As a victim, you will otherwise be entitled to receive Benefits despite whether or not you were a driver, passenger, bicyclist or pedestrian.
In addition to the likelihood of a lawsuit to recover a cash award or settlement for injuries, pain and suffering and other different losses, California’s government requires car insurance companies to supply certain obligatory benefits to most of the people who are wounded or killed in car accidents. These benefits are known as “statutory accident benefits.” This system operates on a “no-fault” basis. This implies that subject to certain limited restrictions; you will be entitled to compensation, even in the case you were the one that caused the accident.
As a victim, you will otherwise be entitled to receive benefits despite whether or not you were a driver, passenger, bicyclist or pedestrian. You, as well as members of your family and dependents, will typically receive benefits, even in the case you did not have car insurance at the time of the accident.
Typically, there are disputes concerning what benefits you are entitled to and what insurance assessments you are required to attend. It’s usually a decent plan to seek advice from a private personal injury attorney to see what you are entitled to and what steps you need to take to safeguard your interests.
What Kind of Benefits Can I Receive?
Income Replacement Benefits
These benefits are designed to reimburse you for some of the money will you lose as the result of being unable to work due to an injury suffered during a car accident or derived from it. These benefits are not payable during the first week, and it is required for you to meet a disability test to qualify for the benefits. The disability test becomes more difficult to meet after more than two years have passed since the accident. You can receive income replacement benefits whether you are an employee or a self-employed individual. The maximum that you can receive is generally $400 per week unless other optional increased benefits are purchased.
If you are self-employed, your income calculation is going be even more complicated, and insurers will usually hire accountants to assist them with the calculations.
Non-earner Benefits
You might be able to receive these benefits if you are 16 years old or older and have suffered a complete inability to carry on a normal life as a result of the accident within two years after the accident. An attorney can assist you in explaining what “complete inability to carry on a normal life” means, and how that term has been interpreted by the case. The benefits are only available to certain classes of people, i.e.: Unemployed but enrolled in school on a full-time basis or have completed your education less than one year before the accident and not be employed in a job that reflects your education and training.
The amount of the non-earner benefit is generally $185 per week, although nothing will be payable for the first 26 weeks of the disability. However, if your disability has lasted for more than 104 weeks, you will be entitled to receive $320 per week following the initial 104-week period.
Caregiver Benefits
These benefits could also be collectible if you – the injured person – were living with an individual in need of care (such as a minor or an older person) before the accident and weren’t being paid for these services. You will be able to recover reasonable and necessary expenses up to $250 per week for the first person in need of care and $50 per week for every extra person.
You must note that, when it involves the financial gain replacement, non-earner or caregiver benefits, only one of those three benefits can be paid at any given time.
Medical and Rehabilitation Benefits
This benefit deals with compensation for reasonable and necessary expenses like medical, surgical, dental, optometric, hospital, nursing, ambulance, speech-language pathology, chiropractic, psychological, physiotherapy, physiotherapy, medication, prescription eyewear, dentures, hearing aids, wheelchairs, prosthesis, orthotics, transportation to and from treatment sessions (Excluding the primary fifty kilometers of the trip within the injured person’s vehicle), workplace/Home/Vehicle modifications, life skills coaching, counseling, and job assessments.
Subject to some exceptions stated within the pre-approved framework guidelines, you need to submit a treatment plan to the insurance firm before starting treatment. If you do not submit a treatment plan, the insurance firm may refuse to compensate you for treatment. The treatment plan should be carried out by a professional and signed by one of the subsequent physician, psychologist, physiotherapist, dentist, or optometrist.
You can receive at most a compensation of $100,000 for “reasonable and necessary” expenses acquired within ten years following the accident. If you suffered “catastrophic impairment,” you will be entitled to receive up to $1,000,000 incurred over your life.
Attendant Care Benefits
This benefit might give compensation for services of an aide or associate attendant who is aiding you because of your injury. This might include services of a loved one or a different aide taking care of you at home, or services provided by a long-term care facility as well as a rest home, home for the aged or chronic care hospital.
You may be entitled to up to $3,000 per month for two years following the accident. If you suffered “catastrophic impairment,” you will receive up to $6,000 per month up to $1,000,000 without a closing date. The insurance firm might ask you to produce it with a certificate from a professional confirming that you simply need attendant care services.
Funeral and Death Benefits
When someone dies because of a car accident, his or her estate is also entitled to compensation of ceremonial expenses up to $6,000.
The deceased’s spouse, dependents, and caregivers may additionally be entitled to death benefits. Death benefits are typically solely collectible if the deceased died inside a hundred and eighty days after the accident or if the deceased was perpetually disabled as a result of the accident and died within 156 weeks after the accident. No benefits are payable to someone who dies before the deceased or within thirty days after the deceased.
A spouse might receive $25,000 if the deceased was married. If the deceased was not married, however, had dependents, the $25,000 would be divided equally among the dependents. On top of the $25,000, every one of the dependents and former spouses of the deceased (To whom the deceased had an obligation to pay spousal support) Are going to be entitled to $10,000.
If the deceased was himself or herself a dependent at the time of the accident (Ex. If the deceased was a minor child), $10,000 would be payable to the person upon whom the deceased was dependent (Ex. Parent or grandparent) Or, if that person is dead, to that person’s living spouse or dependents.
Visiting Expenses
If you sustained an injury during a car accident, you and the members of your family and people who were living with you at the time of the accident would also be entitled to compensation for all of their reasonable and necessary expenses incurred as a result of coming to visit you during your treatment or recovery. The visitors can only be reimbursed for expenses incurred inside of the lapse of 104 weeks after your accident unless your injury is catastrophic.
Lost Education Expenses
If you are unable to continue in the education program in which you were enrolled at the time of the accident due to your injuries, you may be entitled to claim for your lost education expenses up to the maximum amount of $15,000. You may get reimbursed for expenses incurred before the accident including tuition, books, equipment or room and board.
Housekeeping and Home Maintenance Expenses
You might receive compensation for all the reasonable and necessary housework and residential maintenance expenses if your injury resulted in a very substantial inability to do your housework and residential maintenance if you normally performed home maintenance services before your accident. Your housekeeping and home maintenance expenses may be paid for 104 weeks to a maximum of $100, unless the injury is catastrophic, in which case the time-limit does not apply.
Psychological and Mental Injuries
Your family members and dependents (Whether related or not) may be entitled to receive benefits if they have suffered psychological injuries as a result of your accident.
Cost of Examinations
You may be reimbursed for reasonable fees charged by health care providers in preparing disability certificates, reviewing and approving treatment plans, preparing applications for approval of assessments or examinations, preparing assessments of attendant care needs, and preparing applications for determinations of catastrophic impairment. You are normally required to obtain the consent of the insurer before incurring examination expenses. However, there are certain exceptions. Your treatment providers may well be able to assist you in applying for these benefits
Other Expenses
You may be entitled to be reimbursed for all reasonable expenses you incurred in repairing or replacing clothing, prescription eyewear, dentures, hearing aids, prostheses and other medical or dental devices that were lost or broken as a result of the accident.
How Can I Claim My Benefits?
Compensation will not be paid to you automatically following your accident. In order to receive benefits, you should notify your insurer within seven days of the date of the accident that you wish to submit an application. Late applications are made in many cases and you could discuss this with an attorney. The insurer will then be required to send you the application forms as soon as possible. You will have to complete the forms and send them back to your insurer within 30 days. If you will not be able to meet the 30-day deadline because of the severity of your injuries, it is probably a good idea for you to advise your insurance company, but you may well wish to seek legal advice from an attorney.
Which Insurance Company Will Provide My Statutory Accident Benefits?
If you have car insurance or if you are a listed driver on someone else’s car insurance policy, your own insurer will likely be responsible for providing you with benefits.
If you do not have car insurance, and you were injured in a car accident as a pedestrian or a cyclist, you may be able to apply to the insurance company that insured the car that hit you. If you were a passenger, you might well be able to apply to the company that insured the car in which you were riding.
In some situations, no insured drivers are involved. In such cases, you may be able to claim compensation from a special government fund set up to handle these types of scenarios.
It is important to remember that statutory accident benefits will typically only compensate you for losses that are not covered by some other private insurance policy or employment benefits plan. If these other policies or plans will cover only part of the losses incurred, the statutory accident benefits can be used to compensate you for the balance, subject to some limitations.
What Can I Do If the Insurance Company Denies My Claim?
If you are having problems recovering benefits to which you are entitled, you may be entitled to sue the insurance firm in court or try to enforce payment through arbitration. It is extremely important to initiate mediation within two years from the date that the benefit was denied.
If you or a loved one has been having trouble with their insurance company, or their coverage has been denied, contact us today!
