Chapter 3 Flashcards
The terms and conditions of accident benefits coverage in Alberta are set out where ?
Insurance act
Automobile accident insurance benefits regulation
Owners policy SPF 1
Coverage details are further defined in MIR and DTPR
What types of injuries does the DTPR apply to
It applies to sprains, strains, whiplash associated disorders, some temporomandibular joint injuries, and related physical or psychological symptoms
Specific limits apply to these injuries for the number of visits and treatments injured persons will recieved
Subsection 1 medical payments covers all reasonable and necessary expenses incurred within two years from the date of the accident as a result of those injuries list the following
Medical treatments Surgical treatments Chiropractor treatments Dental services Hospital services Psychological services Physical therapy Occupational therapy Massage therapy Acupuncture Professional nursing Ambulance services
Define dependant
One who is not able to exist or sustain himself or herself without the power of aid of someone else I’ve who relies on another for support..
What is the minor injury regulation ? And the DTPR regulation?
The minor injury regulation and the diagnostic and treatment protocols regulation settle the treatment framework and timeline for a minor injuries. They provide a format to officially process predefined injuries such as brain strains and Whiplash associated disorders among others. The formant is designed to promptly place the injured person into a treatment plan without the need for expensive and prolonged assessments.
Who is the priority of payments under the DTPR state
The priority of payments under the DTPR state that an insurer is the first pair after the Alberta Healthcare insurance plan
List limits that apply to coverage under subsection 1
$50,000 per person
75,000 per person for chiropractic service
$250 for massage therapy and acupuncture services
Under subsection 2 part 1 how much does the spouse get in the head of the household dies ? How much for depends under 5 and over 69? How much for dependants between 10 and 17 and dependants all other ages ?
10,000 for the spouse or adult interdependent partner
1,000 for depends under 5 and over 69
3,000 for dependants between 10 and 17
2,000 for all other dependants
What happens if there is 2 or more survivors after the death of the head of house hold ?
when there are two or more survivors after the death of a household, the death benefit is increased by 20% for each Survivor other than the first period an additional 15,000 is provided for the first surviving spouse, idle interdependent partner, or dependent living in the household plus $4,000 for every dependent after that
In What scenario is the death benefit reduced?
the payment of a death benefit will be reduced if a person was injured in an accident and received payments from the total disability benefit but subsequently died. The reduction is based on the amount of the total disability benefits received
How much money is available for funeral expenses and to the family of a victim for grief counseling expenses?
up to 5,000 is available for funeral expenses and $400 is available to the family of a victim for grief counseling expenses. Both of these coverages relate to the death of any one person. In the case of grief counseling, the amount payable applies when the accident has resulted in the death of the insurance immediate family members. Benefits for death, grief counseling, and funeral expenses will only be paid to someone who is alive 60 days after the death of the insured person
What qualifications need to be met for an insured person who is disabled as a result of an automobile accident entitled to weekly income replacement benefit
then third person was employed at the time of the accident or was working for any six months during the 12 months proceeding to the accident for persons 18 and over
Within 60 days from the date of the accident, such injury prevents the insured person from performing any and every duty pertaining to the interred person’s occupation or employment
it required by the insurer, the disability of the insurance person must be certified by a dually qualified medical practitioner
there’s a 7-Day waiting period so this benefit is not payable for the first week of disability. It is not payable for more than 104 weeks of disability
What is the calculation of the disability benefit
The weekly benefit paid for total disability of employed persons is determined as the lesser of 400 per week and 80% average gross weekly earnings less any payments for loss of income or employment received by or available to the injured person including employer sick leave plans groups accident insurance and accident and sickness policies
the average gross weekly earnings is determined as the greater of the average from 4 weeks prior to the accident or the average from 52 weeks preceding the accident.
Canon in turd person get monetary compensation if they are not employed but completely incapacitated and unable to perform their household duties if so what is their disability payment and for how long can they get this payment
injured persons who are not employed but are completely incapacitated and unable to perform their household duties can receive a disability payment of $135 per week for a period of 26 weeks they must be age 18 or older. This intention of the benefit is to pay for cost of running a household cleaning, shopping, cooking, childcare and so on
Supplemented benefits in no-fault jurisdictions
In the absence of reciprocal agreements, the treatment of non-residents May differ among jurisdictions for example in quebec, manitoba, and saskatchewan, non-residents are not entitled to benefits under the provincial no-fault plans. Instead, benefits are determined based on the degree that the non-resident is not at fault for the accident
