Chapter 3 – Accidents Benefits Model Narrative Application Questions

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Chapter 3 – Accidents Benefits Model Narrative Application Questions
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Chapter – Accidents Benefits Model Narrative Application Questions
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Chapter 3 – Accidents Benefits Model Narrative/Application Questions
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  1. Outline the coverage provided for Death Benefits and Funeral Payments under the Personal Injury Protection Plan (PIPP).
    • Death Benefits and Funeral Payments-          If an insured dies as a result of injuries sustained in an automobile accident, death benefits are payable to the insured’s spouse. o   Dependants,
    • o   Or both (if applicable).

    - In addition, PIPP will pay for grief counseling for immediate family members.

    - Spouses or common law partners receive different amounts than dependents.

    - The amounts depend on a number of factors, including the deceased’s age,

    o   The deceased’s gross yearly employment income,

    o And the age of dependent children.

    - The indemnity amounts are described in the MPIC Act,

    - But they are beyond the scope of this course.

    - A dependant who is disabled on the insured dies receives an additional lump sum indemnity if the person providing support dies as a result of a motor vehicle accident.

    - If deceased insureds have no dependant on the day they die,

    o   Their children

    o   And parents are entitled to a lump sum indemnity even though they are not dependents.

    - The Corporation will also reimburse funeral expenses,

    o Including the cost of transporting the deceased

    o And cost of a grave marker,

    o Up to a maximum amount stated in the MPIC Act.

    - It pays these expenses directly

    o Or reimburses the deceased’s estate if the bills have already been paid.
  2. Describe the compensation provide to claimants who experience permanent impairment.
    Compensation for Permanent Impairment

    - Insureds who permanently lose normal physicalo   Or mental function

    o Or are permanently scarred

    o Or disfigured because of a motor vehicle accident are entitled to a lump sum payment under PIPP –under the compensation for permanent impairment.

    - The Corporation evaluates permanent impairment amounts according to a schedule contained in the legislation.

    - If the impairment is not listed on the schedule, the Corporation evaluates it using the schedule as a guideline.

    - If then uses these evaluations to calculate the amount of indemnity it will provide to the victim.

    - If a victim has multiple impairments, the Corporation will consider this when calculating the amount of compensation it will provide.

    - The lump sum impairment payment is made after treatment has been completed; the injury has healed as much as possible.

    o And the extent of the impairment can be properly assessed.

    - This may take a year or more, depending on the injury.

    - No compensation is paid for permanent impairment if the victim dies from the accident.
  3. You are a claims adjuster and you have been assigned the following automobile claim.  An insured, Donny, was involved in a two-car accident while on his way home from work. A third party, who was not paying attention while driving, hit Donny’s vehicle from behind, and has been deemed 100% at fault. As a result of the accident Donny was left with serious injuries to his spine and head. Donny has basic Autopac insurance policy.  Prior to the accident Donny was working full time as a long distance truck driver.  

    a) Does Donny qualify for Accident Benefits under his basic Autopac policy? Explain your answer.

    b) The injuries that Donny sustained prevent him from returning to work. How will he sustain himself financially? Explain your answer.

    c) To accommodate his injuries Donny had to make several renovations to his home, including the installation of a wheel chair ramp, hydraulic lift, and several specialized kitchen aids. Will these renovations be covered under the Accident Benefits of Donny’s basic Autopac policy? Explain your answer.
    a) Personal Injury Protection Plan(PIPP)  

    - Yes, Donny does qualify for Accident Benefits.

    – PIPP actually applies to ALL Manitoba residents. It is not tied into an Autopac policy. Any MB resident injured as a result of a motor vehicle accident is covered by PIPP.

    - In Manitoba, Accident Benefits are included in the basic Autopac coverage provided by MPI,

    o And are called the Personal Injury Protection Plan (PIPP).

    - These benefits help victims who are injured in motor vehicle accidents with medical costs

    o And wage loss regardless of who is at fault.

    - All Manitobans have their own injury coverage through Autopac.

    - Manitoba implemented PIPP on March 1,1994, based on these four principles:  

    1) Coverage extends to all Manitoba residents injured in automobile accidents anywhere in Canada or the U.S.A.

    2) Compensation focuses on specific economic losses from an automobile injury or death.

    3) Compensation is guaranteed for all injured Manitobans, regardless of who was at fault for the accident.

    4) Most benefits are indexed to the Consumer Price Index (CPI) to reflect changing economic conditions.        


    b) Manitoba Accident Benefits  

    - Because Donny was working Full-time prior to the accident the Personal Injury Protection Plan provides an income replacement indemnity (IRI).

    - The Personal Injury Protection Plan provides an income replacement indemnity(IRI) to people who were working(full- or part-time)

    o Or who could have been working when the accident happened.

    - It covers 90 percent of their net employment insurance benefits,

    o Lost wages,

    o Or salary based on gross yearly employment income.

    o Up to a maximum benefit amount that is adjusted annually.

    - There is a seven-day waiting period for benefits, meaning insureds (Donny) are entitled to income replacement,

    o Beginning on the 8th day after the accident, when

    o A motor vehicle accident caused the injury,

    o And the injury prevents them from performing all

    o Or most of the main daily duties of the job that they had at the time of the accident.   

    c) Rehabilitation 

    - The renovations made to Donny’s house to accommodate his injuries would be covered under the Personal Injury Protection Plan (PIPP) of his Accident Benefits of his basic Autopac policy.

    - The goal of rehabilitation coverage under PIPP is to help insureds (Donny) resume their normal pre-accident activities as much as possible, and

    - To assist their recovery and offset economic hardship, PIPP provides compensation for treatment costs

    o And a range of economic losses.

    - Rehabilitation coverage includes the following, where appropriate:

    - Home renovations

    - Transportation assistance and vehicle modifications

    - Services, such as assessments and treatment by special health care practitioners

    - Equipment, such as specialized kitchen aids

    - The type of rehabilitation assistance insureds(Donny) receive depends on many factors, including their

    o   Medical condition,

    o   Employment options,

    o   Retraining possibilities,

    o   And commitment to recovery.

    - If insureds (Donny) cannot return to their pre-accident job, MPI will help them identify other employment options.

    - Again, the kind of help MPI will provide depends on each individual’s circumstances.

    - The options include job search assistance,

    o On-the-job training,

    o Or other training,

    o Home renovations,

    o Transportation assistance and vehicle modifications,

    o Services, such as  assessments and treatment by special health care practitioners, ando   Equipment, such as specialized kitchen aids

    - The goal of rehabilitation coverage under PIPP is to help insureds (Donny) resume their normal pre-accident activities as much as possible.

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