Medical expenses covered by Section B “no fault” insurance_.

You are entitled to receive up to $50,000 (NS, NB, PEI) or $25,000 (NL) in coverage for all medical and rehabilitation expenses incurred resulting from a motor vehicle accident. There are three main categories of expenses:

• All expenses incurred for necessary medical, surgical, dental, chiropractic, hospital, professional nursing and ambulance service;
• Any other service within the meaning of insured services under relative insurance acts; and
• Such other services and supplies that the insured’s physician and the insurer’s medical advisor agree are essential for the treatment, occupational retraining or rehabilitation of the insured.

Expenses can include treatments, prescriptions, outpatient care, mileage to and from treatments as well as expenses related to retraining for employment. The court in MacKay v. Rovers (1987) 79 NSR (2d) 237 (CA) confirmed that Section B will also cover reasonable cost for food and lodging where appropriate.

In Axa Insurance v. Rolfe, 2004 NBCA 14, the court held that medical services “…certainly includes therapeutic services prescribed by a physician and rendered by a duly qualified health professional” such as a chiropractor or a physiotherapist. This was confirmed in Veno v. United General Insurance Corp, 2008 NBCA 39 when the New Brunswick Court of Appeal held that medical examinations and treatments covered under Section B are not limited to those performed by a physician. Treatments provided by massage therapists, chiropractors and physiotherapists can be covered under Section B.

In Biddle v. Allstate Insurance Co, [1981] ILR 1-1396 (Ont. Co. Ct), the court specified that “necessary care” varies from case to case and is ultimately left to the discretion of the court.

Time limit for Section B medical coverage

Section B medical and rehabilitation coverage extends to “all reasonable expenses incurred within four years of the date of the accident”. This means that courts have the discretion of extending the time limit of the coverage where the nature and cost of ongoing care is determined within the four-year period.

The court in Rushton v. Economical Mutual Insurance Company, 2008 NSSC 237 held that treatments that were obtained after the four-year mark were still covered under the Section B policy as they were “incurred” within the four years following the accident. The Adjudicator gave the word “incurred” the broadest meaning, in finding that something is incurred when it becomes certain that the expense is necessary.

What if Section B refuses to pay my medical expenses?

Your insurance company may refuse to pay Section B benefits if they feel you have recovered from your injuries or if you’ve reached the maximum number of treatment sessions they originally approved. If this is the case, you should visit your family doctor and have additional treatment prescribed. It is very important that you have your doctor’s full support in your treatment. If you are still denied, we step in on your behalf.