Extended Health Care Benefits & their interplay with Accident Benefits

If you are one of the fortunate people who have coverage for extended health benefits through employment, spouse’s employment or parents’ employment this information is for you.

Once you are injured in an accident and proceed with an Accident Benefits claim you will likely be referred for some type of therapy.  If you do not have any extended health benefits and only O.H.I.P. coverage, your physiotherapist, for example will invoice your Automobile insurance company directly for full payment.  However if you do have extended health benefits, your therapist must bill this policy first with the balance going to your Auto Insurer.

Example:

Jim is involved in a serious motor vehicle accident.  He sustained various injuries.  His family doctor refers him to physiotherapy, massage therapy and recommends several devices to assist him at home.

Before the accident Jim was a stay at home dad and his wife worked at a bank.  He had extended health benefits coverage (“Policy A”) through her policy.  He submits an application for Accident benefits to his own automobile insurer (“Policy B”).

The physiotherapy, massage therapy and devices would first be billed to Policy A, even if Jim is uncertain they will be covered.  Policy B will not issue any payments until Policy A responds in writing that they are not paying or that they have paid out what is covered.

Many injured people find it unfair that their own personal extended health benefits are utilized when their injuries are as a result of an accident.  Unfortunately the law states that if an injured party has extended health benefits these must be used first.

It is best to be familiar with your coverage and be aware of what your rights are.  As Accident Benefit coverage decreases finding any way to access additional coverage will be helpful in your recovery.

• About
• Latest Posts

Greg Neinstein

Greg Neinstein, B.A. LLB., is the Managing Partner at Neinstein Personal Injury Lawyers LLP. His practice focuses on serious injury and complex insurance claims, including motor vehicle accidents, slip and fall injuries, long-term disability claims and insurance claims. Greg has extensive mediation and trial experience and has a reputation among his colleagues as a skillful negotiator.

Latest posts by Greg Neinstein (see all)

• Do I have a personal injury case? - April 23, 2019
• Are your insurance premiums high? Check your postal code - April 17, 2019
• This was an unusually harsh winter for slip-and-falls - April 11, 2019