Changes to the Reimbursement Procedure for Expenses Incurred for Travel, Meals and Lodging

Transcription

1 Changes to the Reimbursement Procedure for Expenses Incurred for Travel, Meals and Lodging As of January 1, 2015, you are no longer required to enclose receipts for travel, meal and lodging expenses with your claim for compensation. You must, however, keep all your receipts for a period of three years so that you can provide them to us upon request. You can therefore disregard the instructions to the contrary in the following sections of this document: - Section 14 of the Claim for Compensation form; - Section 14 of Part II of the guide. For more information, please contact us at one of the following numbers: In the Québec area: ; From elsewhere in Québec: ; From elsewhere in Canada or the USA: Thank you for your cooperation. Société de l assurance automobile du Québec 7735A 80 ( )

2 Guide TO THE CLAIM FOR COMPENSATION Claim Number For Accident-Related Expenses DI A 7735A 45 ( )

3 Compensation paid by the SAAQ I Compensation paid by the SAAQ You can file a claim for compensation for accident-related expenses if you find yourself in any of the following situations: You only wish to be reimbursed for the following expenses you incurred as a result of a traffic accident: expenses incurred to purchase medication and medical dressings expenses incurred to replace or repair clothing expenses incurred to repair or replace prescription eyeglasses, contact lenses or dental prostheses fees paid for medical reports travel, lodging and meal expenses You are under 16 years of age or are 65 or older and are not entitled to an income replacement indemnity. You would like to report a traffic accident to the SAAQ without claiming an indemnity. However, if you sustained injuries that resulted in permanent impairment or scarring, or that rendered you unable to perform your usual activities for more than seven days (including the day of the accident), or if you would like to be reimbursed for any expenses not listed above, you must contact the SAAQ to obtain the claim for compensation form that corresponds to your situation; if the accident took place while you were at work, do not fill out this form. Your claim should be addressed to the Commission de la santé et de la sécurité du travail du Québec (CSST). Reimbursement of expenses The expenses claimed can be reimbursed upon presentation of invoices or receipts, up to the maximum amounts prescribed by the Automobile Insurance Act and its attendant regulations. In order to rule on the amounts to which you are entitled, the compensation officer must have access to all the necessary information and supporting documents. 1

4 Completing the Claim for Compensation form II Completing the Claim for Compensation form 1 Accident Victim Québec driver s licence number, Social Insurance Number and Health Insurance Number Indicate your Social Insurance Number, Health Insurance Number and Québec driver s licence number, if you have one. In the case of a minor who does not yet have a Social Insurance Number, indicate the Health Insurance Number only. If this information is not provided with your claim, the SAAQ will have to contact you for it at a later date. This can cause an unnecessary delay in processing your claim for compensation. Present last name if different from last name at birth Write the last name you are using at present if it is different from the one you had at birth. For example, if you are married and you use your husband s name, write that last name. Please note: All correspondence sent and cheques issued to you by the SAAQ will bear your last name at birth. Civil status at the time of the accident Please check only one box to describe your most recent civil status on the date of the accident. For example, if at the time of the accident you were divorced and had begun living in a de facto union, check the In a de facto union box. 3

5 3 Accident Date and time of accident Indicate the date and time of the accident as specifically as possible. Location of accident Indicate the municipality in which the accident occurred. If you are not a Québec resident but are covered by either of the two situations described below, you can file a claim for compensation with the SAAQ. You are a person from outside Québec who was involved in a traffic accident in Québec and the motor vehicle you were in at the time of the accident (as the driver or as a passenger) was registered in Québec. Regardless of whether or not you owned the vehicle you were in at the time of the accident, if this situation applies to you, you are entitled to the same compensation as Quebecers. You are a person from outside Québec who was involved in a traffic accident in Québec and at the time of the accident you were either a passenger in, or the driver of, a motor vehicle that is not registered in Québec; OR a pedestrian or a cyclist. If this situation applies to you, you will be compensated in inverse proportion to your share of liability, unless your province of residence has entered into an agreement with the SAAQ. If outside Québec, indicate the province, state or country If the accident happened outside Québec, indicate the province, state or country. A Québec resident injured in an accident that occurred outside Québec is entitled to the same compensation as if the accident had occurred in Québec. If this is your case, you can file a claim for compensation with the SAAQ. If, as a result of the accident, you incurred medical expenses outside Québec (hospitalization costs, professional fees, etc.), you must follow the steps outlined below. 4

6 If you have not yet paid the expenses incurred Send all supporting documents to the SAAQ. Only originals will be accepted. If you have already paid the fees Contact the Régie de l assurance maladie du Québec (RAMQ) to obtain a copy of the form entitled Application for reimbursement. You can also download a copy from the RAMQ Web site. Your duly completed form must be accompanied by the appropriate supporting documents. Please note that the RAMQ requires the originals. The RAMQ will reimburse your expenses in accordance with the provisions of the Hospital Insurance Act and the Health Insurance Act. The supporting documents will be automatically transferred by the RAMQ to the SAAQ, which will then reimburse any remaining amount that qualifies for reimbursement under the Automobile Insurance Act. Liability If you are at fault for the accident and a person from outside Québec decides to launch a lawsuit against you, your private third-party liability insurance will cover you for this. If it is a person from outside Québec who is deemed to be at fault for the accident, you may, where legal recourse is allowed in the jurisdiction where the accident took place, initiate court proceedings against that person. However, before doing so, you must notify the SAAQ as it has a right of priority that it may decide to exercise. For further information on this topic, contact the compensation officer who will be assigned to your case as soon as the SAAQ receives your claim for compensation. Licence plate number of the vehicle you were in If you were the driver or a passenger at the time of the accident, provide the licence plate number of the vehicle you were in. If the accident occurred while you were a passenger aboard a bus and you do not know what the licence plate number was, leave this space blank. Province, state or country in which the vehicle you were in was registered If you have written the licence plate number of the vehicle you were in, indicate the province, state or country that issued the licence plate. 5

7 Was a vehicle registered outside Québec involved in the accident? If you know of a vehicle registered outside Québec that was involved in the accident, you must report it. 4 Please give a full, detailed account of all the facts relating to the accident. You are required to give a full and detailed description of all the facts relating to the accident, even if a police report was filed or a joint report of the accident was drawn up. Please indicate the following: your intended destination the lane or the intersection where the accident took place the manoeuvre you were preparing to make how impact occurred the number of vehicles involved any other relevant fact related to the accident You may also enclose a diagram with the Claim for Compensation form to show how the accident occurred. Use a separate sheet if need be. Make sure to indicate your claim number or, if unavailable, your Health Insurance Number at the top of that sheet. 5 Was an accident report drawn up by a police officer? If a police report was filed following an accident in Québec, it will be forwarded to the SAAQ by the police force present at the accident. If you know the report number, please provide it. If the accident occurred outside Québec and you already have the report, please enclose a copy with the Claim for Compensation form. Was a joint report of the accident drawn up? If no police report was filed but a joint report of the accident was drawn up, please enclose a copy. Did anyone witness the accident? If neither of the above-mentioned documents exists, but there were one or more eyewitnesses to the accident, please provide the identity of one of the witnesses. If need be, that witness could be called upon to corroborate your statement. note: The witness can be one of the people involved in the accident. 6

8 6 Did the accident occur - in the context of work If the traffic accident took place while you were at work, do not fill out this form. Your claim should be addressed to the Commission de la santé et de la sécurité du travail du Québec (CSST) or to the appropriate body outside Québec responsible for compensating victims of work-related accidents. An accident is considered to have taken place in the context of work if the accident took place on the employer s property during business hours; the accident victim was travelling during business hours paid for by the employer; the accident victim was carrying out orders or running an errand for the employer; the accident victim was travelling in a vehicle owned by the employer; the accident victim was using a means of transportation provided by the employer; the employer paid for the travel expenses. If you have already applied for compensation from the CSST and were turned down, you may file a claim for compensation with the SAAQ, in which case you must include with your claim the letter of refusal from the CSST. - while someone was carrying out a criminal act If the driver of a motor vehicle injured you intentionally, you are considered a victim of a criminal act and can decide to seek compensation under either the Crime Victims Compensation Act or the Automobile Insurance Act. - while assisting a person in distress If you were involved in a traffic accident while assisting a person in distress, you are considered to be an accident victim who was engaged in an act of good citizenship, and you may therefore seek compensation under either the Act to promote good citizenship or the Automobile Insurance Act. In both of the above cases, compensation is paid under only one Act. If you would like to know which Act would be more advantageous, you can file a claim for compensation with both the CSST, which administers the Crime Victims Compensation Act and the Act to promote good citizenship, and the SAAQ, which administers the Automobile Insurance Act. However, only one of these bodies will pay you an indemnity. 7

9 7 Injuries Please describe, in your own words, the injuries you sustained This description can include objects that struck you, the parts of your body that were injured, as well as the type of injuries sustained (cuts, scratches, fractures, etc.). PLEASE NOTE: If, during your first medical consultation after the accident, the physician gave you the Initial Medical Report form, please send it to the SAAQ. Medical information dated shortly after the accident is important for the processing of a claim for compensation. If the physician did not complete the form during your first consultation, the compensation officer will discuss the matter with you when he/she begins processing your claim. Any fees you paid for this report can be reimbursed, up to the maximum amount covered. 11 Pension, Benefits, Indemnities, Compensation or Allowances Received from Another Body If you were receiving benefits or an allowance from the Ministère de l Emploi et de la Solidarité sociale (MESS), the MESS may reimburse some of the expenses related to the accident. Please contact this government department first to claim those expenses. For more information, visit the MESS Web site. The SAAQ will reimburse you for any expenses not covered by the MESS that qualify for reimbursement under the Automobile Insurance Act. 12 Reimbursement of Expenses Were any of the following items damaged in the accident? You can immediately claim a reimbursement for expenses already incurred due to the accident. If you have further expenses, you can claim them as they are incurred, provided you enclose the relevant supporting documents with your claim for reimbursement. Please note: Do not forget to write your claim number or, if unavailable, your Health Insurance Number on every receipt or invoice you send to the SAAQ. 8

10 Prescription eyeglasses Replacement Only expenses for medically prescribed glasses are reimbursed. Please enclose an invoice on which the cost of the lenses and frames bought following the accident are indicated separately, along with a copy of the prescription. For information on the maximum amounts covered, see Type of expenses in the Compensation Table. Note: eye examination fees may be reimbursed if not already covered by a social security plan. Purchase of eyeglasses due to the accident If the injuries sustained in the accident warrant the purchase of a pair of glasses, it is best to submit an estimate to the SAAQ before incurring costly expenses. A medical prescription establishing a connection between the injuries sustained and the need to purchase a pair of glasses must be sent to the SAAQ. Note: eye examination fees can be reimbursed if not already covered by a social security plan. Contact lenses To obtain a reimbursement, you must provide a detailed invoice and a copy of the prescription. For information on the maximum amounts covered, see Type of expenses in the Compensation Table. Prostheses or orthoses Expenses incurred for the purchase, rental, repair, fitting or adjustment of orthoses or prostheses you were wearing and that were damaged in the accident can be immediately reimbursed. Replacement For the replacement of a dental prosthesis, it is best to submit a detailed estimate to the SAAQ before incurring any costly expenses. Do not forget to ask your dentist or denturist to indicate the applicable treatment codes. The maximum amount that can be reimbursed varies from one type of prosthesis to another and is set by regulation (Regulation respecting the reimbursement of certain expenses). Expenses for other types of prostheses or orthoses (i.e. hairpieces, orthopedic footwear, etc.) that have been medically prescribed are also reimbursable. For more information, call

11 Purchase of prostheses or orthoses due to the accident If the injuries sustained in the accident warrant the purchase of a prosthesis or an orthosis, it is best to submit an estimate to the SAAQ before incurring costly expenses. A medical prescription establishing a connection between the injuries sustained and the need to purchase the prosthesis or orthosis must be sent to the SAAQ. Clothes Identify any damaged clothing. Cleaning and repair Priority goes to the cleaning and repair of clothing that was worn and damaged in the accident. For a reimbursement of cleaning and repair expenses, submit the original invoices or receipts to the SAAQ. Replacement If your clothing had to be replaced because it was damaged beyond repair or could not be cleaned, attach a receipt for any article you had to buy because of the accident. A helmet worn by a cyclist, a motorcyclist or a person riding a moped or a motorized scooter could qualify for reimbursement if it was damaged in the accident. The SAAQ reserves the right to have a damaged helmet or damaged clothing checked, so keep those items until a decision on your claim has been rendered. Please note: Watches, jewellery and handbags are not covered under the Automobile Insurance Act. For information on the maximum amounts covered, see Type of expenses in the Compensation Table. 13 As a result of the accident, have you incurred, or do you expect to incur, expenses for any of the following? You can immediately claim a reimbursement for expenses already incurred due to the accident. If you have further expenses, you may claim them as they are incurred, provided you enclose the relevant supporting documents with your claim. Please note: Do not forget to write your claim number or, if unavailable, your Health Insurance Number on every receipt or invoice that you send to the SAAQ. 10

12 Child care or care of a disabled person An accident victim who, at the time of the accident, had been looking after a child under 16 years of age or a disabled person and who, due to the accident, is no longer able to look after that person, is entitled to a reimbursement of the expenses incurred to ensure the care he/she can no longer provide. Please note: only the additional care expenses incurred because of the accident can be reimbursed. Care expenses are reimbursable if the accident victim has a job or jobs at which he/she works at least 28 hours a week, or is 16 years of age or older and attends an educational institution full time; the spouse of the accident victim is unable to take care of the child (or the disabled person) that the accident victim had been looking after at the time of the accident. To claim a reimbursement of care expenses, you must submit the invoices or receipts provided by the person you paid to look after the child or disabled person. For information on the maximum amounts covered, see Type of expenses in the Compensation Table. Personal home assistance Personal home assistance expenses can be reimbursed if, due to the accident, the accident victim is unable to take care of himself/herself and carry out essential activities of daily life (for example: getting out of bed, getting dressed, preparing meals, etc.). To find out if you are eligible for this type of assistance, inform the SAAQ of your needs so that it can assess the situation and determine the weekly amount to which you may be entitled. For information on the maximum amounts covered, see Type of expenses in the Compensation Table. Availability allowance When an accident victim requires medical treatment, an allowance can be given to the person who escorts the accident victim or who needs to be present if the accident victim s health or age requires it. To be eligible for this allowance, the person assisting the victim must provide a statement specifying the reason for accompanying the accident victim or for being present, and the time spent providing such assistance. If travel or lodging expenses were incurred, see Section 14 Did you incur travel expenses as a result of the accident? For information on the maximum amounts covered, see Type of expenses in the Compensation Table. 11

13 Medical dressings You can only claim the medical dressings that you had to buy because of the accident. Medical dressings are articles used to dress an injury, to protect against infection and to promote healing. To obtain a reimbursement, please enclose your invoices or receipts and indicate the type of bandage bought the date the amount Also included under the classification of medical dressings are the following: compresses gauze wadding bandages compression stockings Jobst or Dr. Gibaud clothing, etc. adhesive bandages and medical tape, such as Micropore Medication You can claim a reimbursement for medication where both of the following conditions are met: 1. The medication is required to treat injuries sustained in the traffic accident. 2. The medication is listed on the RAMQ s List of Medications, which is a list of all the prescription drugs covered by the public prescription drug insurance plan. Health professionals know this list well and can prescribe prescription drugs that meet your needs. The List of Medications is available for consultation on the RAMQ Web site, should you require more information. Note that when you consult health professionals for any injuries sustained in your accident, it is important to let them know that you are a traffic accident victim. Be sure to enclose your receipts and invoices with your claim for reimbursement. Automated reimbursement directly at the pharmacy The SAAQ now offers a service that allows accident victims to be reimbursed for the cost of medication directly at the pharmacy. If you wish to take advantage of this service, you must provide your Health Insurance Number in Section 1 of the Claim for Compensation form. Your Health Insurance Number is required because this service uses the RAMQ s direct reimbursement system that only functions with this number. Your Health Insurance Number and a list of all your medication that qualifies for reimbursement will be sent to the RAMQ. To use this service, you must present your Health Insurance Card to your pharmacist and let know him/her know that you are a traffic accident victim. You will then be able to receive your medication without having to pay for it up front. The SAAQ will contact you to confirm that you are eligible to use this service. For more information, go to 12

14 Other Professional fees The SAAQ reimburses professional fees incurred in Québec according to certain criteria. To qualify for reimbursement, the health care or treatment received must be dispensed by a doctor, optometrist or dentist, or by another professional regulated by the Professional Code. In the latter case, the health care or treatment must have been prescribed by a physician. Professionals regulated by the Professional Code include acupuncturists audiologists audioprosthesists chiropractors dental hygienists dental technicians denturists dieticians guidance counsellors medical technologists midwives nurses nursing assistants occupational therapists opticians pharmacists physiotherapists psychoeducators psychologists podiatrists respiratory therapists social workers speech therapists X-ray technicians Please note: Algotherapy, auriculotherapy, balneotherapy, homeopathy, iontophoresis, oligotherapy, orthotherapy, phytotherapy, prolotherapy and radiesthesia are not recognized by the medical profession and do not qualify for reimbursement. To claim a reimbursement, please enclose your invoices or receipts on which the following information is provided: the name of the professional the type of treatment the number of treatment sessions or the number of hours of treatment the fees Where required, also provide a copy of the prescription. For information on the maximum amounts covered, see Type of expenses in the Compensation Table. Care or treatment received outside Québec is also reimbursable in certain cases. Your compensation officer can inform you about the conditions that apply. For information on how such expenses are reimbursed, see Location of accident in Section 3. 13

15 Hospital room Expenses incurred for private or semi-private hospital rooms are reimbursable if the health of the accident victim requires that he/she stay in such a room. A prescription attesting to the need for a private or semiprivate room must be submitted before such a room can be allocated. Please note: In the case of Québec residents hospitalized in Québec, these fees are generally covered by the Québec Hospital Insurance Plan as stated above. If the accident occurred outside Québec, hospitalization expenses may be reimbursed. For information on how such expenses are reimbursed, see Location of accident in Section 3. Transportation by ambulance Usually, the invoice for ambulance transportation in Québec is sent directly to the SAAQ by the ambulance company. However, if you received an invoice for such expenses, you can be reimbursed for the cost of transportation from the scene of the accident to a hospital. Be sure to enclose your receipt. For all other types of transportation by ambulance, please complete Schedule 5 Expenses for Travel to Receive Care and enclose the prescription. Other expenses You may be entitled to a reimbursement for several other types of expenses. If any other expenditure was necessary because of the accident, call the SAAQ at to find out whether it is covered by the plan and how to claim a reimbursement, if applicable. 14 Did you incur travel expenses as a result of the accident? Expenses for travel in order to receive health care or treatment are reimbursable upon presentation of receipts. Expenses for transportation by private automobile qualify for reimbursement, as do charges for parking. However, taxi fares are reimbursed only where public transit does not serve the route that must be taken or where your condition does not allow you to use it. Please note: If several trips are needed for treatment, please complete Schedule 5 Expenses for Travel to Receive Care. In addition, if this travel obliges you to pay for an overnight stay or for meals, these expenses can be reimbursed upon presentation of invoices or receipts, up to the prescribed maximum amounts. To find out what the maximum amounts are, contact the SAAQ at the following number:

16 15 Signature of the Claim for Compensation The accident victim must personally sign the Claim for Compensation form and any other required documents. If the accident victim is a minor (under 18 years of age) or if he/she is unable to fill out the Claim for Compensation form, the accident victim s representative may sign the form and any other related documents. The signature on the Claim for Compensation form is also a declaration that the information provided in the appended forms, where applicable, is accurate. note: As of January 1, 1994, under the Civil Code of Québec, the father and mother of a minor are automatically that person s tutors, without any other formality. If only one parent signs the Claim for Compensation form, he/she is considered by the SAAQ to have the other s consent to act as sole tutor and to be seeking compensation on behalf of both parents. The Public Curator is responsible for supervision of the administration of tutorships and curatorships. As such, the Public Curator is authorized to examine the payment of sums to tutors and curators, in compliance with section 12 of the Public Curator Act. If the person who signs the Claim for Compensation form is the accident victim s dative tutor (appointed by the court) or curator, that person must enclose with the form the judgment certifying that he/she may legally act as such. If the form is not signed, it will be returned to you, which may result in an unnecessary delay in processing your claim. 16 Authorization to Disclose Medical Information Under the Automobile Insurance Act, the SAAQ requires your written consent to disclose medical information to your attending physician or to any other health care professional. Accordingly, you must fill out and sign this authorization. 15

17 17 Direct Deposit Through direct deposit, the SAAQ can deposit your compensation payments directly into your bank account (in Canada only). To avail yourself of direct deposit, check Yes in answer to the question Do you want to use direct deposit? and provide the information for your account. Enclose a cheque with VOID written across it. Do not staple the cheque to the form. PLEASE NOTE : the SAAQ is required to make all direct deposits of payments to an accident victim into an account in the accident victim s name. No deposit can be made into a joint account. In the case of an accident victim who is a minor, an account in the accident victim s name must be opened by a parent. Branch No., Institution No., Account No. VOTRE NOM 123, RUE PRINCIPALE OUEST VOTRE VILLE (PROVINCE) A2B 3C4 DATE 001 A A A A M M J J PAYEZ À L ORDRE DE VOTRE INSTITUTION FINANCIÈRE 345, RUE PRINCIPALE OUEST VOTRE VILLE (PROVINCE) A2B 3C4 Void /100 DOLLARS $ POUR } Cheque no. Not always shown on a cheque (Do not enter) } Branch no. (5 digits) } Institution no. (3 digits) } Account no. (max. 12 digits) Should direct deposit not be possible, payment is made by cheque. note : Your request for direct deposit may be cancelled or changed at any time by calling the person in charge of your file at the SAAQ. 16