Access to Medical and Rehabilitative Benefits After a Car Accident
If you have serious injuries from a car accident, you are entitled to accident benefits from your own insurance company, regardless of whether you are at fault. These benefits are referred to as “no fault” benefits and include a category of benefits referred to as medical and rehabilitative benefits. These benefits cover treatment and measures you need to take to heal your injuries, rehabilitate and re-integrate into your family, society and the work force. Depending on the severity of your injuries and the limits of coverage under the particular policy of insurance you purchased, your insurance company will be responsible for funding your treatment up to certain monetary amounts. Medical and rehabilitative benefits include physiotherapy, chiropractic therapy, massage therapy, vocational rehabilitation, psychological counselling, prescription medication, home renovations, medical aides and devices (ie. casts, canes, crutches, wheelchairs, ergonomic devices).
Your insurer is required to pay for all “reasonable and necessary” medical and rehabilitative treatment that is not covered by OHIP or any extended health care plan you have private coverage under. Whether a particular treatment is reasonable and necessary depends on many factors and unfortunately does not follow a straightforward definition. Your insurer will look at the efficacy of the particular treatment, the appropriateness of the treatment to your injury, the duration of treatment and whether the treatment is likely to alleviate symptoms. You are also required to exhaust any limits under your own private plan before your auto insurer will accept and pay your expenses.
