StateFarm and accident benefits | GTAMotorcycle.com

StateFarm and accident benefits

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BMC

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Hey Folks! Looking for some input on my situation. I was in a motorcycle accident in August 2011. The accident was my fault and I ended up breaking my arm in the ordeal. Now I was off work for 9 weeks in which I was receiving supplemental assistance from my employer. My pay cheque was about 65% of my wage. Now statefarm mentioned that my policy had accident benefits to a maximum of $400/week so I figured that Statefarm would top me up since what I was receiving fell short by about that amount, but that was not the case. Statefarm quickly let me know that since what my employer was paying me was more than $400 a week I wouldn't be entitled to any more money since it was an either or situation.

Now this is the part that has me a little frustrated. A few people that I work with have had similar dealings with statefarm and they topped them up pay additional to what they were receiving from my employer as soon as they threatened with a lawyer. Apparently they try to weasel themselves out of the situation unless called out on it. Statefarm keeps mentioning their accident benefits meanwhile my employers insurance has been paying for my physiotherapy in full while statefarm has been paying for nothing. What's the point of paying all this extra cash for accident benefits when my employer foots the bill for everything?

I'm honestly thinking of getting my lawyer involved my would like some input from those that might have experience with a similar situation. TIA!
 
I think part of our premiums should entitle to us to a NO-BS benefit when it comes time to make a claim. Best of luck to ya and let us know how it turns out
 
Hi BMC

Much like you, I have heard it go both ways. Every adjuster intreprets the SABS (Statutory Accident Benefit Schedule) differently. You're more than welcome to involve a personal injury lawyer. Just be prepared to have a chunk of your settlement be taken by them.

A couple of things you should know. First off, your medical/rehabilitational benefits and your income replacement have nothing to do with each other. It's not like a bank account you pay into and can withdraw any way you want. You should also know that the legislation changed in September 2010 and your co-workers might have dealings with them prior to the changes.

Unless you purchased optional income replacement benefits. Your policy covers 400.00 a week. That's it. Under the SABS it states clearly that an insurer may deduct any amount being paid by your employer. So if you're making more than 400.00 a week in STD/LTD you're out of luck....sorry. (If you want to look it up your self It's section 7 [1]). It's also further explained in section 47 (1).

Technically Statefarm is right. Getting a lawyer may only further complicate your claim. It's usually better to deal with things on your own. As previously discussed in this forum. It can be hard to find decent personal injury lawyers. Most of them are crooks and liars.

I hate to be the bearer of bad news, and I'm sorry to hear about your loss.
 
Can I choose to opt out of the pathetic $400 a week income replacement and lower my premium?
 
murf said:
Can I choose to opt out of the pathetic $400 a week income replacement and lower my premium?
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You can choose to increase your IRB from an upwards of $1,000/wk. It won't lower your premium, it will be the exact opposite. However should you suffer an injury that stops you from working, you'll be grateful for the increased income.

I would speak to your broker about it.
 
murf said:
Can I choose to opt out of the pathetic $400 a week income replacement and lower my premium?
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The $400 limit is the minimum required by law -- you can't opt out of it.
 
So I'm paying for it, but won't recieve it if I have a job with those kind of benefits?
 
murf said:
So I'm paying for it, but won't recieve it if I have a job with those kind of benefits?
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I agree it does seem kind of dumb, but the product is designed by the Gov't, not the insurance industry. There are social benefits to this method though. Consider the alternative where people were allowed to opt out -- in this situation, the premiums would disappear for people with coverage through work benefits, and increase dramatically for people without coverage through work benefits. Since lower-income earners tend to have jobs without benefits, this would essentially be a huge burden on the poor to the benefit of the not-so-poor. Aside from this, determining whether or not a client is adequately insured elsewhere would add huge administrative costs.

I'm not saying I agree not disagree with the current method, but I do see it's benefits (even though, like you, I have benefits through my employer).
 
murf said:
So I'm paying for it, but won't recieve it if I have a job with those kind of benefits?
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How else do you think Insurance companies are going to fund corrupt politicians who will then make stupid rules like these to benefit insurance companies???
 
TheNewDude said:
How else do you think Insurance companies are going to fund corrupt politicians who will then make stupid rules like these to benefit insurance companies???
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It doesn't benefit the insurance company at all -- it benefits people who do not have work benefits, and disadvantages those who do. People with benefits are really subsidizing those who don't have benefits.
 
VifferFun said:
It doesn't benefit the insurance company at all -- it benefits people who do not have work benefits, and disadvantages those who do. People with benefits are really subsidizing those who don't have benefits.
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And as a whole, we benefit the insurance company. As far as I know, almost all insurance companies in Canada made a decent profit last year.

I know the profit ends up in shareholders pockets and those shareholders spend the money in stores which hires people and so on and so forth.... But the point is that it helps wealthy individuals amass more wealth.
 
TheNewDude said:
And as a whole, we benefit the insurance company. As far as I know, almost all insurance companies in Canada made a decent profit last year.

I know the profit ends up in shareholders pockets and those shareholders spend the money in stores which hires people and so on and so forth.... But the point is that it helps wealthy individuals amass more wealth.
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I forget who posted it before (Viffer or Platinum) but SF was paying out $1.43 for every $1 on their Motorcycle policies.
Doesn't sound like a good profit to me.
 
jeffjones said:
I forget who posted it before (Viffer or Platinum) but SF was paying out $1.43 for every $1 on their Motorcycle policies.
Doesn't sound like a good profit to me.
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Well I'm not sure about that tell you the truth... I meant as a whole, State Farm and other insurance companies were making good money.
 
TheNewDude said:
Well I'm not sure about that tell you the truth... I meant as a whole, State Farm and other insurance companies were making good money.
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So they are just like any other business...... :D

Does your employer make a profit?
 
jeffjones said:
So they are just like any other business...... :D

Does your employer make a profit?
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Except they are guaranteed business.
As long as cars exist in Ontario, Insurance companies will have business no matter how they treat the customer, thanks to government rules.

I believe in Manitoba, the Gov't runs the car insurance business. There rates are half of ours from what I heard from a friend. (Don't get me wrong though, I'm not saying that the Gov't does things right/better by any means.)
 
TheNewDude said:
Except they are guaranteed business.
As long as cars exist in Ontario, Insurance companies will have business no matter how they treat the customer, thanks to government rules.

I believe in Manitoba, the Gov't runs the car insurance business. There rates are half of ours from what I heard from a friend. (Don't get me wrong though, I'm not saying that the Gov't does things right/better by any means.)
Click to expand...

You are confounding many issues (all of which have been discussed at length in other threads). The Coles' Notes version:

1.) Insurance is cheap in Manitoba because it's MANITOBA. Not only is the frequency of claims much lower, the severity is MUCH lower because people don't lawyer up over the smallest of collisions. I have priced the optional coverages in Saskatchewan (another Government-run province) and I was cheaper than the Gov't provider.

2.) State Farm did terrible last year. For every $1.00 they took in on all of the Auto/Bike business, they paid out $1.37 in claims. On the whole, insurance companies will break a modest profit if you consider their ten-year performance (since there are cycles of profitability and dismal losses). To say that they are "guaranteed profit" is incorrect; otherwise, everyone and their brother would invest their life savings in publicly-traded insurance companies. FYI, here is the money paid out in claims for each $1.00 received by Canadian Insurance Company during 2011:

$1.37 -- State Farm (Yikes, that's terrible!!)
$1.17 -- Certas
$1.07 -- Dominion
$1.04 -- Wawanesa
$1.04 -- Personal
$1.01 -- Economical
$1.01 -- RBC Insurance
$1.00 -- Aviva
$0.99 -- Co-operators
$0.98 -- TD
$0.97 -- Intact
$0.97 -- Belair
$0.97 -- Nordic
$0.97 -- Royal & Sun Alliance
$0.96 -- Jevco
$0.96 -- Echelon
$0.96 -- Allstate
$0.91 -- Chubb
$0.86 -- Zurich
 
VifferFun said:
You are confounding many issues (all of which have been discussed at length in other threads). The Coles' Notes version:

1.) Insurance is cheap in Manitoba because it's MANITOBA. Not only is the frequency of claims much lower, the severity is MUCH lower because people don't lawyer up over the smallest of collisions. I have priced the optional coverages in Saskatchewan (another Government-run province) and I was cheaper than the Gov't provider.

2.) State Farm did terrible last year. For every $1.00 they took in on all of the Auto/Bike business, they paid out $1.37 in claims. On the whole, insurance companies will break a modest profit if you consider their ten-year performance (since there are cycles of profitability and dismal losses). To say that they are "guaranteed profit" is incorrect; otherwise, everyone and their brother would invest their life savings in publicly-traded insurance companies. FYI, here is the money paid out in claims for each $1.00 received by Canadian Insurance Company during 2011:

$1.37 -- State Farm (Yikes, that's terrible!!)
$1.17 -- Certas
$1.07 -- Dominion
$1.04 -- Wawanesa
$1.04 -- Personal
$1.01 -- Economical
$1.01 -- RBC Insurance
$1.00 -- Aviva
$0.99 -- Co-operators
$0.98 -- TD
$0.97 -- Intact
$0.97 -- Belair
$0.97 -- Nordic
$0.97 -- Royal & Sun Alliance
$0.96 -- Jevco
$0.96 -- Echelon
$0.96 -- Allstate
$0.91 -- Chubb
$0.86 -- Zurich
Click to expand...

Viffer is right. insurance fraud in Ontario is out of control. It has been for years. Insurance companies were literally going bankrupt fighting fraud. rehab clinics and scamming claimants were bilking insurance companies. Now we have the new changes as of September 2010. We will see how those changes fare.
 
BMC said:
Hey Folks! Looking for some input on my situation. I was in a motorcycle accident in August 2011. The accident was my fault and I ended up breaking my arm in the ordeal. Now I was off work for 9 weeks in which I was receiving supplemental assistance from my employer. My pay cheque was about 65% of my wage. Now statefarm mentioned that my policy had accident benefits to a maximum of $400/week so I figured that Statefarm would top me up since what I was receiving fell short by about that amount, but that was not the case. Statefarm quickly let me know that since what my employer was paying me was more than $400 a week I wouldn't be entitled to any more money since it was an either or situation.

Now this is the part that has me a little frustrated. A few people that I work with have had similar dealings with statefarm and they topped them up pay additional to what they were receiving from my employer as soon as they threatened with a lawyer. Apparently they try to weasel themselves out of the situation unless called out on it. Statefarm keeps mentioning their accident benefits meanwhile my employers insurance has been paying for my physiotherapy in full while statefarm has been paying for nothing. What's the point of paying all this extra cash for accident benefits when my employer foots the bill for everything?

I'm honestly thinking of getting my lawyer involved my would like some input from those that might have experience with a similar situation. TIA!
Click to expand...

I work at a law firm that handles Accident Benefits cases.

Here are some things that you should know:

1. Income replacement is - $400/wk unless you are receiving Short Term/Long Term disability benefits from your employer. When you exhaust your benefits you will be able to apply for Income replacement from State Farm.

2. You, as a person with a broken arm, are entitled to $100,000 in medical rehabilitation treatment for the injury that you've suffered. State Farm will attempt to place you under the Minor Injury Guideline and send you to one of their "preferred" rehabilitation clinics which will discharge you from any duty of care within a few months.

3. If you are to opt out of having a lawyer you will not receive any sort of fair Full and Final settlement as SF will simply fight you all the way.

4. If you choose to retain council, make sure that you do so ASAP. There is no telling what documentation you may have signed so far that may have destroyed your chances at a settlement.

5. Do NOT trust the adjusters. They do NOT act in your best interest.

6. Retain a lawyer specifically in the field of Personal Injury. You wouldn't want a lawyer that isn't experienced with SABS (Statutory Accident Benefits Schedule) to handle your claim.

7. Regardless of whether you were at fault or not you are entitled to benefits aside from the Income Replacement as you are outside the Minor Injury Guideline.

With all the above being said, if you are interested in retaining a lawyer you can contact me by sending me a private message.

RE: ABadjusterrider_5
You are completely incorrect. The insurance companies were not going broke at all, with the addition of the MIG guideline in Sept 2010 their profits soared and now the Financial Services Commission of Ontario is planning on raising the MIG due to the unfair financial gain of the ICs.
 
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InsLaw said:
I work at a law firm that handles Accident Benefits cases.

Here are some things that you should know:

With all the above being said, if you are interested in retaining a lawyer you can contact me by sending me a private message.

RE: ABadjusterrider_5
You are completely incorrect. The insurance companies were not going broke at all, with the addition of the MIG guideline in Sept 2010 their profits soared and now the Financial Services Commission of Ontario is planning on raising the MIG due to the unfair financial gain of the ICs.
Click to expand...

Cough cough ambulance chaser cough
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