Chapter 3: Accident Benefits Key point Review questions

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Chapter 3: Accident Benefits Key point Review questions
2014-02-13 14:01:22

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  1. 1) Why are Accident Benefits necessary?
    Accident Benefits are necessary to cover the well-being of the drivers and passengers


    Ex: When injuries or death arise from an automobile accident, heavy financial burdens can result


    • -In the case of a fatal injury, these burdens can fall on spouses or
    • dependants left behind


    • -Injured persons can incur medical and rehabilitation expenses while, at
    • the same time, being unable to work and earn an income; dependants who have
    • lost a loved one in the automobile accident may be left with no means of
    • support.


    • - When insured drivers were not responsible for a mishap, they and the occupants
    • of their vehicles could recover from the responsible parties, provided those other drivers had insurance. However it could be months or even years, if liability was disputed, before settlements were reached in the courts. In the meantime, urgent immediate expenses had to be met. Furthermore, if the driver was found at fault, he or she would never be entitled to any financial assistance from automobile insurance
  2. 2)What does the term “no-fault” mean in the realm of automobile insurance?
    “No-Fault”:means that claims are settled with an insured without regard for the traditional legal liability concepts and that an insured looks to his or her own insurer to recover after suffering a loss
  3. 3)Briefly trace the evolution of no-fault Accident Benefits in Canada.
    • -  In Canada evolved from Medical expense coverage which was first introduced as an
    • optional coverage in late 1940’s

    •  -  Provided minimal coverage on a
    • no-fault basis for medical expenses for drivers and passengers injured in
    • automobile accidents insured had choice of limits

    • - Universal Medicare was established in Canada beginning in the 1960’s before that
    • Canadians were injured in automobile accidents were responsible for paying for
    • medical treatment

    • -   In the early stages, Accident Benefits were very similar in all provinces. They provided modest limits that were immediately available to everyone injured in an automobile accident. Seriously injured people could pay immediate expenses
    • upfront and then pursue recovery from at-fault third parties through to the
    • courts.

    -   Overtime provinces have taken different directions and much more sophisticated plans have emerged

    • -   Songs provinces, the right to sue has been removed or limited to specified
    • circumstances to compensate for that coverage has been greatly enhanced and
    • limits increased

    • -  Other provinces, innocent parties are still permitted to sue those who are at-fault
    • for full compensation and in those provinces Accident Benefits amounts remain nominal
  4. 4) In automobile insurance, what is a threshold?
    • Threshold: is the degree of injury a claimant must establish before being allowed to sue the negligent party. It may be a dollar
    • amount or a verbal description of the severity of the injuries that must be
    • suffered to establish this right of action
  5. 5) Which provinces have banned lawsuits by motorists and passengers injured in automobile accidents?
    Manitoba and Quebec
  6. 6) How are Accident Benefits provided in Manitoba?
    Provided by MPI through basic Autopac coverage and are called Personal Injury Protection Plan
  7. 7) Does a person injured in an automobile accident in Manitoba have the right to sue the
    responsible motorist? Explain.
    • No they don’t have the right to sue. As the benefits from
    • PIPP help victims who are injured in motor vehicle accidents with medical costs
    • and wage loss regardless of who is at fault. All Manitobans have their own injury coverage through Autopac
  8. 8) What Manitoba legislation defines the scope and breadth of Accident Benefits coverage?
  9. 9) List the 6 main areas of coverage under Autopac’s Personal Injury Protection Plan (PIPP)?
    Division 2: Income replacement indemnity, indemnities for minors and students, and retirement income


    Division 3: Death benefits (including funeral expenses)


    Division 4: Compensation for Permanent impairment


    Division 5: Reimbursement of expenses


    Division 6: Rehabilitation


    Division 7: Claims for compensation (by health practitioners etc.)


    Division 8: How these indemnities are to be paid


    Division 9: Indexation of benefits
  10. 10)  Briefly outline the income replacement
    indemnity (IRI) available under Autopac for employed persons who have been
    injured in an automobile accident
    •  The Personal Injury Protection Plan provides
    • an Income replacement Indemnity (IRI) to people who were working (full-time or
    • part time) or could have been working when the accident happened. IRI covers
    • 90% of their net employment insurance benefits, lost wages, or salary based on
    • gross yearly employment income up to a maximum benefit amount that is adjusted
    • annually

    • There is a 7 day waiting period for benefits.
    • Which means insures are entitled to income replacement, beginning on the 8th
    • day after the accident, when:

    a) A motor vehicle accident caused the injury; and

    b) The injury prevents them from performing all or most of the main daily duties of the job that they had at the time of the accident


  11. 11) Briefly outline the various forms of IRI available under Autopac for people who were not employed at the time of the accident.
    Non-Earners are entitled to an income replacement indemnity for any time during the first 180 days after an accident, if as a result of the accident they are:


    a) Unable to hold an employment that they would have held during that period if the accident had not happened; or

    b) Deprived of a benefit under the Employment Insurance Act or the National Training Act(Canada) to which they were entitled at the time of the accident

    Non-Earners entitled under both a and b can claim whichever amount is greater
  12. 12) When do each of the various forms of income replacement indemnity terminate?
    Victims are no longer entitled to IRI if:

    a) They are able to hold the employment that they held at the time of the accident

    b) They are able to hold higher paying employment;

    c) They are able to hold an employment determine for them by the Corporation;

    • After 180 days of disability, the
    • Corporation will determine an employment for temporary or part-time earners,
    • non-earners, seniors, or students(who qualify for IRI) and pay the IRI based on
    • the new determined employment. This new amount of IRI can never be less than
    • the amount the disabled person was originally receiving. This provides for
    • betterment of the IRI should the disabled person be under-employed at the time
    • of the accident


    • d) It is one year(or more) from the day they are able to hold employment determined for them based on their residual earning
    • capacity(However they continue to receive a top-up IRI payment for the difference if their original IRI is not recaptured by their resident earning capacity);


    e) They hold employment from which the gross income is equal to or greater than the gross income on which the IRI is determined;


    f) The time period specified in the MPIC Act has expired – such as the end of a school term; or


    g) They die.
  13. 13) Are funeral expenses covered under PIPP?
    Yes, the Corporation will also reimburse funeral expenses, including the cost of transporting the deceased and cost of a grave marker up to a maximum amount stated in the MPIC Act. It pays the expenses directly or reimburses the deceased’s estate if the bills have already been paid.
  14. 14) What types of payments are made under death benefits?
  15. 15) What compensation is available for a victim who suffers permanent impairment as a result of an automobile accident?
    A lump sum payment under PIPP
  16. 16) What coverage is available to cover expenses that insureds injured in automobile accidents may face as a result of their
    a) Personal Assistance expenses

    b) Caregiver expenses

    c) Family enterprise expenses

    d) Expenses of companions

    e) Various other expenses
  17. 17) What is the limitation period for claims under PIPP?
    PIPP requires claims for compensation to be made within 2 years after the day


    a) Of the accident;

    • b) On which the symptoms are first observed by the practitioner , if symptoms of a bodily injury that is not apparent immediately after the accident are observed by a practitioner more than 2 years after the
    • day of the accident;

    c) An which the person died , if the claim is based on the death of a person; or

    • d) On which the claimant reaches 18 years of age,if the claimant was a minor on the day of the accident on which the claim is
    • based


    The Corporation may extend the time limitation if it is satisfied that the claimant has a reasonable excuse for failing to make the claim within the specified time


  18. 18) Outline the restrictions on PIPP benefits
    The Corporation may refuse to pay compensation to a person, reduce the amount of an indemnity, or suspend or terminate the indemnity where the person:


    • a) Knowingly provides false or inaccurate
    • information to the Corporation


    b) Refuses or neglects to produce information, or to provide authorization to obtain the information, when requested by the Corporation is writing;



    • c) Refuse to return to his or her former
    • employment, leaves an employment that he or she could continue to hold, or refuses a new employment, without valid reason;


    • d) Neglects or refuses to undergo a medical
    • examination, or interferes with a medical examination requested by the Corporation, without valid reason;

    e) Refuses, does not follow, or is not available for, medical treatment recommended by a medical practitioner and the Corporations, without valid Reason;


    • f) Prevents or delays recovery by his or her
    • activities without valid reason;



    • g) Does not follow or participate in a
    • rehabilitation program made available by the Corporation, without valid reason;


    • h)     
    • Prevents or obstructs the Corporation from
    • exercising its right of subrogation
  19. 19) How do PIPP benefits interact with compensation under private insurance plans or the Workers Compensation Act?
    Private Insurance Plans

    Benefits received under any private insurance plan have no effect on the benefits payable under PIPP. Victims who claim compensation under PIPP are not restricted in any way from claiming compensation they may be entitled to under private claims

    Workers Compensation

    • As a result of an accident, a person who is entitled to compensation under PIPP may elect the compensation under PIPP or the Workers Compensation Act. This commonly happens with accidents involving commercial
    • vehicles
  20. 20) Why might an insured purchase SRE coverage including Accident Benefits?
    SRE can be purchased to provide coverage limits that are higher than the basic Autopac limits or provide coverage – including Accident Benefits – for vehicles excluded from Autopac such as certain types of commercial vehicles.