WHAT HAPPENS IF I’M INJURED IN A CAR ACCIDENT – ALBERTA

So I’ve heard from patients that have been involved in a car accident that they can find a lot of information about how to get their car fixed but not very much information about how they can help themselves with their injuries after a car accident. It can be very confusing and frustrating especially if you’re in pain. So here’s some of that information:

Step 1:

• Seek out emergency services depending on the severity of the injury.
• Report the accident to the police and your insurance company.
• Now here’s the confusing part most people are assigned 2 claim adjusters, 1 for the car and 1 for bodily injuries. It is important you don’t mix up the two otherwise your claim might end up in paperwork limbo.

Step 2:
At this time you might still be waiting to hear back from your insurance but being in pain you can start to seek help from a health practitioner to assess the extent of your injury.
This can only be done by a licenced Chiropractor, Physiotherapist or a Medical Doctor.
The claim adjuster for bodily injuries will send you a package of paperwork and included in that packet are 2 very important forms called an AB-1 and an AB-2.These forms are also usually available at the office of your chiropractor or physiotherapist if you haven’t received that package by the time of your first visit. However its important you have the name and contact information for that adjuster ( phone #, email, fax #)
The AB-1 form is what you fill out to send the insurance company telling them what happened to you and what symptoms you have after the accident.
The AB-2 is filled out by your chiropractor, physiotherapist or family doctor and based on your evaluation they create a treatment plan for you and assign a diagnosis based on your injuries.
 

Step 3
Based on your injuries your assigned into one of four categories of Whiplash Associated Disorders (WAD injuries) and other injuries are included for instance lower back strains and shoulder or knee injuries.
These 4 categories are based on your injuries
WAD I criteria:

• symptoms of spinal pain, stiffness or tenderness
• no demonstrable, definable and clinically relevant physical signs of injury
• no tenderness and normal range of motion
• normal reflexes and muscle strength in the limbs
• no objective, demonstrable, definable and clinically relevant neurological signs of injury
• no fractures to or dislocation of the spine

WAD II criteria:

• symptoms of spinal pain, stiffness or tenderness
• musculoskeletal signs of decreased range of motion of the spine, and point tenderness of spinal structures affected by the injury
• paraspinal tenderness and restricted spine range of motion
• normal reflexes and muscle strength in the limbs
• no objective, demonstrable, definable and clinically relevant neurological signs of injury
• no fracture to or dislocation of the spine

WAD III criteria:

• objective, demonstrable, definable and clinically relevant neurological signs of injury
• abnormal reflexes and/or muscle weakness, often with sensory changes in a dermatomal pattern suggesting nerve root impingement (typically due to disc protrusion)
• no fracture to or dislocation of the spine

WAD IV criteria:

• fracture to or dislocation of the spine
• neck pain, possibly neurological symptoms in limbs, urinary incontinence due to spinal cord involvement
• possible hyperreflexia, positive Babinski’s sign, motor weakness and sensory changes suggesting spinal cord injury

Typically most motor vehicle accidents fall within the WAD 1-3 categories.

Based on those categories you’re allowed 10-21 treatments that are billed directly to your insurance company within PROTOCOL.
Within protocol treatments if you’re a WAD 1 injury your allowed 10 treatments combined of chiropractic, physiotherapy, massage therapy and acupuncture. If you’re a WAD 2 injury your allowed 21 treatments combined.

When you’re within PROTOCOL ( WAD 1 or WAD 2) injuries your treatments are allowed within 90 days of the initial assessment, the first time you saw someone). Usually you receive a letter in the mail telling when this period is, otherwise you can contact your adjuster for more information.

Hopefully at the end of your 10 or 21 treatments you’re feeling good and you follow up any home care exercises. Your healthcare practitioner does an evaluation at the end and submits that to the car insurance company letting them know your status. If you’re still suffering symptoms from the car accident, you can still receive treatment under something called Section B. See below for more information.

Now this is where it gets confusing.
If your’e a WAD 3 injury (meaning you have neurological symptoms like tingling or burning sensations) or WAD 4 (you have a fracture of your neck), you fall outside of protocol and in to something called SECTION  B. Meaning your car insurance company may or may not be billed directly for your treatment depending on the insurance companies’ discretion and you do not receive the 10-21 treatments that occur under protocol this is unfortunate for people but those are the provincial rules. In this category you’re allowed a hard cap (meaning by provincial law established in 2004) of $750 of chiropractic treatment, $250 massage, $250 acupuncture and a soft cap (meaning the adjuster can decide to pay for more treatment if necessary) of $600 physiotherapy and if necessary $600 of psychological an occupational therapy.

If you have private health benefits through work, spouse or parent the government and car insurance companies require you to use those benefits before you can access any of the above outlined benefits.
One last thing that a lot of patients have wondered about is that their rates will go up if they make a bodily injury claim after an accident. In speaking with other patients who are insurance adjusters themselves they have told me that if a rate increase it’s happened because of the car damage itself, the health portion is available regardless by provincial law and making a claim should make no difference to your insurance premium. Otherwise without getting treatment you’re not only in pain but also already looking at a possible rate hike so you might as well at least be checked to assess any injuries.