Chapter 6 - AB Flashcards

Question

Describe non-earner benefit.

Answer 1

- payable to 3 classes of insured persons. They are those who suffer a complete inability to carry on a normal life and: i) do not qualify for IRB ii) cease to receive caregiver benefits because there is no longer a person in need of care iii) were enrolled on a full time basis in elementary, secondary, post-sec education at the time of the accident or had completed their education less than 1 year before the accident and were not yet employed in an employment reflecting education/training - is equal to $185 per week and is not payable for the first 4 weeks after an accident nor until person reaches age 16 - after 104 weeks have elapsed since the onset of disability, the benefit becomes equal to $320 per week - benefit is only payable as long as the person suffers a complete inability to carry on a normal life and is adjusted downward at age 65

Answer 2

- insured person who sustains a catastrophic impairment as a result of an accident, within 104 weeks after the accident, the insured suffers a substantial inability to engage in the caregiving activities in which he/she was engaged at the time of accident and if at the time of accident: 1) insured person was residing with a person in need of care 2) insured was the primary caregiver for person in need of care and did not receive any remuneration for engaging in caregiving activities - will pay for reasonable/necessary expenses incurred as a result of the accident in caring for a person in need of care, but shall not exceed: i) $250/week for expenses in caring for 1 person ii) plus an additional $50/week for each additional dependent - will only be indemnified for actual expenses incurred (above are max amounts) - benefits are payable for no longer than 104 weeks of disability, unless as a result of the accident, the insured is suffering from complete inability to carry on a normal life - the insured may not receive benefit if he/she is receiving an IRB or non-earner benefit - insured has the option of extending coverage to apply to situations where the claimant sustains non catastrophic injuries subject to same max time limit for an add. premium

Answer 3

MEDICAL BENEFITS Pays for all reasonable/necessary medical expenses that are not payable under another ins plan/law - medical, surgical, dental, optometric, hospital, nursing, ambulance, audiometric, speech language pathology services - chiro, psychological, occupational therapy, physio - medication - prescription eyewear - dentures/dental devices - hearing aids, wheel chairs/mobility devices, prosthesis, orthotics, other assistive devices - transportation for insured, and an aide/attendant to and from treatment sessions - other goods/services of a medical nature that insured requires note: transportation costs will be calculated based on a trans. expense guideline produced by FSCO. If person uses his/her own auto, no payment may be made with respect to the first 50 km per round trip to a treatment session REHAB BENEFITS Pays for reasonable measures to reduce/eliminate effects of any disability resulting from impairment - social rehab including training, counseling, home mods, vehicle mods - vocational rehab including counseling, vocational and academic training, workplace mods - transportation to and from sessions - other goods/services required note: professional services guideline publishes the max amounts insurers will be required to pay for life skills training, family counseling, social rehab couns, finan. couns., employment couns., vocational assessments, vocational/academic training CASE MANAGER BENEFITS - pays all reasonable/necessary expenses incurred on behalf of a person sustaining catast. impairment as a result of an accident for services provided by a case manager in accordance with treatment plan - insurers are not required to pay for services of case managers who are not accredited ATTENDENT CARE BENEFITS Pays for all reasonable expenses incurred by or on behalf of an insured person for: i) services provided by an aide or attendant ii) services provided by a long term care facility including a nursing home, home for the aged, or chronic care hospital - max amt payable is $3000/month when injuries are classified as non-cat. and $6000/month for cata. impairment - benefit is subject to a max limit of $36,000 for non cat. and $1M for cata. impairment OPTIONAL DEPENDENT CARE BENEFIT - insured has the option of purchasing benefit which pays for reasonable/necessary add. expenses incurred by or behalf of insured as a result of an accident in caring for insureds dependants, if insured: i) sustained an impairment as a result of an accident ii) was employed at the time of accident iii) is not receiving caregiver benefit - amt of benefit shall not exceed $75/week for first dependant and $25/week for each add. dep. to a max amt of $150/week

Answer 4

a) Educational expenses - insured who was enrolled in a program of elementary, secondary, post-sec, or cont. education who as a result of accident, is unable to continue the program will be entitled to reimbursement for reasonable expenses incurred in respect to tuition, books, equipment, room/board in respect of program term/year in which person was enrolled at time of accident - max amt payable is $15,000 b) expenses of visitors (no max limit) - reasonable expenses incurred in visiting injured person during treatment/recovery by a spouse, child, parent, grandchild, grandparent, bro, sis of insured will be paid - no amts payable for expenses incurred more than 104 weeks after accident unless insured sustained cata. impairment c) housekeeping and home maintenance expenses - pays for reasonable/necessary add. expenses incurred on behalf of insured respecting housekeeping and home main services if because of the accident, insured sustained cata. impairment and suffers a substantial inability to carry out housekeeping and home main. servives that he/she normally performed before accident - max repayment of $100/week from date of onset of disability - insureds have option to extend benefit to apply when injuries/impairments are non-cat. subject to max of 104 weeks from date of onset of disability d) damage to clothing, glasses, hearing aids, etc - Pays for all reasonable expenses incurred by or on behalf of insured in repairing or replacing: i) clothing owrn by insured at time of accident ii) prescription eyewear, dentures, hearing aids, prostheses, other medical/dental devices that are lost/damaged in accident e) cost of examination - pays all reasonable expenses incurred in arranging and attending an exam/assess including fees for service - also pays fees charged by person who provides treatment plan and transportation costs - amounts payable may not exceed max amts established under professional servive schedule published by FSCO - limited to $2000 per assessment

Answer 5

if an insured person dies within 180 days as a result of an auto accident or within 156 weeks if there has been continuous disability and is survived by at least 30 days by a spouse or dependant, benefits are paid as follows: a) $25,000 will be paid to surviving spouse ($50,000 if optional benefit was purchased) b) $10,000 to each surviving dependant and to any person to whom insured has an obligation under domestic contract/court order to support them ($20,000 for increased amt) c) if insured is not survived by a spouse, $25,000 will be divided amongst dependants/person he/she has obligation to d) if insured is survived by former spouse to whom he/she weas obligated to support under court order, $10,000 is payable to former spouse e) if deceased was a dependant, $10,000 is payable to person upon whom the deceased was dependent note: spouse refers to the person who was the spouse at the time of accident - a max funeral benefit of $6000 is payable, but can be increased to $8,000 if opt. benefit is purchased

Answer 6

The following must be made available to all insureds by every insurer that writes auto ins in Ont. 1) increased IRB 2) caregiver benefits extended to apply to non-cat claims 3) increased and extended med, rehab, and att. care benefits 4) addition of dependent care benefits 5) housekeeping and house main. expenses extended to apply to non-cat. claims 6) increased death and funeral benefits 7) annual indexation of benefits and limits based on CPI - these may be purchased at any time before an accident - amount of opt. benefit is available only to the named insured, any person specified in policy as a driver of insured auto, and if named insured is an individual, spouse of named insured, and any dependent of named insured/spouse

Answer 7

- not required to pay income replacement, non-earner, ed. expenses, expenses of visitors and housekeeping/home main. if: 1) to a person who as a result of an accident, was convicted of operating auto while his/her ability to operate auto was impaired by drugs or alcohol 2) to a person, who as a result of an accident, asked to provide a breath sample and is convicted of failure to provide sample 3) to a person, who as the driver, knew/ought to have known that he/she was operating the auto while it was not insured under motor vehicle liab. policy 4) to a person, who as the driver, was driving auto without valid drivers licence 5) to a person, who as the driver, is an excluded driver under policy 6) to person, who as the driver, knew/ought to have known that he/she was operating auto at the time of accident without owners consent Insurer will also not pay benefits in respect of: 1) any person who has made, or who knows of, a material misrep which induced insurer to enter into contract of insurance or who intentionally failed to notify insurer of a change in the risk material to the contract 2) an occupant of an auto at the time of accident who knew/ought to have known that the driver was operating auto without consent - does not prevent occupant of an auto driven by excluded driver from recovering AB

Answer 8

- when a person is engaged, or an occupant of an auto that was being used in connection with an act for which the person is charged with a criminal offence, the insurer must hold in trust, the money payble for IRB, non-earner, ed. exp, exp. of visitors, and houskeep/house main. - these must be paid if the person is found not guilty - criminal offence means operating an auto which a blood alcohol concentration exceeding the legal limit, failing to comply with a lawful demand for a breath sample, or any other criminal offence, whether or not the offence is related to operation of an auto

Answer 9

- eff June 1, 2016 - to help make ins premiums more affordable, benefits/covs included in the standard policy were changed again - some benefits were reduced, and some options for increased cov were eliminated/changed - trying to provide more limited standard AB but also providing more options for insureds to purchase increased limits or additional benefits to enchance their cov