What are Capped Claims and How do They Work?
Did you know that some “minor” personal injuries suffered in Alberta are subject to a claim cap imposed by the provincial government?
Capped claims may affect the amount of compensation you can receive from at-fault parties if you are injured due to their negligent, reckless or malicious actions.
What is a capped claim? Which injuries do they apply to? And how is the amount you will receive calculated in a capped claim?
These questions have generated a fair amount of confusion amongst people involved in accidents (and their families) in Alberta and so the regulations need to be clarified.
What is a capped claim?
A capped claim is a limit placed upon the amount of compensation you can receive for pain and suffering that results from certain types of injuries suffered in motor vehicle accidents.
The injuries affected are soft tissue injuries like minor whiplash injuries, bruising, swelling, strains and sprains that resolve within a very short period of time.
The cap was introduced as part of the Alberta Minor Injury Regulation in 2004. The cap does not impact economic loss claims or out-of-pocket-claims.
How is a capped claim determined?
The guidelines for capped claims are relatively simple on the face of it but confusion has resulted largely from the consideration of what constitutes a “minor” injury.
The injuries suffered must be:
- Soft tissue injuries – damage to bodily tissue, ligaments, muscles or tendons
- Short-term injuries that do not affect the victim’s ability to work or live normally
It is ultimately for a court to determine if injuries are minor. Some injuries may be considered “minor” but still not subject to a capped claim. Whiplash is a good example of why confusion arises: certain instances recover much faster that others and make it difficult for a court to assess whether or not injuries are minor.
A medical report may be required to assess the duration and intensity of the injuries sustained.
Note that capped claims are not confined to just physical injuries. Certain mental, emotional, or psychological trauma can be subject to a capped claim if these injuries are short-lived and heal within a certain timeframe.
After suffering an injury in a motor vehicle accident (or any other accident in Alberta) it is important to be thoroughly checked by a medical professional and obtain the appropriate legal advice.
How much is the cap?
In 2004, when the new regulations first came into being, the cap was set at $4,000 by the Alberta Treasury Board and Finance.
The amount of the cap varies every year and is adjusted for inflation. The current cap amount is set at $5,365 (2021).
If your injuries make you subject to this cap, the cap amount applied will be the appropriate rate in the year of your accident rather than the year of your claim.
Which injuries does the cap NOT apply to?
If you are involved in a motor vehicle accident in Alberta and suffer any of the following injuries, your compensation claim will likely proceed without considering the restrictions of the cap:
- Traumatic brain injuries
- Broken bone injuries
- Spinal cord injuries
- Chronic pain
- Severe mental, emotional, or psychological trauma
- Any other injuries that affect your ability to work or participate in your regular activities
What are you entitled to claim in non-capped injury cases?
If your injury is not subject to a capped claim and the accident was not your fault, you may be able to claim compensation for:
- General damages – compensation for pain, suffering and the loss of amenities of life
- Special damages – reimbursement of out-of-pocket expenses
- Loss of Housekeeping Capacity – to accommodate for a reduction in the ability to tend to household tasks
- Cost of Future Care – to compensate for ongoing medical expenses
- Economic Losses – for lost wages and future potential losses
Speak to your lawyer if you are in any doubt about whether an injury is subject to a capped claim.
What should you do after an accident?
After an auto accident, try to gather as much photographic and video evidence as possible at the scene. Also, gather personal and insurance information from the other party or parties and obtain witness information, if possible.
A thorough medical checkup is a priority once you leave the scene of the accident.
After you have received the appropriate initial medical care, the next thing to do is to make a time to discuss your situation with a personal injury lawyer.
Professional legal assistance can prevent you from making a costly mistake. The insurance company may try to pressure you to settle out of court or at a capped amount. Until you have had a personal injury lawyer assess your injuries, do not make any comment. Your lawyer can manage communications with the insurance company so that you do not have to.
Sometimes, injuries may appear to be minor at first but develop into lasting pain that can affect your work and your life more severely than first thought.
Have you suffered a car accident injury in Calgary?
If you or a loved one have suffered injury from a motor vehicle accident, seek experienced legal assistance from the personal accident lawyers at Vogel Verjee in Calgary.
We are accustomed to assessing personal injury claims on behalf of parties injured in many types of accidents and can ensure that you are not short-changed by the insurance company in your compensation claim.
Book a free consultation and we will be happy to evaluate your case and answer your questions.