Chp 3- Accident benefits Flashcards
Accident Benefits
Are available under the various automobile policies and government insurance plans used in BC.
Benefits and compensation available to drivers, passengers, pedestrians who have been hurt in a accident
Who is covered in accident benefits?
Part 7 accident benefits cover the following:
- All occupants of vehicle licensed and insured in BC
- Members of the household of BC vehicle owners
- Occupants of vehicles licensed in BC
- Pedestrians/cyclists who are in collision with licensed and insured vehicle in BC
- BC residents with valid drivers license, and members of there household who do not have outstanding debt with ICBC
- Resident of BC who is injured by unidentified or uninsured driver
What are the coverages provided by accident benefits?
Disability benefits (wage loss) Disability Benefits (Homemaker) Death Benefits Medical and Rehabilitation expenses Funeral Expenses
Disability benefits
Available to two types of people (Employed persons or homemakers)
Insured person who is disabled entitled to weekly income replacement if they meet the following qualifications:
-Employed at the time of accident or worked 50 % of year
-was not employed at time, but was homemaker and now has injuries which prevent them from performing most household tasks
Benefits for Employed Persons
- Not payable for first 7 days
- To be eligible, insured must be disabled withing 20 days after the date of accident
- Entitled to receive benefits for maximum of 104 weeks, unless suffering a complete inability to engage in any employment which the person is reasonably suited for
- Can receive benefits until 65 if you cant do your job, but after ICBC requires insured to apply for Canada Pension Plan (CPP)
- Amount of benefit is 75% of insureds average weekly gross income from employment (max weekly is $740 unless optional coverage purchased)
- When insured injured in course of their employment and is under workers compensation act, ICBC is not liable to pay for benefits for injury or death
Benefits for Homemakers
- Autoplan will pay up to max $280/week
- To be eligible, must be disabled withing 20 days of accident
- No benefits if family member performs household tasks, a third party must be hired
- Available for duration of disability or 104 weeks, whatever comes first
Medical and Rehabilitation expenses
- Total paid for these expenses is $300,000
- This benefit covers medical expenses that are not payable under another insurance plan or law, such as medical, surgical, dental, hospital, ambulance, physical therapy, chiropractic treatment, prosthesis, orthosis and more
- Benefit may also pay for certain rehabilitation expenses such as funds for buying a vehicle equipped as necessary for use by insured, funds for necessary alterations in insureds home to accommodate their needs and reimbursement for cost of attendant care
- Benefits may also pay for purchase, repair, adjustment or replacement of required equipment (wheelchair, medically prescribed beds, etc)
Death Benefits
- If insured dies in auto accident, death benefits are payable to the insureds spouse, dependants, or both
- Higher benefits are payed if insured was considered head of household.
- Number of dependants will also affect amount paid
- Two types of payment (initial lump sum or weekly which are made for 104 weeks)
Funeral Benefits
Burial and funeral expenses will be reimbursed up to a maximum dollar amount
What are the exclusions to accident benefit coverages?
are not payed to a person who at the time of the accident:
- is a resident outside province and is occupant of vehicle not insured by autoplan
- is an occupant of or struck by vehicle that cannot be licensed by MVA (ATV)
- Is occupant of certain types of vehicles exempted from autoplan (Govt)
- Commits suicide, or attempts to commit suicide
- is occupant of vehicle that was being used for illicit or prohibited trade
- Suffers injury or death caused directly or indirectly by sickness or disease
- is occupant of vehicle that is of such design that it could be licensed but isn’t
Exempted vehicles under Autoplan and Accident benefits
- Vehicles registered in the name of Government, federal agency (canada post, RCMP) are exempt from autoplan
- Certain vehicles that are exempt from requirements to purchase basic autoplan insurance may choose to purchase it through ICBC, which in turn will cover them under Accident Benefits
Loss of benefits due to breach of coverage conditions
Failure to comply with following conditions will invalidate coverage and make you loss your benefits:
- operating vehicle if insured is not authorized and qualified (suspension)
- operating vehicle for illicit or prohibited trade
- operating vehicle to escape or avoid arrest
- operating vehicle in a race or speed test
Accident Benefits Fraud
Well informed fraudulent claimants use cunning tactics to abuse rules and regulations, that hinder investigations, knowing that insurers may face substantial penalties when benefits are not paid promptly
Insurance fraud often involves groups of people who work together in what is known as fraud rings
What is a recruiter?
A recruiter gathers a number of prospective accident benefits claimants, who act in a scheme to commit fraud in exchange for a monetary benefit. The people recruited pay a fee to participate in the scam and in return, are offered a portion of the accident benefits
What are planned accidents?
-Recruiter plans the accident and works out the details (Personal info is exchanged)
-Accidents typically staged at night, behind buildings and areas where there are not witnesses
-The vehicle is often old rental vehicle, usually drive into wall slowly causing damage of usually about $500
- Stage accidents may involve several vehicles or can involve innocent third parties (typical plan is when your turning right, and tp is turning left, you wait for them to turn and crash into them after they do)
Studies show individuals involved in AB fraud are often involved in various other criminal activities such as welfare fraud, employment insurance fraud, drug trade, etc.
