Possible claims by the accident victims
Accident victims can suffer both physically and financially. Physically in the sense that they suffer certain impairments like brain damage or they become paralyzed. Financial suffering is experienced due to the cost of medical treatment. However, SABS comes in to help accident victims recover financially from the impacts of an accident by providing specific provisions that enable them to make accident claims and get compensation.[1]
As a result of the accident, the driver lost an arm and eyesight on one eye. There is a high possibility that due to the injuries suffered she might not be able to work again. This first victim can bring a claim relating to the loss of her arm and eyesight on one eye for the medical and rehabilitation benefits. The loss of an arm and eyesight is categorized as catastrophic impairments.[2]
Moreover, the victim can also make a claim for inability to carry on with her normal life due to the injuries sustained from the accident. Under the SABS regulation 3(7) a person is unable to carry out his/her normal life due to the effects of an accident if the accident prevents the person from engaging in the ordinary activities of the person. For instance in this case, the claimant was a nurse involved in caregiving activities at a local hospital. However, the loss of her hands and eyesight on one eye makes it difficult for her to carry out her ordinary day to day activities. Instead she will need to be cared for, which basically means that she will not be able to go back to her previous employment hence the caregiver benefits claim. She can also bring an income replacement claim to compensate for the fact that she might not be able to work again due to the injuries.
In the second scenario, the next of kin to the deceased who is the deceased’s spouse can claim death and funeral benefits.[3] In this claim, the funeral expenses shall be catered for. They can also claim the loss of income as a result of the death of the victim. My assumption is that the deceased victim was working to sustain his family and therefore his loss will leave the family struggling financially to sustain them.
In the third case the child is now in need of care and he will not function normally for the rest of his life. The victim in this case can bring a medical and rehabilitative claim due to the medical expenses that will be incurred. Also, since he needs care for the rest of his life he can bring a claim for caregiver benefits. A claim for lost educational expenses can also be made in this case as at 16 years it is an assumption that he was still enrolled secondary in school at the time of the accident.[4] The victim’s parents can also claim for non-earner benefits. Ideally, the child would go to school and become successful and take care of himself. However, due to the accident this will not be possible as the promising life was cut short by the brain damage and the child can no longer carry out his ordinary activities.
In the last scenario the victim can bring a claim for social assistance payments since she was depending on the Old age Security and the accident has led to increased expenses. The victim can also claim medical expenses because the accident led to the need for her to replace her prosthetic leg and other expenses due to her paraplegia. Consequently, the victim will be in need of care because her movements have been restricted. This interferes with her normal functioning hence the claim for caregiver benefits.
Preliminary assessment as to the amounts available with each claim
Caregiver benefits are given to a person who sustains catastrophic impairment due to an accident. These caregiver benefits cater for the expenses incurred to care for a victim due to the injuries caused by an accident.[5] The caregiver benefits shall not exceed $250 per week for the first person in need of care and $50 per week for each additional person in need of care. However, these caregiver benefits shall not be given to persons already receiving either income replacement benefits or non-earner benefits.
Medical benefits cater for all the reasonable expenses such as medication, surgeries, wheelchairs incurred as a result of the accident.[6] If the person sustained a catastrophic impairment shall be awarded not more than $1000000. [7]
Section 12(2) provides that the insurer shall pay $185 each week as non-earner benefits. The beneficiary must be completely unable to carry on with his/her normal life.
Income replacement benefits shall only be paid to a person who was employed at the time of the accident and 104 weeks after the accident they are incapable of going back to work. Income replacement benefits are limited to the lesser of the applicant’s gross weekly wages or $400 per week for the first 104 weeks.[8]
- Provide the client with some advice as to how to make the benefits claims.
When a client is involved in a road accident, it is necessary to identify what source of compensation they can get. The main three compensation schemes available for the claimant are; Tort claims, Collateral benefits and Statutory accidents benefits (SABS) . SABS are benefits that people who are involved in accidents can get regardless of whether the claimant was behind the wheel, passenger or pedestrian. The system provides basic benefits such as medical, rehabilitation, and income replacement benefits.
It is critical to note that the procedure for claiming for SABS is extensive in terms of documentation. The injured party must fill and submit the prescribed Statutory Accident Benefits Claims Forms before the benefits can be payable. The initial application has several parts such as a Disability Certificate that must be completed by a healthcare profession. In this scenario, the 16-year-old son, who might be in a wheelchair for the rest of his life due to his horrific injuries, must obtain a Disability Certificate signed by a healthcare professional to ascertain the extent of his injuries . Moreover, the claimant’s employer must verify the Employer’s Confirmation of Income form before an income replacement benefit will be payable. In this scenario, the nurse, who lost eyesight in her right eye and an arm, and might never return to work must submit an Employer’s Confirmation form to prove that she was earning the specific wages she claims. The Employer’s Confirmation of Income must also be produced for the pilot who died at the scene.
After the submission of the initial application, a claimant can advance a claim for benefits which is ongoing. The above-mentioned disability test regulates income replacement payments, and the insurer will periodically request revised Disability Certificates from a health professional to ensure claimant continues to meet the criteria of disability . In terms of care, the applicant will apply approval for therapy (such as chiropractic therapy or physiotherapy) which would be subject to the “fair and essential” requirements. The treatment plans must be completed by the service provider and outline the costs, duration and goals of the specific treatment.
It is crucial that the SABS application be submitted without delay. The Schedule provides that the claimant avails the notice of the motor vehicle accident and their intention to claim SABS not later than 7 days of the accident. The completed application must also be submitted within 30 days after receipt of insurer’s application forms. All forms produced by the claimant must be accurate since they will be producible in any lawsuits.
Please explain any responsibilities she may have with respect to getting her damages or seeking any necessary treatment
After sustaining injuries in the accident, the claimant must quickly seek for medical help to treat their injuries or save any other occupants whose life might be in critical danger. After the accident, the claimant must report the incident to the insurance company within 24 hours and provide information regarding the accident such as the cause and the extent of the injuries sustained by you and the occupants of the car .
Regarding the provide scenario, the claimant must initiate the process of claiming SABS by filling and filing prescribed Statutory Accident Benefits Claims. The claimant must also seek a medical profession to approve various subcomponents of the initial application such as a Disability Certificate confirming that the injuries suffered by the claimant of other occupants of the vehicle are server to the extent of causing disability. Also, the claimant must obtain Employer’s Confirmation of Income form which confirms their income information prior to the accident. After submitting the initial application for benefits, a claimant can advance the ongoing claimant for benefits.
[1] Shauna K. Powell, Lenners LLP ‘Personal Injury Motor Vehicle Litigation: SABS and Tort’
[2] O. Reg. 34/10 section 3.1
[3] Reg 34/10 Section 26(2)
[4] Reg 34/10 Section 21
[5] O. Reg. 34/10 Section 13(2)
[6] O. Reg. 34/10 Section 15
[7] O. Reg. 34/10 Section 18(3)(b)
[8] O. Reg. 34/10 Section 7