach depends on your diagnosis and medical advice, so it’s important to follow the guidance of your healthcare provider when deciding which route to take.
What Happens if My Injury Initially Seems Minor but Later Develops Into a Serious Impairment?
If your injury seems minor at first but later becomes more serious, your claim can transition out of the Section B protocols. The key is reassessment, new medical evidence and updates from your healthcare provider can support this shift. If necessary, you may also gain access to extended benefits to help cover the increased treatment costs and support your recovery.
How Does Section B Coverage Interact With My Private Health Insurance or Provincial Health Plan?
Section B coverage typically covers the costs first, including medical expenses related to your injury. However, if your private health insurance or provincial health plan covers additional services or treatments, those may be billed after Section B benefits. Public healthcare coverage may have limitations, such as not covering certain specialized treatments, which is where your private insurance can fill in the gaps.
What Role Can a Personal Injury Lawyer Play in a Section B Claim, Especially if It’s Denied or Complex?
A personal injury lawyer can be invaluable in a Section B claim, particularly if it’s denied or becomes complex. They help manage disputes, ensure all documentation is in order, and push back against denials or delays. By navigating the legal process and advocating for you, a lawyer protects your access to full benefits and helps ensure you’re not left without the care and compensation you deserve.
Contact Valent Legal to Learn More About Section B Coverage Protocols
While Section B protocols are meant to accelerate medical treatment for minor injuries, you need to properly assess the full extent of your losses. If your injuries leave you unable to work or perform daily activities, you should seek legal advice to determine the car insurance personal injury benefits you qualify for.
Our team of car accident lawyers at Valent Legal understands the devastating impact a car accident can have on you and your loved ones.
If you have questions about your claim or believe an insurer has wrongfully denied a claim, contact Valent Legal for a free, no-obligation case evaluation. We will review the circumstances of your accident and injury, and advise you on your legal rights and options to recover the compensation and medical treatment you are legally entitled to.