Section B: Loss of Income Benefits
Most motor vehicles in New Brunswick are covered by the Standard Owner’s Automobile Policy. This means that if you are involved in an accident and injured while driving an automobile, a motorcycle, a snowmobile, an ATV, or another type of motor vehicle, or you are a cyclist or pedestrian that was injured by a motor vehicle, you may be entitled to medical and loss of income benefits.
This blog will focus on the loss of income benefits that your insurance company may be required to pay if you are injured in a motor vehicle accident. It is important to understand that you can be paid this benefit, along with many others, regardless of whether the accident was your fault. For information about the medical benefits you may be entitled to, read our blog on Section B: Medical Expenses. To learn more about the Standard Owner’s Automobile Policy, check out Understanding your Automobile Insurance Policy
What do you need to do?
The first step to getting this benefit is informing your insurance company of the accident. The person that you will speak with, known as an adjuster, will tell you that they are there to help and that they will send you a package of forms to complete. Although these documents are not legal documents, you should seek legal advice before completing them as they may have an effect on your benefits and any future claims. The following forms are usually completed to open a Section B claim:
- Proof of Claim Form – This form will need to be completed by you. This form will ask the name of your employer, your position, your hours worked, your rate of pay and other employment details.
- Employer’s Confirmation Form or Employer’s Statement – This form will need to be completed by your employer. It will ask your employer to confirm your position, how long you have worked there, what types of tasks you are required to do, how many hours you work per week, and how much you earn.
- Medical Report – This form will need to be completed by a doctor, preferably your family doctor. They will be asked to confirm your injuries, your limitations, your treatment plan, whether you are unable to work or whether your injuries reduce your capacity to work.
- Medical Authorizations – Those forms may need to be completed by you in order for your insurer to obtain medical and employment information. We caution our clients when signing those forms without understanding how they will be used. If you are worried about signing any forms, do not hesitate to contact our office and one of our experienced lawyers will assist you with legal advice.
Were you employed?
The second step is submitting these forms to your adjuster. Once submitted, the adjuster responsible for your Section B claim will need to determine whether you are eligible for loss of income benefits. The first thing that they will typically look at is your Employer’s Statement and ask themselves the following:
1. Were you employed at the time of the accident?
2. If not, were you employed six of the twelve months before the accident?
3. If not, are you an exception to the two rules above?
Below you can find some of the more common exceptions:
a. A person who works part-time can receive this benefit;
b. A person participating in a training program can receive this benefit;
c. A person who was going to start a new job can receive this benefit;
d. A seasonal worker can receive this benefit.
If you were not employed at the time of the accident or if you did not work six of the twelve months before the accident, you will need to prove that you are entitled to receive this benefit. This may be difficult for you to do on your own, but we can help.
Are you able to work?
The third step is determining whether you are able to work. We noted above that your adjuster will probably look at your Employer’s Statement in order to confirm whether you should receive the loss of income benefits. They will probably do the same with the Medical Report when it comes to confirming whether you are able to work. It is important to understand that it is a medical decision and not a legal one. Therefore, it is up to your doctor to confirm whether your ability to work has been affected by the injuries that you have sustained in the accident.
Your adjuster will have to figure out whether you:
- Suffer a substantial inability to perform the essential duties of your occupation or employment; and,
- Suffer such an inability for not less than seven (7) days within the first thirty (30) days from the date of the accident.
You do not have to be completely off of work in order to receive the loss of income benefit. Therefore, if you return to work on a part-time basis or on light duties, you can still receive this benefit.
If you have been denied this benefit, our team of personal injury lawyers can deal with insurers in order to ensure that you have been treated fairly.
How much will I receive?
The fourth step is determining what amount you should receive from your insurance company. Your adjuster is typically responsible for calculating the amount. In New Brunswick, you can receive 80% of your gross weekly income up to a maximum of $250.00 per week. This benefit is calculated by using your gross weekly income. However, the insurance company can deduct Employment Insurance Disability benefits or Short-Term and Long-Term Disability benefits that you may receive from either Service Canada or another insurance company.
If you are a salaried employee, this calculation is relatively simple. However, if you work different hours any given week, if you are a seasonal worker or if you work on commission, this can be quite difficult. If you were able to return to work part-time or on modified duties, this can have an effect on the amount that you can receive for the loss of income benefit. If you feel like you have not received what you are entitled to or if you are unsure of how to calculate your loss of income benefit, we can help.
How long will I receive these benefits?
Finally, the fifth step is ensuring that you continue to obtain documents that support the fact that you are unable to work. You are entitled to receive the loss of income benefit for up to 104 weeks or 2 years if you cannot return to your job.
You are still eligible for this benefit after the first 104 weeks or 2 years have expired. However, at that time, you will be required to prove that the injuries that you sustained in the accident continuously prevent you from engaging in any occupation or employment for which you are reasonably suited by education, training or experience. This means that if you are able to perform some other type of work, you may not be entitled to receive this benefit after the 104 week period following the accident. This is often very difficult to establish. If you are approaching the 2-year mark and fear that you will be cut off, contact a lawyer immediately.
What can I do if I am cut off?
If your loss of income benefits have been cut off, you should contact our firm immediately. If we believe that you are entitled to this benefit, we can take the necessary steps for your benefits to be reinstated immediately or file a lawsuit against your insurer if they refuse to reinstate your benefits.
If you are having any issues with your insurance company and you need someone to assist you in dealing with them, do not hesitate to contact our team of personal injury lawyers. We have helped hundreds of people receive the benefits to which they were entitled. Here at Fidelis, we’re in your corner.