Accident Benefits and Medical Payments Coverage
The no-fault principle
Accident benefits (Coverage B) pay regardless of fault for medical expenses, rehabilitation, income replacement, death benefits, funeral expenses and attendant care. They are mandatory in most provinces and are the first payer for auto-related injuries. The rationale is speed and certainty: injured persons are compensated without proving negligence.
Key concepts
Understand medical payments (reasonable and necessary treatment), income replacement (a percentage of gross income subject to a weekly maximum and a waiting period), attendant care, death and funeral benefits, and rehabilitation. Note the distinction between no-fault benefits and tort rights - some provinces allow lawsuits for pain and suffering above a threshold (a deductible applies in several jurisdictions).
Coordination with other coverage
Group health plans, workers' compensation, and provincial health insurance interact with accident benefits. Insurers may coordinate or seek reimbursement. Candidates should know that accident benefits are payable even if the insured was at fault.
Traps
(1) Assuming accident benefits require proving fault. (2) Forgetting the waiting period for income replacement. (3) Confusing the medical limit with the income replacement maximum. (4) Overlooking that benefits may be reduced by other collateral sources.
Rule of thumb
If the question involves an injured insured or passenger and no fault needs proving, it is accident benefits. If it involves an injured third party suing, it is liability.