1. What will the insurance company for the person, persons, or company who caused my injury do about my claim?

After the insurance company has been notified about the claim, a file is established on you and your case. An insurance claims adjuster is assigned to your file by a claims manager or claims supervisor. The supervisor may assign different adjusters to your case as it progresses.

The insurance claims adjuster responsible for your file will maintain contact with your lawyer. The adjuster will also perform an independent investigation of your claim to ascertain the following:

1. Who is at fault in your case;
2. Whether or not you bear any fault or responsibility for your own injuries. This is also referred to as comparative negligence or contributory negligence.
3. Potential witnesses in the case.
4. The location of the scene of the accident;
5. The contents of police reports, Highway Traffic Board reports, and any other investigative reports that have been filed in the case.

After the initial investigation, the claims adjuster will correspond with your lawyer and request medical reports and any other reports dealing with your injuries. The adjuster will also review documents about your time lost from work. Most importantly, the insurance claims adjuster will want to receive accurate records of your medical bills, prescription bills, therapy bills, and any other actual expenses incurred as a result of you injury. That is why it is very important for you to maintain an accurate account of your medical bills, lost wages, and other expenses which result from your injury.

2. How does the insurance company put a value on my case?

The question is quite complicated. First, the claims supervisor or claims manager will provide that a certain amount be "set aside" as a potential value of your case. This figure is usually called "reserves". Such reserves are the outside value that the company has established on your claim. The reserves may change as the case progresses. In serious cases, such reserves may equal what are called policy limits. Policy limits are the outside limit amounts of liability established in the insurance policy of the person or persons who caused your injury.

During the various stages of your case, the insurance company will keep track of your medical bills, lost wages, any permanency regarding your injury, and other factors. The company will also take into consideration the quality of evidence against their insured, the quality of your witnesses and their witnesses, extent of liability on your part, and other important considerations such as previous injuries.

If you had a previous injury or medical problems in the same area of your body, the insurance carrier will want to see medical records pertaining to that injury. During the course of your claim, your lawyer will be notified by the insurance company about the important factors that are being considered in your particular case.

3. Should I communicate with or contact the insurance company for the person who caused my injuries?

Absolutely not! Under no circumstances should you contact the insurance company once you have retained a lawyer. If you contact the other person's insurance company, for any reason, you could ruin you entire case with one wrong question or statement.

4. Can I contact my own insurance company?

If you have health insurance, medical payments insurance, automobile uninsurance or underinsurance coverage, there may be occasions when it is appropriate for you to contact your own company. However, you should always ask your lawyer whether or not such contact is appropriate. Never contact an insurance company without first obtaining approval from your lawyer.

5. Will the insurance company for the person who caused my injuries dispute my claim?

If liability and responsibility are well-established in your case -- that is, if fault clearly rests with the insurance company's insured (the person or persons who caused your injury), they will try very hard to settle your claim. Insurance companies usually dispute the following types of claims:

1. Claims in which the fault rests with someone other than their insured. This could mean you or someone else involved in the incident who may have caused your injuries rather than the person who is insured by the insurance company.
2. Claims in which the insurance company and its representatives do not believe that you are injured, or that you were injured as badly as you claim. For this reason, documentation of medical bills, lost wages, and other expenses are extremely important to establish credibility and the existence of your injury.
3. Cases in which you or your witnesses have lied, exaggerated, or fabricated the nature and extent of your injury or how the incident occurred.

6. What can I do to convince the insurance company that my claim is valid?

As stated above, the most important thing you can do is recover as quickly as possible from your injury. Insurance company personnel tend to believe those people who actively try to recover from their injuries. That is why you must cooperate with your doctor, physical therapist and other personnel who are trying to help you improve from your injury.

Secondly, insurance companies believe those people who can document their injuries through medical bills, credible medical reports and accurate lost wage information that is neither exaggerated nor subject to dispute and interpretation.

Thirdly, insurance companies usually settle cases easier with those clients who have been in active contact and cooperation with their lawyer.

In summary, it is important for you to try to get better, keep an accurate record of your expenses, and cooperate with your lawyer and his or her staff.

7. What are Section B Benefits?

Prior to a person registering a vehicle in Alberta they are first required to purchase liability insurance. If you are involved in an accident and the accident is your fault, the liability insurance covers you for the liability you have for the damages caused by your negligence. Collision insurance is optional and is not mandatory. Collision insurance is to insure you against the cost of repair or replacement of your own vehicle in an accident.

When you purchase vehicle insurance you also purchase certain insurance that is mandatory under the legislation in Alberta. The most commonly relied-upon benefits are called Section B benefits. They cover you, your passengers and any pedestrian your vehicle hits for the following amounts:

1. Wage loss of 80% of your average gross weekly earnings to a maximum of $300.00 per week (subject to a one week waiting period).
2. The cost of chiropractic treatments to a maximum of $500.00
3. The cost of physiotherapy treatments deemed necessary by your medical doctor and by the insurance company.

The medical expense benefits are secondary insurance. They only cover you for any expenses not covered from any other medical, surgical, dental or hospitalization plan or law or under any other insurance plan such as group insurance through employment. These benefits are to a maximum of $10,000 and must be paid every 30 days by the insurance company. Should you and the insurance company not agree as to whether the benefits are properly payable, you have the right to take the insurer to court to enforce payment.

8. When are rental vehicles paid for by insurance?

If you are in a collision and your vehicle is not driveable, your insurance company is not responsible for the cost of a rental vehicle unless you have a specific rider on your insurance coverage. Responsibility for a rental vehicle usually falls on the owner and driver of the vehicle who is at fault for the accident. Sometimes the insurance for the "at fault" party will pay for a rental vehicle in advance. However, if liability is disputed you will not be paid for a rental vehicle early on in the proceedings. Sometimes court action may be required to collect the cost of a rental vehicle. Should court action be required, the court will look at the reasonableness of the rental charges. Reasonableness will be determined both from the cost incurred on a per day basis and the number of days for which the cost is claimed. Often insurance companies for the "at fault" driver will advise you to go ahead and rent a vehicle if it is necessary and they will consider paying for it later on. That is, the insurance company is not giving you a blank cheque for rental costs and can assess the reasonableness down the road. The risk to you is that you do not know if you will get your rental costs reimbursed. The benefit to the insurance company is that you will probably only rent a vehicle if it is really necessary, since there is no guarantee of coverage in advance.

Some automobile repair shops also provide courtesy cars free of charge for the time period they are fixing your vehicle. This would not apply as part of your insurance but is paid out by the automobile repair company in the form of a good will gesture to get your business. If you are getting your vehicle fixed, it pays to ask around for the best deal.