How Do MVA Benefits Work and What Do I Need to Know?

What are Accident Benefits?

Accident benefits are no-fault coverage for medical expenses available to you and your passengers, regardless of who was responsible for the accident. In most cases, this benefit is provided by the insurance company of the vehicle you were traveling in at the time of the accident. Injured pedestrians should contact the insurance company of the vehicle that hit them.

What does Diagnostic Treatment Protocol Regulation (DTPR) mean?

Diagnostic Treatment Protocol Regulation (DTPR) coverage provides a set number of treatments based on your diagnosis from your Primary Health Care Practitioner, such as a chiropractor, physical therapist, psychologist, or physician. This coverage applies within the first 90 days of your accident and can include chiropractic care, physiotherapy, psychology, massage therapy, and acupuncture. For more information, please visit the Government of Alberta website.

Treatment TypePrior to November 1, 2020November 1, 2020 forward
DentalCoverage under AAIB, subject to private or group health benefits as primary payer.$1,000 (combined limit)
Occupational TherapyCoverage under AAIB, subject to private or group health benefits as primary payer.$1,000 (combined limit)
PsychologicalCoverage under AAIB, subject to private or group health benefits as primary payer.$1,000 (combined limit)

What does Automobile Accident Benefit Regulation (AAIB) mean?

You have coverage under your vehicle policy if your injuries fall outside DTPR or if you still require services 90 days after your accident. If you have a private group benefit plan (Extended Health Benefits plan, such as Blue Cross or Green Shield), you must submit the expenses to them first, and the unpaid portion can be submitted to your MVA insurer. If you do not have a private group benefit plan, our clinic can coordinate benefit approval and coverage with your MVA insurer.

Do I require a doctor’s note?

Most MVA insurers require a doctor’s note, so it is best to see your doctor and request one. This will ensure you have the note ready when it needs to be submitted to your insurer. The doctor’s note should confirm that your injuries are MVA-related and that you require psychological treatment to address these injuries. Doctor’s notes or referrals are often not required for chiropractic, massage therapy, and acupuncture treatments.

What amount does MVA insurance coverage provide?

The Alberta government introduced increases in some accident benefits coverages, effective November 1, 2020. These increases apply to both new claims and to claims that were already in progress as of this date. The changes to the AAIB Regulation only apply if the available benefits have not been fully used. For more information, please visit the Government of Alberta website. The limits are outlined below for your reference.

Treatment TypePrior to November 1, 2020November 1, 2020 forward
Chiropractic Services$750$1,000
Massage Therapy$250$350

Why do I have to use my group or private medical or dental benefits?

As regulated by the Government of Alberta, automobile insurance requires that your private or group benefit plans, including health care spending accounts, be utilized first for any medical expenses not covered under the Diagnostic Treatment Protocol Regulation (DTPR). If there are approved treatments not covered by your medical plan, you should submit them to your adjuster for review.

What forms are needed to receive approval for treatments?

To process your claim, the Alberta Government mandates the completion of two forms: the Notice of Loss and Proof of Claim (Form AB-1) and the Treatment Plan (Form AB-2). You can obtain these forms directly from your treating provider or by visiting the provided links. Look for the “Accident Benefit Claim- Prescribed Forms” section to locate the specific forms you require.

The Notice of Loss and Proof of Claim (Form AB-1) is to be filled out by you and enables communication with your Primary Health Care Practitioner (such as chiropractor, physical therapist, physician, dentist, occupational therapist, or psychologist) to discuss the best treatment plan. Part 6 of this form should include the name of your insurance company.

The Treatment Plan (Form AB-2) is to be completed by your Primary Health Care Practitioner. It provides your insurer with information regarding your diagnosis and initial treatment recommendations.

I am unable to work due to the injuries from this accident, what can I do?

  • If you are unable to work due to injuries sustained in the accident, you may qualify for a Disability Benefit. However, specific requirements must be met:
  • Your Medical Doctor (MD) must determine that your injuries from the accident render you unable to work.
  • You have been unable to work within the first 60 days following the accident.
  • You have been off work for more than 7 days.
  • You were employed on the date of the accident or, if you are over 18 years of age, you worked for 6 of the last 12 months prior to the accident.

Am I still entitled to a disability benefit if I was not employed on the date of the accident?

If you are completely incapacitated due to the accident and are over the age of 18 without any occupation or employment for wages or profit, you may be eligible for the non-earners benefit. For further information on how to claim this benefit, please reach out to your adjuster.

What forms must be completed to start a claim for disability benefits?

To initiate a claim for disability benefits, the following forms need to be completed:

  • Claim for Disability Benefits (Form AB1-A) by your Medical Doctor (MD).
  • Request for Verification of Employment form by your employer (if you indicated that you were missing work).
  • If you are self-employed, provide your Income Tax Assessment for the prior year. Additional information may be requested by your adjuster to process your benefit.

How can I receive any payments owed to me?

To ensure secure and timely payments for any reimbursements you are entitled to, contact your insurer and set up Direct Deposit. This process is quick, secure, simple, and often the best method to receive payment.

I have an ambulance bill from the accident. What do I do?

If you have a private group benefit plan, submit the ambulance bill to them for coverage. If you do not have a group benefit plan or if the entire amount is not covered, you can submit the bill to your insurer for review.

How long is coverage available for Accident Benefits?

Accident Benefits coverage is available for a maximum of 2 years from the date of the accident for medically essential treatment and rehabilitation expenses.

Is it possible for me to receive an injury settlement?

If it is determined that the other driver involved in the accident is at fault for the collision, you have the option to pursue a compensation claim, commonly known as a bodily injury claim, with the insurance company of the other driver. All communication regarding the settlement should be conducted directly with their insurance company.



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