Insurance

Many people with brain injury rely on insurance to pay for much-needed services such as hospital stays, in-patient/out-patient rehabilitation, community services, and in-home treatments. Navigating the insurance system after brain injury can be like following a complicated road without a map. There are many different types of insurance to cover treatment and recovery, but it depends on the circumstances of their injury and your public or personal insurance plans. If they have a lawyer working with them or have a case manager, they may be able to help determine what the person is eligible for and how much. If neither of these are available, the person should look at their policy or call their insurance company. They may need your help with this process as well.

We have included this section on types of insurance in Canada to provide a broad overview of what may be available. Please note that the person will not be eligible for every coverage we have listed here.

Topics in this section include:

Public health insurance

The universal health-care system in Canada is paid for through taxes. Every eligible Canadian receives a health insurance card (often called a health card). This card must be shown at hospitals or medical clinics to receive health-care services. All provinces and territories have their own health insurance plan with different cards. You can contact your provincial or territorial Minister of Health to see what coverage residents of the province receive. You can also speak to physicians. For more information about provincial and territorial health services, visit your province or territories’ website using the list below.

Please note: Not every treatment or health service is covered under provincial/territorial health plans.  

Automobile/car insurance

Drivers in Canada are covered by their car insurance whether they are a driver, passenger or pedestrian. Any person who owns a car in Canada must have mandatory insurance coverage at the very least. Car insurance is provincially/territorially regulated: there is no standardized insurance system across the country. Some regions may require more coverage than others and prices may vary, even from urban to rural areas.

Here is an overview of types of automobile insurance:

Liability insurance

Third-party liability insurance covers losses -such as injury or death – which your vehicle causes to other people. It also covers damage your vehicle causes to other vehicles. If the cost of the losses or damage is more than your liability limit, you’ll need to pay the balance of the settlement yourself. Some people opt to pay more or “top-up” their third-party liability insurance to ensure they won’t need to pay out of pocket.

Liability insurance does not cover the cost of repairs to your own vehicle. Additional insurance to cover these costs can be added. This can be discussed with the insurance broker or agent.

Accident benefits/bodily injury insurance

This type of coverage is mandatory in almost all provinces and territories. Accident benefits cover the cost of medical treatments, attendant care, income replace and even some funeral costs in the case of death. 

 In the case of a catastrophic brain injury, the person would have access to increased coverage for treatment and services if they had a larger accident policy.

Uninsured automobile insurance

This type of coverage is mandatory across Canada. This protects people in the case of death or injury caused by an uninsured driver or as a result of a hit-and-run. It also covers damages to the vehicle by an uninsured driver. 

No fault insurance

Some provinces have implemented no-fault insurance and there is some confusion about what this means. Despite how the term makes it sound, no-fault insurance does not mean that no one is at fault for an accident. No-fault insurance means your insurance company will be responsible for your claim and pay your benefits or damages regardless of who is determined to be at fault for the accident. The same goes for the other driver or drivers involved in the accident. Their insurance company will be responsible for their claims. 

If you are unclear as to what is included in your friend/family member’s current coverage, contact their insurance broker or the insurance company about the following:

  • Ask them to outline what is covered in the current plan;
  • Ask them to use plain language and avoid the use of acronyms;
  • Ask them the amount for which the person is covered.  Get them to put this in a format that is easily understandable, and;
  • What are the options for further coverage and what would be the cost

Do not be afraid to ask questions and seek clarification.

While we never plan to get in a car accident, it is helpful to educate yourself in the event of an accident. If you or your friend/family member are in a car accident, you or a designated family member/caregiver should contact the insurance company as there are accident reporting timelines that need to be followed.   

To learn more general information about car insurance in your province or territory you can visit the insurance regulator for your province or territory below:

Disability insurance

Disability insurance is a policy that people can purchase which will replace a certain percentage of their salary for a set period of time if they temporarily can’t work or are permanently disabled. They must have purchased the plan before their acquired brain injury to receive benefits.

Extended health care

Extended health care plans are designed to supplement and fill the gap from existing provincial health insurance plans. These plans provide for reimbursement of expenses and services not covered by public health plans, such as dental and vision care. These plans can also cover prescription drugs, medical equipment and services, such as private nursing or homecare, as well allied health care services such as chiropractor, physiotherapy and massage therapy. 

Extended health care plans are typically available through employers as a group insurance plan or as a personal plan. If the person is already paying into a group insurance plan through their employer, it is always advisable to ensure they know what benefits they are entitled to. If they have a personal insurance plan, you should also check what is covered under their policy. They can contact the human resources representative at their place of work for more information or can contact the insurance directly.

Workers’ compensation 

If a person is injured while at work, they may be entitled to worker’s compensation. Workers compensation is a provincially run system to protect employees from the financial hardships associated with work-related injuries and illnesses.

To find out more about what people are entitled to as an employee or how to file a claim, contact a human resources representative or contact your provincial/territorial compensation board.

In the event of a dispute

If there is a dispute with the insurance company, contact the insurance company representative or insurance adjuster. See if any accommodations can be made and ensure they have all the relevant medical information. If this is unable to resolve the dispute, you can consider contacting a lawyer.

The insurance system in Canada is complicated and unfortunately there is no clear path to follow. The first step will be to find out what insurance the person has. Then look at what is covered under those policies. You can also reach out to your local brain injury association to see if there are any additional resources available to help you navigate the insurance process.