Section B benefits in PEI pay for your treatment and part of your lost wages after a car crash, and they pay whether or not the crash was your fault. Every standard automobile policy in Prince Edward Island includes them. The Insurance Act makes the coverage mandatory. Drivers, passengers and pedestrians are all covered.
The point of Section B is speed. A lawsuit takes years to decide who was at fault. Physiotherapy is needed this week. Section B pays for the physiotherapy now, and the lawsuit sorts out the rest later.
Insurers pay what the policy requires and stop when they can. This post sets out what the policy requires.
Who Is Eligible for Section B Benefits in PEI?
Coverage attaches to the vehicle. If you were injured in a car, you claim on the policy for that car, as the driver or as a passenger.
A pedestrian or cyclist struck in Charlottetown claims on the driver’s policy. That matters for people who own no car and have no policy of their own. The firm represents clients in pedestrian accidents who would otherwise have no coverage at all.
Multi-vehicle collisions and uninsured vehicles raise the question of which insurer pays first. A personal injury lawyer in Charlottetown sorts that out at the start, because a claim sent to the wrong insurer sits unpaid.
The insurer for the vehicle you were in pays first. Where that vehicle was uninsured, who pays is decided under the Insurance Act and the policy wording, and it is decided before the forms go in.
Section B Benefits in PEI Have Three Parts with Separate Limits
Section B has three parts: medical and rehabilitation, income replacement, and death and funeral benefits. Each has its own limit and its own qualifying rules.
The Medical Benefit Is $50,000 Over Four Years
The medical benefit is capped at $50,000 a person and runs for four years from the accident. It pays for treatment that is reasonable and necessary: chiropractic care, psychological counselling, medical equipment.
Insurers end it early by declaring maximum medical recovery. If your doctor has recommended a treatment and the insurer refuses it, the decision is disputable and the treating doctor’s opinion is the evidence.
Section B is a secondary payor. A workplace health plan pays first. Section B pays the balance once the private plan is exhausted.
The four-year limit is a limit on when the expense is incurred, not on when the receipt is submitted. Treatment after four years is not covered under Section B and is claimed in the lawsuit instead.
Weekly Indemnity Pays 80 Percent of Earnings to $250 a Week
If you cannot work, Section B pays 80 percent of gross weekly income to a maximum of $250 a week.
You qualify if you were employed at the time of the accident, or if you had worked six of the previous twelve months. After 104 weeks the definition of disability changes and the benefit is harder to keep. Clients with permanent injuries usually move to long-term disability claims at that point.
$250 a week is the statutory cap and has been for years. The difference between it and your actual wage is claimed in the lawsuit against the at-fault driver as excess income loss. On a serious injury that is the largest part of the claim.
The Housekeeper Benefit Pays $100 a Week for 52 Weeks
A person who was the principal unpaid housekeeper for the home and cannot do the work receives $100 a week for up to 52 weeks.
Adjusters do not offer it. A stay-at-home parent who cannot run the house after a car accident has to ask for it, and should.
Applying for Section B Benefits in PEI Takes Three Forms Within 30 Days
Notify the insurer as soon as possible after the accident. The formal application forms are due within 30 days. A late application is the first ground for denial.
You submit your notice of claim, an employer’s statement of earnings if you are claiming lost wages, and a medical certificate from your doctor or therapist. A mistake on any of them delays payment by weeks.
Insurers Limit Section B Benefits in PEI Through IMEs, Necessity Disputes and Terminations
The Independent Medical Examination is the main one. The insurer sends you to its own doctor, who reports that you can return to work. Your own physician’s contrary opinion is what answers it.
An IME report is one medical opinion. The treating physician’s report is another. The insurer chooses its own, and the dispute is decided on which report the evidence supports.
The second is the reasonable and necessary clause. The insurer pays for physiotherapy and refuses the back brace. Whether an item is necessary is a medical question, not an adjuster’s.
The third is termination without explanation. Payments stop while you are still injured. That is a breach of the policy, and there is a limitation period for suing your own insurer on it, so the dispute has to start quickly.
Section B Payments Are Deducted From the Lawsuit Award
Section B is a claim against your own insurer. The lawsuit, Section A, is against the at-fault driver’s insurer. They are linked to prevent double recovery: any lost wages the lawsuit awards are reduced by the Section B indemnity already paid.
Because Section B is mandatory, you must use it. You cannot skip Section B and then claim the same treatment costs in the lawsuit. The court expects you to mitigate with the “no-fault” funds available. The firm runs both claims from the same file so the numbers reconcile.
The deduction works one way. Section B reduces the lawsuit award. The lawsuit does not reduce Section B, and settling the lawsuit does not end the Section B medical benefit while the four-year period is running.
The Firm’s Charlottetown Office Handles Section B Disputes on Contingency
Michael B. Murphy, KC, has practised for over 40 years. The firm has five offices in Atlantic Canada, including Charlottetown, and over 100 reported decisions.
Personal injury claims, from motorcycle accidents to insurance disputes, are taken on a no win, no fee basis. There are no upfront costs.
Courts Decide What the Policy Terms Mean
A Section B dispute that cannot be settled goes to court, where the question is the wording of the Insurance Act and the standard automobile policy. The provincial materials are at the PEI Department of Justice and Public Safety.
Court decisions fix the meaning of terms like total disability for the weekly indemnity. Seasonal employment, common on the Island, raises its own questions about the six-of-twelve-months test and the earnings figure, and the case law on both is where those answers come from.
Receipts and Medical Records Are the Claim
Keep every receipt: prescriptions, taxi fares to the hospital, hours of missed work. Those records are the Section B claim.
If the insurer pushes you back to work before your doctor agrees, or refuses treatment your doctor prescribed, do not accept it. The policy sets the entitlement, not the adjuster.
FAQ
What Is the Maximum Medical Benefit Under Section B in PEI?
$50,000 a person for medical and rehabilitation expenses, for four years from the accident. It covers physiotherapy, massage, medication and equipment that is reasonable and necessary for recovery.
Can I Get Section B Benefits If I Was at Fault for the Accident?
Yes. Section B is no-fault. Your own insurer pays medical and income benefits whoever caused the collision.
How Much Does Section B Pay for Lost Wages in PEI?
80 percent of gross weekly income, to a maximum of $250 a week. You must have been employed at the time of the accident or for six of the preceding twelve months. The benefit can run 104 weeks while you cannot do your own job.
What Happens If My Insurance Company Denies My Section B Claim?
You can dispute it. That usually means more medical evidence or attending an IME. If the insurer holds its position, the remedy is a lawsuit against the insurer for breach of the policy.
Do I Need a Lawyer to Apply for Section B Benefits in PEI?
You can apply on your own. The deadlines are short and the medical documentation has to be exact, and a denial or termination is a legal dispute from the moment it happens. Most clients bring the firm in at the application stage so the file is right from the start.
If you need help securing your Section B benefits in PEI, call the Mike Murphy Law Group at 902-334-4228 or contact the firm through the secure online intake form. There are no fees unless the firm wins your case.