Legal Blog

Extended Health Benefits Plans and Accident Benefits

Monday, October 01, 2007

Many people injured in automobile accidents are surprised to discover that their extended health benefit coverage is considered the primary payer. When you file an initial Application for Accident Benefits form you must disclose in Part 10 the name of the benefit carrier, the coverage type and your policy or certificate number.

In accordance with Section 60 of the Statutory Accident Benefits Schedule a party?s extended health benefit plan must be billed first when applying for a medical or rehabilitation benefit. After the specific coverage from this plan has been exhausted then Accident Benefits coverage will kick in.

The majority of people who have extended health benefits through their work or their spouse have coverage for dental services, medications and a per calendar year amount for such items as physiotherapy, massage therapy, chiropractic treatment etc. An example of the effect of this Section follows:

You have coverage through your workplace plan for $500.00 per year for physiotherapy services. You are involved in a motor vehicle accident and are recommended to start physiotherapy. The clinic you attend will have to submit invoices first to your extended health plan and when this is exhausted your Automobile Insurer will accept billing.

Many people find this system unfair as an extended health benefit plan is usually used on an as needed basis and the coverage disappears quickly after a traumatic event such as an automobile accident. This situation makes it impossible for someone who wants to use their coverage for regular maintenance to do so without paying out of pocket.