How to successfully navigate your claim

How to successfully navigate your injury claim


Experiencing a motor vehicle or motorcycle accident is a terrifying experience, but the aftermath doesn’t have to be.

Beyond the actual collision, your recovery and wellbeing should be your most important focus.  Dealing with insurance companies is ours.



What are your rights to compensation?

You have a right to claim compensation for pain and suffering due to injuries sustained in a motor vehicle accident.  You are also entitled to compensation for any losses you suffer as a result of your injuries, such as loss of income, lost ability to do housework (including yard work) and the cost of present and future medical expenses.

The Minor Injury Regulation in Alberta limits your compensation to a maximum of $4,892 (as of January 2015) if you are proven to have suffered only a minor injury as a result of an accident.  In most cases, insurers for the other driver will claim that you suffered only minor injuries since that is in their best interest.

However, if you have suffered more than a minor injury, your claim for pain and suffering is not limited to the maximum sum.


What is the extent of your injury:  is it minor, non-minor, chronic?

Generally speaking, the Minor Injury Regulation in Alberta is intended to apply only to sprains, strains or whiplash injuries which have healed completely within 3 to 6 months following an accident.

If you continue to suffer from significant ongoing pain symptoms more than 6 months after your accident, it's likely you have suffered something more than a minor injury, in other words, a non-minor injury or even a chronic pain injury.

Other types of non‑minor injuries include (but are not limited to): chronic pain, spinal injuries, disc injuries, fractures, and head injuries which may include concussions and other trauma.  Another non-minor injury is a temporomandibular joint disorder (commonly referred to as a TMJ injury which may include your jaw and face muscles.)

A chronic pain injury is valued much higher than a minor injury which leaves no lasting damage.


How do we prove what kind of injury you have suffered?

Because you won’t know the extent of your injury right away, it’s extremely important for you to see your doctor immediately following your accident, and at least once per month until your injury claim is settled.  Records and details of these appointments substantiate your claim and serve as our primary evidence.

If you fail to regularly see your doctor and/or other treatment providers, the insurance company representing the other driver may significantly reduce or even deny your claim.


dreamstimesmall_27433762Be sure to follow your doctor’s advice with respect to treatment of your injury.  If your doctor recommends you see a physiotherapist, massage therapist, chiropractor, psychologist or other treatment provider, you should actively and consistently pursue those recommendations.  Failure to follow your doctor’s advice, or only attending treatments sporadically, could be used against you by the insurers for the other driver, and could lead to a presumption that you aren’t significantly injured.

When it’s time to settle your injury claim, your doctor’s medical report and treatment notes, and the notes of other treatment providers (such as physiotherapists) are the primary evidence we rely on.  Therefore, at each appointment with your doctor and other treatment providers, you should clearly describe your current symptoms, level of pain, and how your symptoms are affecting various aspects of your day-to-day life, such as work, recreational activities, housework, and family activities.  You must be consistent in providing this same information to all of your treatment providers as we rely on the medical records, charts and treatment notes of all of your care providers to prepare your proposal and determine the value of your claim.  Inconsistencies are a problem and may compromise the outcome of your claim.

At some point during your case, we may retain the services of an independent medical expert to assess and diagnose your injuries.


What to do if you are asked to attend a medical examination

Contact us immediately  if your Section B insurer or the insurers for the other driver request that you attend a medical examination by their own doctor to assess either your need for ongoing treatment, or to determine whether you have suffered a minor injury.  You have a duty to cooperate with your own insurance company.

You do NOT have a duty to cooperate with the insurance company for the other driver.

If you are contacted by an adjuster for the insurance company for the other driver, inform them that you do not wish to speak with them.  They are investigating you to find weaknesses in your claim and we strongly recommend you refrain from discussing anything with them.


In a world of online surveillance and private investigators, are you being watched?

In all likelihood, the answer is probably yes.  With the popularity of social media, insurers now have easy access to your online life and will engage in surveillance of social networking sites such as Facebook, Instagram, Twitter etc. to investigate injury claimants.  They are checking to see if you are planning holidays or activities with friends and family that may be inconsistent with the injuries you are claiming.

Your comments and “likes” will even be monitored.  For example, if you were recently injured in a motor vehicle accident, but make a joke on Facebook that you’re not really that hurt, or you share plans on your news feed about doing physically demanding activity such as horseback riding or mountain biking, the insurer may try to use this information to discredit your injury claim at some future date.

Our advice is to be careful not to make comments on any social media sites, even if it’s just meant to be funny, as these could minimize your injury claim.


You should also be aware that insurance companies are known to hire private investigators to attempt to discredit your claim.  They may take photographs of you performing activities inconsistent with the injuries you have described to your doctor or treatment providers.  Our advice is to be realistic about your physical capabilities since you don’t want to injure yourself further, and to follow your doctor’s orders about restricting your activities during this time.

Investigators may also interview your “friends”, neighbours, or co‑workers in an attempt to discredit your claim.  Again, our advice is to be careful who you discuss your case with, and be cautious about the specifics of what you discuss.

We know this can be overwhelming, so please contact us if you need assistance
with organizing your records, or if you have further questions about evidence.

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