Personal Injury Protection Plan. Your Guide

Transcription

1 Persoal Ijury Protectio Pla

2 Maitoba law defies this isurace policy. Ulike other isurace policies you may have, which are sold by private compaies, Maitoba s Persoal Ijury Protectio Pla is Maitoba law. The Maitoba Public Isurace Corporatio Act ad its regulatios set out types of coverage ad eligibility for beefits. This law also describes how the Maitoba Public Isurace Corporatio (MPI) operates. We must follow the law whe we respod to a claim from a perso ijured i a motor vehicle accidet. The Maitoba Public Isurace Corporatio Act is Chapter P215 of the Cotiuig Cosolidatio of the Statutes of Maitoba (C.C.S.M.). The PIPP Regulatios are Maitoba Regulatios (Ma. Regs.) 37, 38, 39, 40 ad 41 of These referece materials are available i most public libraries ad ca be purchased from Statutory Publicatios, Office of the Quee s Priter, 200 Vaugha Street, Wiipeg, R3C 1T5, (204) This Guide provides iformatio, ot advice or legal iterpretatios. This Guide describes the coverages ad beefits available uder the Persoal Ijury Protectio Pla (PIPP). If ay differeces arise over iterpretig what this Guide says ad what the law says, the law applies. 2

3 Usig this Guide Your Referece Page Ijury Claim Number Vehicle Damage Claim Number Date of Accidet Persoal Ijury Case Maager Name Telephoe umber Best time to call Vehicle Damage Claims Adjuster Name Telephoe umber Best time to call i

4 Usig this Guide How this Guide ca help you This is your guide to how PIPP works ad what etitlemets it provides. Though it will likely aswer most of your questios, it may ot aswer all of them. That s where our staff ca help. They re the most valuable source of iformatio at your disposal. If you eed more iformatio about PIPP, call your Case Maager or our geeral iformatio lie for help. ii

5 Usig this Guide Your Situatio you eed medical treatmet ad have persoal ad medical expeses Medical ad Persoal Expeses Sectio I you ll be off work for more tha 7 days because of your ijuries Icome Replacemet Sectio 2 you ca t care for a child uder 16 or a adult depedat whom you were carig for before the accidet Caregiver Expeses Sectio 3 you eed help carig for yourself ad with basic household tasks Persoal Care Assistace Sectio 4 you have a permaet disability or scarrig from the accidet Impairmet Sectio 5 you eed help returig to work Rehabilitatio Sectio 6 a family member died ithe accidet Death Paymets Sectio 7 you disagree with a MPI decisio Appeals Sectio 8 iii

6 Medical ad Persoal Expeses Sectio 1 Medical ad Persoal Expeses Your coverage PIPP reimburses expeses medically required because of the accidet. PIPP also reimburses you for certai persoal expeses resultig from the accidet, icludig travel costs associated with medical treatmet. Key poits PIPP covers medical, persoal ad travel expeses related to the accidet ijury. These expeses will oly be reimbursed after a claim has bee filed with us, with oe exceptio. We ll pay for ambulace trasport to a hospital without a completed claim form if that s the oly expese related to the vehicle accidet. We pay medical practitioers, detists ad other health care providers directly, i most cases. The amout covered is set i a fee schedule, established i cosultatio with the professioal orgaizatios. PIPP pays for medical treatmet that cotributes to your recovery ad rehabilitatio. It does t pay for treatmet that has o measurable beefit to you. If you use your ow car or a family member or fried drives you to medical appoitmets or treatmet, car travel expeses are reimbursed at the rate show o the sheet at the back of this Guide. Depedig o your situatio, PIPP may also reimburse you for parkig, public trasportatio or taxi costs to atted medical treatmet. You ll eed pre-approval from your Case Maager to have these costs reimbursed. Iclude your origial receipts whe you claim for medical ad persoal expeses. Medical treatmet urelated to your accidet ijuries is ot covered. 1

7 Medical ad Persoal Expeses We share a goal: your recovery You re expected to work toward your recovery ad to participate fully i the rehabilitatio program that your health care team believes will help you. I priciple, PIPP covers medical treatmet expeses for as log as they re ecessary. However, costs wo t be covered idefiitely whe a treatmet shows o sigs of helpig you. At some poit, we may ask you to cosult aother medical practitioer ad try a differet type of treatmet. Medical expeses Maitoba Health provides primary health care coverage whe you re ijured i a motor vehicle accidet. Whe you eed additioal treatmet to fully recover, PIPP exteds the health care safety et, payig for medically required treatmet by a medical practitioer or prescribed by a physicia ad ot paid for by ay govermet health care program. PIPP covers care by a detist, optometrist, chiropractor, physiotherapist, registered psychologist or athletic therapist. Some treatmets are oly covered whe performed by certai health professioals. For example, acupucture is covered oly whe performed by a medical doctor, physiotherapist or accredited acupucturist (icludig a chiropractor certified i acupucture). Massage therapy is oly covered whe doe by a physicia, chiropractor, physiotherapist or athletic therapist. We must authorize detal treatmet before treatmet begis, except for emergecy detal work just after the accidet. Your case maager ca cofirm that a specific treatmet is covered. If i doubt, please check with us before startig treatmet. Most physiotherapists ad chiropractors bill us directly Most physiotherapists ad chiropractors bill MPI directly for accidet-related treatmets. This meas there is o direct cost to you for these treatmets. PIPP covers these treatmets provided they re medically ecessary because of your ijuries from the accidet. 2

8 Medical ad Persoal Expeses Claimig your expeses If your claim is i Wiipeg You ll get these five forms i the mail shortly after reportig your claim by phoe: 1. Applicatio for Compesatio completed i all cases 2. Record of Medical & Persoal Expeses excludes travel expeses 3. Record of Travel Expeses travel expeses oly 4. Medical Iformatio Authorizatio completed i all cases 5. Iitial Health Care Report for your health care professioal s completio Complete the forms ad retur them to us, with your origial receipts for your expeses. Oce we ve received the proper documetatio from you, you ca expect a cheque i the mail for your expeses, usually withi a week. If your claim is at a rural Autopac claims office Your case maager will esure you get the forms you eed for ay related expeses. Your case maager will help guide you through the process. Treatig whiplash The good ews about whiplash is that it usually gets better. About three quarters of people with these ijuries have o whiplash pai oe year later. The remaiig oe quarter cotiue to have some pai. This does t seem to be affected by how much or by what type of treatmet they receive. Fortuately, most of these people ca still retur to their ormal activities at home ad at work, despite some ligerig pai. You ca choose from a variety of treatmets for whiplash, icludig athletic therapy, chiropractic, medicie ad physiotherapy. For PIPP to cotiue to cover these treatmets, they must be measurably effective i improvig your coditio. Treatmet should improve your rage of motio ad your ability to fuctio as you ormally would. You should otice these improvemets after a relatively short course of treatmet. The most effective treatmets ecourage mobility ad a retur to your ormal activities. If you otice o improvemet after a short course of treatmet, the treatmet probably is t workig for you. At that stage, you should discuss other treatmet optios with your health care provider. I fact, log-term ieffective treatmet of whiplash may make you worse. No treatmet is completely without risk. 3

9 Medical ad Persoal Expeses The Maitoba Brach of the Caadia Physiotherapy Associatio ad Maitoba Public Isurace share the goal of treatig your ijury as effectively as possible. To achieve this, we ve developed guidelies joitly to help you avoid depedecy o treatmet ad get you better, faster. Your physiotherapist ca explai these guidelies to you i more detail. The Cliical Guidelies for Chiropractic Practice i Caada (1994) recommeds that chiropractors discourage depedecy o treatmet. It also suggests that most patiets should reach their maximum beefit from treatmet withi 16 weeks. To sum up, PIPP covers treatmet for whiplash as log as you re gettig measurable improvemet from it. If a treatmet is workig, improvemet should come quite quickly. PIPP wo t cotiue to cover treatmets that do t improve your rage of motio ad retur you to your ormal activities. If you are t improvig, your health care practitioer should cosider referrig you for aother type of treatmet or dischargig you from care. Your case maager ca also help aswer ay of your questios about treatmet. Is treatmet helpig you? Here are some questios you ca ask yourself about the treatmet you re receivig. The aswers will help you evaluate if it s time to talk to your health care professioal about your treatmet or to ask aother health care professioal for advice. Am I feelig better tha I felt a moth ago? Do I kow what treatmet pla my health care practitioer is followig? Has my health care practitioer discussed treatmet goals with me? Is treatmet likely to make a differece? Is it ecessary? Have we reviewed my treatmet pla i the last two moths? Has my treatmet pla chaged to reflect the progress of my recovery? How will I kow whe treatmet is complete? Am I still takig medicies that I oly started takig after the accidet? What will make me feel better? If you aswered o to ay of the first six questios or if you have ay doubts about your treatmet pla, talk to your health care provider. 4

10 Medical ad Persoal Expeses Medicies ad medical supplies PIPP covers the costs of over-the-couter ad prescriptio medicies ad medical supplies for example, badages, oitmets ad dressigs that you require because of the accidet ijuries. Medical device expeses We also cover the costs of purchasig, retig, repairig, replacig, fittig or adjustig devices that are medically required ad prescribed because of the accidet ijuries. Devices covered iclude eyeglasses, hearig aids, back supports, special footwear, crutches ad artificial limbs. If the device wears out from ormal use, we ll pay for its repair or replacemet. Repairs or replacemet due to eglect, misuse or wilful damage is t covered. Jaso s right leg was severed above the kee i a car accidet. PIPP will cover the cost of purchasig a artificial leg ad will cotiue to pay for the repair ad replacemet of the artificial leg. PIPP also covers the cost of repairig, replacig or adjustig a device that you had before the accidet ad that was damaged or lost i the accidet or that o loger meets your eeds because of the accidet ijuries. This is oe-time replacemet coverage. Paula broke her prescriptio eyeglasses whe her head hit the su visor i a car accidet. PIPP will pay the costs of replacig her eyeglasses. Origial receipts Please give us origial receipts whe you claim reimbursemet for medical device expeses, medicies ad medical supplies. Ambulace services PIPP pays the costs of trasportig you by ambulace from the scee of the accidet to the hospital. We also pay for ambulace services whe, because of the ijuries i the accidet: it s medically ecessary to trasfer you from oe hospital to aother the physicia resposible for your treatmet orders the ambulace service so that you ca receive ecessary treatmet a emergecy arises, requirig urget trasportatio either by groud or air ambulace. 5

11 Medical ad Persoal Expeses Coverage for attedig to someoe who eeds critical care PIPP covers out-of-pocket expeses for attedig to a close relative i hospital requirig critical care because of a automobile ijury. Up to two people are covered, for up to 21 days after the accidet. Expeses up to $3,700 i total are covered. To be covered, you must be the ijured perso s: paret or guardia; or gradparet; or spouse, commo-law parter, or fiacé; or adult child; or brother or sister. The ijured perso must: be uder 16 years old; or be i itesive care; or require a ivasive examiatio or surgery, both uder geeral aesthesia; or suffer from a ustable/life-threateig ijury; or be ear death. We reimburse out-of-pocket expeses related to: authorizig the ijured perso s treatmet; or persuadig or ifluecig the ijured perso to take treatmet; or helpig admiister treatmet; or other medical or compassioate reasos at our discretio. You must prove your expeses, ad they must be for oe or more of the followig: trasportatio, parkig ad tolls accommodatio ad meals child care beyod the care you d ormally provide 90% of your et icome lost, calculated the same way as Icome Replacemet Idemity, but with o waitig period These are ot covered: visitig a hospitalized perso who is t i critical care escortig a ijured perso, whe there s other PIPP coverage for it 6

12 Medical ad Persoal Expeses PIPP also does t cover your expeses if they re covered by: The Health Services Isurace Act aother policy of isurace social assistace ay employmet beefits (icludig sick leave or compassioate leave) ay other pla or paymet Travel expeses to ad from treatmet or medical appoitmets PIPP covers the costs of travel to ad from medical appoitmets ad treatmets that are ecessary because of the accidet ijuries. We reimburse: car travel at the govermet of Maitoba rate whe you drive your car or a fried or family member drives you to a medical appoitmet. Please refer to the sheet at the back of this Guide for this year s rate. parkig costs whe you use a private vehicle to go to a medical appoitmet public trasportatio costs taxi costs if you ca t drive yourself ad public trasport is t available or appropriate travel ad accommodatio costs for someoe to accompay you to medical appoitmets or treatmet if your age or your metal or physical coditio prevets you from goig aloe The 100 kilometre rule You ca choose where you wat to receive medical care. However, PIPP limits coverage for travel expeses to a medical appoitmet or treatmet to a maximum of 100 kilometres each way whe similar care is available closer to your home. Norma lives i a farmig commuity south of Brado. She s seeig a chiropractor twice a week for treatmet of eck pai resultig from a car accidet. Although there s a chiropractor i a tow 20 km away, Norma prefers to see a chiropractor i Brado, which is 110 km away. We ll cover Norma s travel expeses up to a maximum of 200 km (maximum of 100 km each way) per visit. 7

13 Medical ad Persoal Expeses Questios ad aswers Q I uderstad I have to submit origial receipts to you, but the receipts from my pharmacy iclude other prescriptios urelated to the accidet ad covered by my compay s health pla. How ca I provide both MPI ad my compay s health pla with the origials? A We ca retur the origial receipts to you after we ve reviewed them. Just let us kow that you eed the origial receipts back. Q My husbad ad I were both ijured i a car accidet. We re goig to a cliic for treatmet every Moday morig ad drive our ow car. Ca we both claim this travel expese? A No. PIPP reimburses you for the costs you have from ijuries i a motor vehicle accidet. You ad your husbad do t have separate travel costs whe you go to the cliic together. Oe of you ca claim the expese. 8

14 Icome Replacemet Sectio 2 Icome Replacemet Your coverage You re etitled to icome replacemet, begiig o the eighth day after the accidet, whe: a motor vehicle accidet caused the ijury, ad the ijury prevets you from performig all or most of the mai daily duties of the job you had at the time of the accidet. Icome replacemet covers 90% of your et employmet isurace beefits, or lost wages, or salary, based o gross yearly employmet icome. Icome replacemet uder PIPP has a maximum limit. You ca buy extra coverage from us to icrease this limit, if eeded. Key poits Icome replacemet begis o the eighth day after the accidet whe ijuries cotiue to prevet you from workig. Icome replacemet starts after we ve received icome iformatio from your employer or the required busiess records from you. Oce icome replacemet paymets begi, a cheque will be mailed or deposited directly ito your bak accout every 14 days, util you re o loger eligible for icome replacemet. Icome replacemet stops whe there s o medical reaso prevetig your retur to work. Icome replacemet is based o the icome you were earig before the accidet. Your past icome tax returs ad employmet slips are the best ways to establish your icome at the time of the accidet. Icome replacemet is 90% of your et icome, up to a maximum amout that s adjusted aually. 9

15 Icome Replacemet Icome replacemet is for people who were workig or could ve bee workig whe the accidet happeed For someoe who was workig at the time of the accidet: Icome replacemet begis o the eighth day after the accidet PIPP provides icome replacemet to full- or part-time workers who caot cotiue workig because of the accidet ijuries. For someoe who could have bee workig at the time of the accidet but was t: Icome replacemet begis after 180 days People who were employable but ot employed at the time of the accidet become eligible for icome replacemet for their determied employmet 180 days after the accidet, if they still ca t work because of the accidet ijuries. However, if you ca prove you would have held employmet durig the first 180 days, you ll be etitled to icome replacemet based o that job. There must be eough evidece to verify, or at least show a strog likelihood, that you would have bee employed had you ot bee ijured. Employmet status categories Do you fit oe of these categories? Special provisios apply to icome replacemet for miors ad studets. Mior someoe uder 16 years of age at the time of the accidet Studet someoe 16 ad over who was attedig school full-time at the time of the accidet Please refer to the material later i this sectio if you are a mior or a studet. No-earer someoe who was uemployed at the time of the accidet but was able to work Part-time earer someoe who had a regular, part-time job of less tha 28 hours a week at the time of the accidet Temporary earer someoe who, at the time of the accidet, held a regular job of 28 hours a week or more, for less tha 12 moths before the accidet Full-time earer someoe who, at the time of the accidet, had a regular, full-time job of at least 28 hours per week 10

16 Icome Replacemet For someoe who could t work at the time of the accidet: No eligibility for icome replacemet People who had a physical or metal illess that preveted them from workig at the time of the accidet are t eligible for icome replacemet. The law distiguishes betwee full-time earers ad part-time, temporary ad o-earers for a good reaso. It would be ufair to lock i the icome replacemet paid to people who were employable ad could have held full-time work but did ot happe to be workig full-time whe the accidet happeed. We reassess the employmet status of o-earers, part-time earers ad temporary earers if they are still uable to work because of the accidet 180 days (six moths) after it occurred. Mario worked for 15 years as a shipper i a factory. Four moths ago, the factory closed. He was lucky eough to fid a ew full-time job i a large retail outlet, but for less pay. Last week, Mario lost cotrol of his car ad was seriously ijured. Mario is a temporary earer because he has t worked at his curret job for oe year. He will receive icome replacemet based o his salary at his ew job for 180 days (six moths). If he s still uable to retur to work after 180 days, we ll reassess his employmet status ad base icome replacemet o the type of work he was capable of doig at the time of the accidet. Icome replacemet after six moths wo t be less tha the amout he received for the first six moths. Determiatio of employmet 180 days after the accidet for part-time, temporary ad o-earers We determie employmet for people who were part-time, temporary or o-earers at the time of the accidet ad who still ca t retur to work 180 days after the accidet. Determiig a employmet meas establishig the type of work that you could reasoably have bee doig at the time of the accidet. This employmet the becomes the basis for icome replacemet ad for your job search. We determie the type of employmet you were capable of doig at the time of the accidet usig several criteria, regardless of the work you were actually doig. We assess these criteria as they were at the time of the accidet: Your educatio traiig work experiece physical abilities itellectual abilities 11

17 Icome Replacemet The amout of icome replacemet will be adjusted to reflect your determied employmet. Uless you could oly work part-time, we readjust icome replacemet 180 days after the accidet as if you were workig full-time i your determied employmet at the time of the accidet. After we determie a employmet for you, you wo t receive less icome replacemet tha you received durig the first 180 days after the accidet. Determiatio of employmet is very importat for two reasos. First, it may icrease the icome replacemet you receive. Secod, it establishes the type of work you re cosidered qualified to do whe your ijuries heal. We usually require a medical specialist to assess your physical abilities after we determie your employmet. If this specialist fids that you ca do the determied employmet, your icome replacemet stops. If this specialist fids you ca t do the determied employmet, the you ll receive icome replacemet based o the salary rage for that type of employmet. Hery had a office job as a project maager for a miig compay. Last summer, he became tired of paperwork, decided he wated to get out of the office ad trasferred to a positio i the mie. His salary was $100 less a week. O his way back to tow oe day, his car was sideswiped by a truck. Hery broke his collarboe ad had iteral ijuries. He was classified as a temporary earer ad received icome replacemet based o his salary as a mier. Hery still could t retur to work 180 days after the accidet. We determied employmet for Hery as a project coordiator. The doctor said he could t retur to this type of work at the time so, 180 days after the accidet, Hery s icome replacemet amout was icreased to reflect his employmet as a project maager. A few moths later, Hery was able to retur to the office job, his determied employmet, at the same salary he was earig at the time of the accidet, ad his icome replacemet eded. Residual earig capacity Full-time earers ad people for whom employmet was determied 180 days after the accidet Sometimes, a accidet causes ijuries that prevet you from returig to exactly the same kid of full-time work you did before the accidet. However, you re capable of workig at a differet type of job. The isurace idustry refers to this as residual earig capacity. This meas you ca still ear icome, although maybe ot i the same kid of job or at the same pay level as before the accidet. 12

18 Icome Replacemet We ll determie a employmet for you if, two years after the accidet: you re able to work, full- or part-time, you ve recovered as much as you are likely to recover from the accidet ijuries, ad you ve explored all viable employmet rehabilitatio optios ad ca t retur to either the kid of work you were doig at the time of the accidet or the employmet we determied for you 180 days after the accidet. We ll use the followig criteria to determie the type of employmet you re able to do two years or loger after the accidet: Your educatio traiig work experiece physical abilities as they are ow (after the accidet ad recovery) itellectual abilities as they are ow (after the accidet ad recovery) kowledge or skills acquired durig a rehabilitatio program, if applicable The determied employmet will be full-time employmet, uless you ca oly work part-time because of the accidet ijuries. It will also be based o employmet ormally available where you live. We idetify the type of employmet that best matches your skills ad traiig ad your post-accidet abilities ad capacity. Before we determie employmet for you, a case maager will meet you to aswer your questios. Oce we officially iform you, i writig, of the employmet determiatio, you begi the job search year. Durig the job search year, icome replacemet cotiues, so log as you cotiue to be eligible for the beefit. Whe the job search year is over, there are three possibilities: 1. You have work that pays the same or more tha the icome replacemet you ve bee receivig. Icome replacemet eds. 2. You re workig at a job that pays less tha the icome replacemet you ve bee receivig ad less tha your determied employmet. We ll reduce the icome replacemet you ve bee receivig either by: how much your job pays; or how much your determied employmet pays; whichever is greater. That may leave you with some icome replacemets beefits to top up your icome. 3. You have ot foud work. Icome replacemet will be reduced by the icome set for your determied employmet. 13

19 Icome Replacemet Dale was a high school teacher whe he was ijured i a car accidet. He has bee receivig icome replacemet of $1,250 every two weeks ad has take courses to retrai as a commuity cousellor. He fids a job that provides a et icome of $1,000 every two weeks. Dale will cotiue to receive $250 of icome replacemet every two weeks to top up his ew employmet icome. Marily was receivig icome replacemet of $1,600 based o the salary she was earig as a real estate aget at the time of the accidet. After two years, we determied her employmet to be a travel aget because her ijuries permaetly preveted her from drivig a car, essetial for a real estate aget, ad she had previous experiece i the hospitality ad travel idustry. Marily did t fid work durig her job search year. At the ed of the job search year, her icome replacemet was reduced by $1,500, which is the amout set for her determied employmet. Fidig work We ca help you fid work by providig you with job search couselig ad with traiig, to improve your iterviewig ad resume writig skills. Please uderstad, though, that gettig work is mostly up to you. Icome replacemet eds whe you ca retur to your old job or work at your determied employmet Icome replacemet replaces icome you would be earig had you ot bee i the accidet ad become uable to work. Except for the most serious ad disastrous accidets, icome replacemet is a temporary measure to compesate for your loss of icome while you recover from the effects of the accidet. You re o loger eligible for icome replacemet whe: you re able, oce agai, to do the work you were doig at the time of the accidet you re able to work at the employmet that we determied for you 180 days after the accidet you re able to do work that pays as much as, or more tha, the amout used to calculate the icome replacemet paid to you at the start of your claim. Special rules apply to the ed of icome replacemet for employed people over 60 years of age at the time of the accidet ad for people who are receivig icome replacemet whe they tur 65. Please refer to the iformatio o seiors later i this sectio. 14

20 Icome Replacemet Your gradual retur to work It may ot be possible for you to retur to full-time work right away. You ca retur to work gradually ad still receive icome replacemet. Talk to your case maager about your plas for returig to work ad about the effect o your icome replacemet. A recurrece of the disablig coditio caused by the accidet Occasioally, a ijury that seems to have healed flares up. Icome replacemet ca resume whe a disablig coditio caused by the accidet comes back. PIPP provides you with a safety et i this situatio. If you retur to work ad the ijury flares up, it s importat to idetify the cause. You also eed to cotact your case maager to explai what has happeed. I most cases, icome replacemet, at the same level you were receivig before your retur to work, will resume immediately, without a seve-day waitig period. Steps i calculatig icome replacemet To calculate your icome replacemet properly, we eed accurate ad complete iformatio from you. Step 1 We classify your employmet status We classify your employmet status based o your employmet situatio at the time of the accidet: full-time earer, part-time earer, temporary earer, o-earer, mior, studet, or someoe who could t work at the time of the accidet because of a physical or metal coditio. This classificatio relates to the amout of icome replacemet you ll receive ad to the eed to reclassify your employmet status i certai cases. Those who are ieligible for icome replacemet wo t progress beyod Step 1. Step 2 We establish your gross yearly employmet icome Gross yearly employmet icome is the total of gross yearly icome from salaried employmet ad self-employmet. We cosider all the employmet icome that you lose because of the ijuries from the accidet for the icome replacemet calculatio, icludig Employmet Isurace beefits or Natioal Traiig Allowace beefits. 15

21 Icome Replacemet 2a Salaried employmet We iclude all these amouts as icome from salaried employmet: wages or salary, icludig vacatio pay overtime declared tips commissios bouses cash value of your persoal use of a compay vehicle value of the employer s cotributio to your pesio pla cash value of your share of a profit-sharig pla other beefits that are part of your employmet compesatio package For example: employer cotributios to a health pla a reduced iterest rate o a loa the paymet of professioal fees housig provided by your employer remote locatio bouses Remember, PIPP replaces icome that you lose because of the ijuries you had i the accidet. So, for example, if your compay cotiues to pay ito your pesio pla while you re off work, you wo t receive icome replacemet for that portio of your icome. 2b To establish your salaried employmet icome We eed a completed Employer s Verificatio of Earigs (E.V.E.) form to pay you icome replacemet. Please ask your employer to complete the form ad retur it to us as quickly as possible. Your case maager ca help you if you re havig trouble gettig the ecessary employmet icome iformatio. We may also ask you for other documets to verify your employmet icome, especially if your employer fails to retur a properly completed E.V.E. Form to us. 2c Self-employmet Self-employed people work for themselves, ot for someoe else. Idepedet cotractors, sole proprietors, uicorporated farmers ad members of uicorporated parterships are all self-employed. People who work for their ow icorporated compay are ot selfemployed. They are employees of their privately owed compay. 16

22 Icome Replacemet Because self-employmet icome ca vary greatly from year to year, the gross yearly employmet icome of a self-employed perso is determied by: your most recet busiess year, your most recet fiscal year, a average of your icome from two or three busiess years, or the pro-rated, average gross icome for your class of employmet, whichever of these amouts is highest. 2d To establish your self-employmet icome For busiesses that are oly a few moths old, a statemet listig icome sources may be sufficiet to establish your self-employmet icome. For busiesses that have bee operatig for more tha a few moths, we eed to see icome tax returs, fiacial statemets or tax assessmets. 2e Other cosideratios There are may details cocerig the way we calculate gross yearly employmet icome that we ca t describe here. Your case maager ca explai how we factor i, for example, shift premiums, periodic overtime, seasoal fluctuatios i icome, sick credits ad vacatio time whe establishig gross yearly employmet icome. The key is to make sure that we have all the iformatio we eed to do the calculatio. Step 3 We calculate your et icome Net icome approximates your actual take home pay before the accidet. Your et icome is calculated from your taxable icome. Here are the deductios from gross yearly employmet icome that establish taxable icome. Some of these deductios may ot apply to you. the basic persoal credit the age credit (for people over 65) the married perso s credit (regardless of your spouse s icome) the equivalet to married credit (whe you have a depedat ad o spouse) the depedet s credit (regardless of the depedat s icome) employmet isurace premiums Caada Pesio Pla cotributios child ad spousal support paymets A case maager will complete a worksheet with iformatio o your age, marital status, umber of depedats ad other tax iformatio. We follow icome tax rules that applied durig the year prior to the year i which we are makig the calculatios. 17

23 Icome Replacemet Step 4 We calculate icome replacemet Icome replacemet is 90% of et icome (the amout calculated i Step 3). This amout will be paid to you every two weeks, util: you retur to work, your icome replacemet is adjusted for reasos discussed i other parts of this Guide, you re eligible for a Retiremet Icome Beefit, or you re o loger eligible for icome replacemet. However, there are some situatios i which other amouts you re paid uder other programs will be subtracted from your icome replacemet. If, for example, because of the accidet you receive a disability beefit from the Caada Pesio Pla, your icome replacemet will be reduced accordigly. Maximum amout of gross yearly employmet icome for PIPP calculatios We ll ever use a amout higher tha the maximum isurable Gross Yearly Employmet Icome amout whe calculatig your icome replacemet. You ll fid this year s maximum o the sheet at the back of this Guide. Be is a highly skilled heavy equipmet operator who works overtime regularly. For the last three years, his icome has bee over $70,000 a year. I August 2004, he was hit by a car. He ll be off work for four moths. Durig this time, he ll receive icome replacemet based o a yearly icome of $65,000, the maximum coverage i Worker s Compesatio paymets Employees covered by Worker s Compesatio are etitled to Worker s Compesatio beefits for lost icome if they ca t work because of a job-related ijury. If the job-related ijury happeed i a motor vehicle accidet i Maitoba, the employee also qualifies for icome replacemet coverage ad other beefits uder PIPP. Employees therefore ca choose betwee collectig beefits uder the Worker s Compesatio Pla or PIPP. Beefits uder Worker s Compesatio ad PIPP are ot idetical. It s i your iterests to cotact both the Worker s Compesatio Board (WCB) ad MPI to get iformatio about the coverage to which you are etitled. The, you ca make a decisio about the pla from which to receive beefits. The telephoe umber for the WCB is at the ed of this Guide. 18

24 Icome Replacemet Miors: childre uder the age of 16 PIPP pays a mior: a lump sum idemity for each school term the mior does t complete because of ijuries from the motor vehicle accidet, ad icome replacemet for ay icome the mior would have bee earig but ca t ear because of the ijuries from the accidet. PIPP defiitios: mior child uder the age of 16 elemetary school Kidergarte to Grade 8 secodary school Grade 9 to Grade 12 A school year begis o July 1 ad eds o Jue 30, for the purposes of calculatios uder PIPP. A lump sum idemity is oly payable whe a mior would have completed the school year except for the accidet. The idemity becomes payable o July 1 for the loss of part or all of the precedig school year. The idemity amouts for this year are o the sheet at the back of this Guide. Josh is 15 ad i Grade 10. He also works i a fast-food restaurat o Friday ights ad weekeds. He s ijured i a car accidet i August ad misses the whole year of school ad has to quit his job while he recovers from his ijuries ad works at his rehabilitatio. Josh will receive icome replacemet to cover the lost icome from his part-time restaurat job ad a lump sum paymet (see amout o the sheet at the back cover of this guide) for his missed year of schoolig. Etitlemet to a lump sum idemity stops at the ed of the school year i which the mior tured 16. Whe miors reach 16 ad still ca t work because of the accidet ijuries, icome replacemet begis, based o the Idustrial Average Wage for Maitoba. The Idustrial Average Wage is set usig Statistics Caada data for the earigs of all employees i Maitoba. This year s Idustrial Average Wage for Maitoba is o the sheet at the back of this Guide. Icome replacemet cotiues accordig to the eligibility criteria described i this sectio. 19

25 Icome Replacemet Studets Uder PIPP, a studet is at least 16 ad was erolled full-time i a secodary or postsecodary school at the time of the accidet. PIPP provides a lump sum idemity to studets who miss a portio or all of a academic year because ijuries i a accidet prevet the studet from attedig school. Studets (16 or older) who miss a full year of secodary school or post-secodary school because of the accidet ijuries receive a maximum lump sum idemity. This year s amout is o the sheet at the back of this Guide. If the studet misses oe term of school, the lump sum is pro-rated. For example, if there are three terms i the studet s secodary school year ad the studet misses oe term, PIPP will pay the studet oe-third of the lump sum idemity. Whe the studet loses a full school year, the lump sum idemity is paid o July 1, followig the lost school year. Whe the studet loses a term or semester of the school year, the lump sum idemity is paid at the begiig of the ext term or semester. These lump sum paymets cotiue util the scheduled ed date for the studet s curret level of studies. For example, the ed date would be the ed of high school if the studet was i high school, or the ed date for completio of a degree if the studet was i college or uiversity. If the studet still ca t work or retur to the studies uderway at the time of the accidet because of the accidet ijuries, PIPP pays icome replacemet based o the Idustrial Average Wage. This icome replacemet will cotiue for as log as the claimat meets the eligibility criteria. We also determie employmet for a claimat who was a studet at the time of the accidet ad ca work. Please refer to determiatio of employmet earlier i this sectio. People 65 ad older This applies to people i oe of these three categories: someoe 65 years of age or over ad who is ot employed at the time of a car accidet someoe 65 years of age or over ad is employed at the time of a car accidet someoe beig paid icome replacemet ad turs 65 People 65 years of age or over at the time of a accidet ad ot employed are ot eligible for icome replacemet or the Retiremet Icome Beefit (R.I.B.). 20

26 Icome Replacemet Walter is a 66-year-old retired factory worker. He s i a car accidet ad has ijuries affectig his ability to sit or stad for log periods of time. Walter does t qualify for icome replacemet or a R.I.B. because he s over 65 ad was t workig at the time of the accidet. There s o icome to replace. Walter will receive the other PIPP beefits to which he s etitled. A employed perso who s 65 years of age or over at the time of a accidet is etitled to icome replacemet if ijuries i a vehicle accidet prevet the perso from workig. We calculate the icome replacemet for a employed perso who s over 65 i the same way as for other claimats, ad apply the same rules about whe icome replacemet eds. Five years after the date of the accidet, if the perso still ca t work because of the accidet ijuries, the perso becomes eligible for the R.I.B. ad icome replacemet eds. Martha is 67 ad still workig as a secretary i a lawyer s office, a job she s had for 35 years. She s i a car accidet i May Her ijuries iclude a serious brai ijury that will prevet her from ever returig to work. Martha will receive icome replacemet based o her salary util May 2009 (five years after the accidet). The, she ll be eligible for a R.I.B. For claimats 65 years or older, icome replacemet eds whe: the claimat is o loger disabled, or the claimat has received icome replacemet for five years. If a perso became eligible for icome replacemet before he or she tured 60, icome replacemet eds whe the perso ca retur to work or turs 65. I this situatio, someoe receivig icome replacemet at the age of 65 will be eligible for a R.I.B. If a perso became eligible for icome replacemet whe he or she is over 60, icome replacemet cotiues for five years (if the perso cotiues to be uable to retur to work because of ijuries from the accidet). The, the perso will be eligible for a R.I.B. The Retiremet Icome Beefit (R.I.B.) R.I.B. took effect o March 1, It s meat to provide a retiremet icome, for life, for people who have a ogoig disability because of a motor vehicle accidet ad, as a result, ca t save adequately for their retiremet years. 21

27 Icome Replacemet The R.I.B. is 70% of your et icome mius ay other pesio icome you receive, icludig Caada Pesio Pla ad Old Age Security paymets. If the perso s pesio icome is more tha 70% of the et icome used i our calculatio, the perso wo t receive a R.I.B. The R.I.B. is adjusted o each aiversary after you became etitled to it, accordig to the Cost of Livig Idex. People who receive a R.I.B. must: iform us of ay chages i their pesio icome, ad provide us with a certified copy of their icome tax retur every year. The R.I.B. wo t be paid to a perso who returs to work ad ears the same amout of moey as before the accidet. A perso s eligibility for the R.I.B. is subject to the same rules applyig to icome replacemet. All other icome you ear is subtracted from your R.I.B. Crimial Code covictios ad icome replacemet I geeral, PIPP covers ijuries from a vehicle accidet, o matter who caused the accidet or how it happeed. But if the perso who caused the accidet is covicted of a Crimial Code offece related to the accidet, icome replacemet will be reduced for the first 12 moths after the accidet. I these cases, two factors affect how much less icome replacemet will be: the ijured perso s fault for the accidet: for example, if the ijured perso was 50% at-fault, icome replacemet reduces by 50%; ad how may depedats the ijured perso has. If a perso is covicted i the Uited States for a crime related to the accidet, it will have the same impact o icome replacemet as if the offece occurred i Caada. No icome replacemet will be paid to a perso who is i priso. To speed up your claim Here are some thigs you ca do to speed up your claim for icome replacemet: Make sure we have all the iformatio we eed about your employmet icome at the time of the accidet. Aswer our requests for iformatio as quickly as you ca. We ca t begi regular icome replacemet paymets util we have all the required documets. 22

28 Icome Replacemet Questios ad aswers Q Why do t I receive icome replacemet for the first seve days I missed work after the accidet? A The seve-day waitig period is like a deductible i other isurace policies you share a small part of the loss. But, you re covered for the more substatial loss whe you re off work for more tha a week. This protects more seriously ijured people who eed icome replacemet log-term, ad keeps the overall cost of coverage dow. Q I was collectig Employmet Isurace at the time of my accidet. My ijuries are serious eough to prevet me from lookig for work at this time so I m o loger eligible for Employmet Isurace. Do I qualify for icome replacemet? A Yes. Icome replacemet will replace 90% of the et beefit you were receivig from Employmet Isurace. However, icome replacemet will oly cotiue for the time you were eligible for employmet isurace. Whe that claim expires, your etitlemet to icome replacemet eds. Q My car flipped over o a icy road ad I was i hospital for two moths, the i rehab for six moths. I m ow able to retur to work. Whe I cotacted my employer, I was told that my full-time job had bee take by someoe else ad that there was o work for me. I m able to work at my old job but there s o work for me. Ca I still get icome replacemet? A Yes. Icome replacemet cotiues temporarily for full-time or part-time earers who have lost a job because of the accidet. Ordiarily, icome replacemet would ed as soo as you were able to retur to work at your old job. However, icome replacemet will cotiue as follows: for 30 days, if you were eligible for icome replacemet for 90 to 180 days for 90 days, if you were eligible for icome replacemet for 181 to 365 days for 180 days, if you were eligible for icome replacemet for more tha oe year but less tha two years for oe year, if you were eligible for icome replacemet for more tha two years. Q I have bee collectig icome replacemet sice March 1999 ad tured 65 i April Am I eligible for the Retiremet Icome Beefit? A Yes. You were receivig icome replacemet whe the Retiremet Icome Beefit came ito effect so you are eligible for it. Cotact your case maager. 23

29 Icome Replaceme Icome Replacemet Q I have bee doig the bookkeepig for my husbad s greehouse busiess for the last five years. I do t get paid. Last week, I was i a car accidet ad my ijuries are prevetig me from doig the bookkeepig work at this time. Are the costs of hirig someoe to do this work util I m able to do it agai, covered? A Yes. PIPP covers the cost of hirig someoe else to do your work, up to a maximum weekly amout. Please refer to the sheet at the back of this Guide for the amout covered at this time. The coverage ca cotiue for 180 days while you ca t do the bookkeepig because of the accidet ijuries. After 180 days, the compesatio eds, eve if you still ca t do the work. However, if you re still disabled after the 180 days, you ll be etitled to icome replacemet based o a determied employmet. 24

30 Caregiver Expeses Sectio 3 Caregiver Expeses Your coverage Full-time caregivers You re eligible for a Caregiver Weekly Idemity whe: your mai job before the accidet was carig for a child or childre uder 16 or a adult who could t hold employmet because of poor physical or metal health, ad you ca t cotiue to provide this care because of your ijuries. Part-time caregivers You re eligible to have care expeses reimbursed whe: you cared for a child or childre uder 16 or a ifirm adult part-time before the accidet, ad you ca t cotiue to provide this care because of your ijuries. Key poits Caregiver Weekly Idemity For full-time caregivers The weekly amout depeds o how may childre uder 16 ad adults who ca t work you were carig for at the time of the accidet. The idemity will be adjusted whe circumstaces chage, for istace, whe a 15-year-old turs 16. If, 180 days after the accidet, your ijuries cotiue to prevet you from carig for childre uder 16 ad adults who ca t work, you have a choice. You ca receive icome replacemet based o your determied employmet, or you ca cotiue to receive the Caregiver Weekly Idemity. After 180 days, you caot receive both icome replacemet ad the Caregiver Weekly Idemity. Your case maager will explai this choice to you. Also, see the sectio o determiatio of employmet. Depedat care expeses For part-time caregivers You re etitled to be reimbursed for extra caregiver expeses resultig from the accidet, if, at the time of the accidet,you were: workig full-time, or workig 28 hours or more per week part-time, or attedig school full-time, ad were 16 or over ad you were carig for a child uder 16 or a adult who ca t work. Depedat care expeses will ot be reimbursed whe your spouse ca provide the care. 25

31 Caregiver Expeses Coverage for people who ca o loger care for others PIPP covers people ijured i motor vehicle accidets who, at the time of the accidet, were carig for childre uder 16 or adults who ca t work. There are two differet types of coverage. Full-time caregiver People whose mai occupatio was carig for childre uder 16 or adults who ca t work ad were uemployed or workig part-time at paid employmet are eligible for the Caregiver Weekly Idemity. Part-time caregiver People who were workig full-time, workig more tha 28 hours a week part-time or were over 16 ad full-time studets, ad who were also carig for childre uder 16 or adults who ca t work are eligible to have their uexpected, accidet-related caregiver expeses reimbursed. You re eligible if you ca t cotiue to care for childre or a ifirm adult because of your ijuries. At the time of the car accidet, Martie was a full-time mother, takig care of her three childre, all of whom were uder five. She broke her leg ad her wrist i the car accidet ad could t clothe, bathe or supervise her childre. Martie received the Caregiver Weekly Idemity durig the four moths it took for the ijuries to heal ad for Martie to agai be able to care for her childre uassisted. At the time of the car accidet i which he ijured his back, Stepha worked full-time ad took care of his father, who lived with him. Stepha s father uses a wheelchair ad eeds help gettig ito ad out of bed. While Stepha s back healed, he had to hire someoe to help his father i the morigs ad i the eveigs. PIPP paid this caregiver expese whe Stepha provided the receipts, which were below the weekly maximum amout PIPP covers. Childre uder 16 The Caregiver Weekly Idemity ad the reimbursemet of caregiver expeses are available whe you ca t care for a child uder 16 years of age because of the accidet ijuries. Whe a child turs 16, coverage relatig to that child eds, uless the child requires care because of a metal or physical disability. 26

32 Caregiver Expeses Adults who ca t work The Caregiver Weekly Idemity ad the reimbursemet of caregiver expeses are available whe you ca t care for a perso over 16 who is regularly uable to work for whatever reaso a metal or physical disability, for example whe you were carig for that perso at the time of the accidet. We cosider the aswers to the followig questios to determie if a adult is uemployable ad relies o your care: Is the perso uable to hold employmet? What type of care were you providig to this perso? How do the accidet ijuries prevet you from providig this care? Laura s mother has Alzheimer s disease ad has bee livig with Laura for the last year. Laura does t work. She has bee preparig meals for her mother ad goig with her wheever she eeds to leave the house for fresh air or appoitmets. Laura was ijured i a car accidet ad ow ca t care for her mother because of the ijuries. Laura is eligible for the Caregiver Weekly Idemity. Amout of the Caregiver Weekly Idemity The Caregiver Weekly Idemity depeds o how may childre uder 16 ad adults who ca t work you were carig for at the time of the accidet. Care icludes: bathig, dressig, feedig, liftig ad supervisig. It does t, however, iclude housekeepig-type activities, such as doig laudry ad cleaig. If you ca t cotiue to do these household tasks because of the accidet ijuries, persoal care assistace coverage applies. (Please see Sectio 4 for more iformatio o persoal care assistace coverage.) The sheet at the back of this Guide lists the maximum amouts of the Caregiver Weekly Idemity this year. 180 days after the accidet If, 180 days after the accidet, you still ca t work ad ca t care for a child uder 16 or a adult who ca t work, you have the optio of cotiuig to receive the Caregiver Weekly Idemity or of receivig icome replacemet based o your determied employmet. Sectio 2 explais how we determie employmet for you. Your case maager will talk to you about this optio ad calculate how much you d receive based o icome replacemet for your determied employmet. 27