Why Your Section B Benefits Claim Was Denied (and What to Do Next)

posted in: Section B Benefits

Section B benefits are an essential part of Alberta’s auto insurance coverage, providing medical and disability benefits to those injured in motor vehicle accidents, regardless of fault. However, despite having these benefits available, many claimants find their claims unexpectedly denied. When this happens, it can feel frustrating and overwhelming—especially when you are still in need of treatment and financial support.

At KMSC Law LLP, we have extensive experience dealing with insurance companies and understand the tactics they use to deny or limit claims. If your Section B benefits have been denied, you may have options to challenge the decision and ensure you receive the coverage you deserve.

Common Reasons Why Section B Benefits Are Denied

Missed Deadlines

Section B benefits come with strict deadlines, and missing them can lead to an automatic denial of coverage. To avoid this, claimants must:

• Notify their insurance company of the accident within 30 days of the crash.
• Submit an AB-1 Form within 90 days to access medical benefits.
• Submit an AB-1A Form within 90 days to apply for disability benefits.

If these deadlines are not met, insurers often deny benefits without further review. If you are unsure whether your claim was submitted correctly, our legal team can assist in reviewing your paperwork and determining if an appeal is possible.

Reaching the Maximum Coverage Limit

Section B benefits have limits on coverage. Generally, insurers will take the position that they only have to cover the first 21 treatments for medical and rehabilitation expenses. However, the truth is that you have a right to Section B benefits until one of three things occurs:

• two years pass following the date of the accident;
• a medical professional (usually your treating physiotherapist or physician) concludes you would not benefit from further treatment; or
• your medical and treatment expenses hit the $50,000.00 maximum.

If you still require treatment after your expire or are used up, a personal injury lawyer can help explore alternative legal options for securing compensation.

Denial Based on the $50,000 Maximum

Section B benefits have limits on coverage. Coverage applies for expenses incurred in the two years following the accident date for any treatment, medical aids and other expenses prescribed by a medical professional up to a maximum of $50,000.00 total cost. There are also prescribed limits for chiropractic treatment ($1,000.00), massage therapy ($350.00), and acupuncture ($350.00), all of which are included in the $50,000.00 maximum coverage. If you feel you are still benefitting from those types of care after hitting the maximum coverage, or benefits overall have ended for any of the other reasons mentioned above, a personal injury lawyer can help explore alternative legal options for securing compensation

With respect to rehabilitation treatments, insurers will often take the position that they only have to cover the first 21 treatments by a physiotherapist or other care provider. The reality is that within the two-year and $50,000.00 maximum, your treatments should continue as long as your doctor or care provider feels you need them, and the insurer can only end coverage if they send you to a doctor that they choose and they conclude you will no longer benefit from ongoing treatment.

Denial Based on an Independent Medical Examination (IME)

Insurance companies have the right to request that claimants attend an Independent Medical Examination (IME) with a third-party medical professional. These IMEs are often used to determine whether further treatment is necessary. Unfortunately, if the IME doctor concludes that you no longer require medical care, the insurance company may use this as justification to cut off your benefits—often disregarding the opinion of your treating physician.

If an IME results in a denial, it is still possible to challenge the decision. Seeking a second opinion from your own doctor and obtaining a medical report in support of continued treatment can be a crucial step in overturning an unfair denial.

What to Do If Your Section B Benefits Are Denied

1. Obtain a Rebuttal Report

If an IME leads to a denial, consult your treating physician about preparing a rebuttal report. This report should outline your ongoing medical needs and provide evidence that further treatment is required. Submitting this to your insurance provider may be enough to reverse their decision.

2. File a Formal Complaint

All insurance companies in Alberta must have a formal complaints process. If you believe your claim was unfairly denied, you can file a complaint directly with the insurer. However, navigating this process can be difficult without legal support. Our injury law team at KMSC Law LLP has extensive experience handling insurer disputes and will advocate for you to ensure your claim receives fair consideration.

3. Seek Legal Assistance

Insurance companies often act in their best interest—not yours. Having a personal injury lawyer represent you can significantly strengthen your case. Having legal representation ensures that your case is presented effectively, with all necessary evidence and supporting documentation

At KMSC Law LLP, we will assist you with an application against your Section B insurer to ensure you receive the benefits you are entitled to.

4. Keep Paying for Treatment & Maintain Medical Records

Even if your claim is denied, continuing your medical treatment is important. Pay out-of-pocket for such treatment if necessary, and keep all receipts, as you may be eligible for reimbursement later. Maintaining a record of ongoing treatments demonstrates that you are attempting to heal from your injuries, which will strengthen your case for compensation.

Take Action: Protect Your Rights with KMSC Law LLP

If your Section B benefits have been denied, you do not have to accept the insurer’s decision without challenge. At KMSC Law, our Injury Law Team has dealt with insurers countless times and understands how to navigate claim denials. We will review your case, explore all available options, and fight to ensure you receive the coverage you deserve.

Section B benefits exist to help injury victims recover, but insurers frequently deny claims to minimize payouts. Whether your claim was denied due to missed deadlines, medical disputes, or other insurer tactics, legal assistance can make a significant difference. Contact our Injury Law Team today for a free consultation and let us help you secure the benefits and compensation to which you are entitled.