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

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Société de l’assurance automobile du Québec

7236A 84 (2015-02)

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;

-

Schedule 5 – Expenses for Travel to Receive Care;

- Section 14 of Part II of the guide; and

- Part IV of the guide (section pertaining to Schedule 5).

For more information, please contact us at one of the following numbers:

In the Québec area: 418 646-9877;

From elsewhere in Québec: 1 800 463-6890;

From elsewhere in Canada or the USA: 1 800 463-6898.

Thank you for your cooperation.

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Claim Number

Guide

_{TO THE}

CLAIM FOR

COMPENSATION

For an Inability to Perform

Activities and for

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I

C

ompensation

paid

by

the

saaQ

The various indemnities paid by the SAAQ have three main objectives:

Objectives Indemnities Categories Page

Income replacement indemnity

Indemnity for care expenses ... 8

Lump-sum indemnity for the loss of one year of schooling or one school term

Full-time worker ... 3

Person with a

temporary job ... 4

Part-time worker ... 5

Unemployed person ... 6

Person permanently unable

to work in any capacity ... 7

Student 16 years of age or older ... 9

Child under 16 years of age ... 10

A

To compensate for economic loss due to an accident

B

To compensate for the after-effects of injury, such

as pain, mental suffering and loss of enjoyment of life ... 11

C

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Compensation Paid by the SAAQ

a

C

ompensation

for

eConomiC

loss

As compensation for economic loss, you may be entitled to receive one or more of the following indemnities:

• an income replacement indemnity • an indemnity for care expenses

• a lump-sum indemnity for the loss of one year of schooling or one school term

◾

Income Replacement Indemnity

This indemnity is paid to a person who loses employment earnings due to an accident. It corresponds to 90% of net income, which is based on gross annual income (up to a maximum provided for under the Automobile Insurance Act). Net income is established by subtracting federal and provincial income tax, Employment Insurance premiums, Québec Parental Insurance Plan (QPIP) premiums and contributions to the Québec Pension Plan from gross income. You may be entitled to compensation for the loss, as a result of the accident, of any Employment Insurance benefits payable under the Employment Insurance Act. In some cases, such compensation may be payable in addition to an income replacement indemnity.

For information on the amounts to which you may be entitled, consult the Compensation Table.

Please note: No compensation is payable for the first seven days including the day of the accident.

Job Categories

In order to rule on the indemnity or indemnities to which you may be entitled, your compensation officer will have to determine into which of the following categories you fit according to the Automobile Insurance Act:

• full-time worker

• person with a temporary job • part-time worker

• unemployed person

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◾

Full-time worker

If, at the time of the accident, the accident victim held a job at which he/she had been working at least 28 hours per week, and that job was expected to last for at least a year, that person is considered a full-time worker.

Such a person may be entitled to an income replacement indemnity if he/she is no longer able to work at his/her job because of the accident. The indemnity is payable until that person is able to resume his/her employment.

Starting from the 3rd year after the accident

An accident victim who remains unable to work in any capacity will continue to receive an income replacement indemnity, except if he/she is 64 years of age or older (see “Person 64 years of age or older” in the box on page 7).

If that person is unable to do the job he/she had at the time of the accident but becomes able to work in another capacity, the SAAQ may take this into account.

Determining employment three years after the accident

The SAAQ may determine the type of employment the accident victim would be able to hold by taking into account his/her training, experience, physical and intellectual abilities and, where applicable, any knowledge or skills acquired under a rehabilitation program. Once an employment has been determined, the accident victim will continue to receive the same income replacement indemnity as before for a period of one year. At the end of that year, the indemnity will be reduced by an amount equal to the net income of the employment determined for that person.

Employment is also determined for accident victims who held temporary or part-time employment before the accident, or who were unemployed before the accident.

PLEASE NOTE: If an accident victim receives a surviving spouse’s pension from the Régie des rentes du Québec (RRQ), the amount of that pension may be reduced if that person receives an indemnity from the SAAQ for a particular disability and is deemed to be disabled by the RRQ for the same disability. For more information, visit the RRQ Web site.

(6)

◾

Person with a temporary job

If, at the time of the accident, the accident victim held a job at which he/she had been working at least 28 hours per week, and that job was expected to last for less than one year, that person is considered a temporary worker. Such a person may be entitled to an income replacement indemnity if he/she is no longer able to work at his/her job because of the accident.

For the first 180 days after the accident, the amount of the income replacement indemnity is based on the job the person held before the accident and is paid until that person is able to resume his/her employment.

Starting from the 181st day after the accident

In cases where the disability persists, the accident victim may receive an income replacement indemnity based on an employment he/she would have been able to hold were it not for the accident.

The SAAQ takes into account the following when determining an employment for an accident victim:

• the person’s physical and intellectual abilities • his/her training

• his/her work experience

The amount of the indemnity is established on the basis of the gross income corresponding to the employment determined for the accident victim. The indemnity is paid until the accident victim becomes able to do the job determined for him/her.

If that person is unable to do the job determined on the 181st day after the accident but becomes able to work in another capacity, the SAAQ may take this into account.

For more information, see “Determining employment three years after the accident” in the box on page 3.

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◾

Part-time worker

If, at the time of the accident, the accident victim held a job at which he/she had been working for fewer than 28 hours per week, he/she is considered a part-time worker, regardless of how long that job was expected to last (more or less than one year).

Such a person may be entitled to an income replacement indemnity if he/she is no longer able to work at his/her job because of the accident.

For the first 180 days after the accident, the amount of the income replacement indemnity is based on the part-time job and is paid until the person is able to resume his/her employment.

If, at the time of the accident, the accident victim was also taking care of, without pay, one or more children under 16 years of age or a person with a disability, the accident victim may be entitled to an indemnity covering the cost of care if he/she is no longer able to take care of that person or those people (see “Indemnity for care expenses” in the box on page 8).

The amount of the indemnity is established on the basis of the gross income corresponding to the employment determined for the accident victim. The indemnity is paid until the accident victim becomes able to do the job determined for him/her.

An accident victim who was also receiving an indemnity for care expenses will no longer receive both indemnities as of the 181st day (see “Indemnity for care expenses” in the box on page 8).

If that person is unable to do the job determined for him/her but becomes able to work in another capacity, the SAAQ may take this into account. For further information, see “Determining employment three years after the accident” in the box on page 3.

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◾

Unemployed person

An accident victim is considered to be unemployed if he/she was able to work at the time of the accident but did not have a job. Such a person is eligible to receive an income replacement indemnity for the first 180 days after the accident, but only in the following cases:

• The accident victim is unable to hold a job he/she would have held during that period, had the accident not occurred;

• As a result of the accident, the accident victim is deprived of regular Employment Insurance benefits or an employment-assistance allowance. If, at the time of the accident, the accident victim was taking care of, without pay, one or more children under 16 years of age or a person with a disability, the accident victim may be entitled to an indemnity covering the cost of care if he/she is no longer able to take care of that person or those people (see “Indemnity for care expenses” in the box on page 8).

Even in cases where an accident victim was not entitled to an income replacement indemnity in the first 180 days, he/she may receive an income replacement indemnity based on the job determined for him/her. The indem-nity is paid until the accident victim becomes able to do the job determined for him/her.

excePtion: A person 65 years of age or older who was unemployed at

the time of the accident and who does not provide proof of hiring within 180 days after the accident will not be entitled to an income replacement indemnity.

An accident victim who was also receiving an indemnity for care expenses will no longer receive both indemnities as of the 181st day after the accident (see “Indemnity for care expenses” in the box on page 8).

An accident victim who remains unable to work in any capacity will continue to receive an income replacement indemnity, except if he/she is 64 years of age or older (see “Person 64 years of age or older” in the box on page 7). If that person is unable to do the job determined for him/her but becomes able to work in another capacity, the SAAQ may take this into account.

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◾

Person permanently unable to work in any capacity

An accident victim who, at the time of the accident, was permanently unable to work in any capacity (whether on a full-time or a part-time basis) for physical or intellectual reasons other than those caused by the accident, is not entitled to receive an income replacement indemnity.

Person 64 years of age or older

A person 64 years of age or older on the date of the accident may be entitled to an income replacement indemnity for the year after the accident.

However, this indemnity is reduced by

• 25% as of the second year after the date of the accident • 50% as of the third year

• 75% as of the fourth year

Eligibility for this indemnity ends four years after the date of the accident.

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◾

Indemnity for Care Expenses

An indemnity for care expenses is paid to an accident victim whose main activity was unpaid work taking care of children under 16 years of age or one or more disabled individuals.

To be entitled to this indemnity, this person must have been unemployed or working only part-time when the accident occurred.

The amount payable varies according to the number of children or disabled individuals he/she was caring for.

This indemnity cannot be combined with an income replacement indemnity based on a job at which the person had been working for more than 28 hours per week.

An accident victim who was also receiving an income replacement indemnity will no longer receive both indemnities as of the 181st day after the accident.

At the time he/she deems appropriate, the accident victim must choose between the indemnity for care expenses and the income replacement indemnity. Pending that decision, only the indemnity for care expenses will be paid.

For information on the amounts to which you may be entitled, see the Compensation Table.

◾

Lump-Sum Indemnity for the Loss of One

Year of Schooling or One School Term

This lump-sum indemnity is paid to students who fall behind in their schooling due to a traffic accident and miss

• one year of studies at the elementary or secondary level; • one school term at the post-secondary level.

This indemnity is paid at the end of the term or year of schooling in question.

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◾

Student 16 years of age or older

Students 16 years of age or older who are enrolled full time in a secondary or post-secondary educational institution and who fall behind in their schooling because they are unable to resume studying due to the accident are entitled to a lump-sum indemnity.

The amount of the indemnity is based on the level of schooling.

The indemnity ceases to be paid as of the scheduled date for completion of the studies underway at the time of the accident.

ExAmPLE: Jane is a CEGEP student who had not yet registered at a university at the time of the accident. She will be entitled to an indemnity until the date on which she was scheduled to complete her college-level studies, unless she is able to resume studying in the meantime.

An accident victim who held a job or jobs, or who would have held one if the accident had not occurred, may also be entitled to an income replacement indemnity.

Income replacement indemnity

An accident victim who is a student 16 years of age or older may be entitled to an income replacement indemnity if

• he/she held a job or would have held a job had it not been for the accident; • he/she is deprived of regular Employment Insurance benefits;

• he/she is deprived of an employment-assistance allowance.

The indemnity is paid to the accident victim up until the date when he/she was scheduled to complete the studies then underway, but only for such time as

• the job would have been available and the person remains unable to hold it; • the person is deprived of regular Employment Insurance benefits because

of the accident;

• the person is deprived of an employment-assistance allowance because of the accident.

Starting from the scheduled date for completion of the studies underway at the time of the accident

As of the date the accident victim was scheduled to have completed his/her studies,

• if that person is unable to resume studying due to the accident, he/she is no longer entitled to the lump-sum indemnity;

• if that person is unable to resume studying or to work in any capacity, he/she may be entitled to an income replacement indemnity. The amount is based on the average weekly earnings of Québec workers;

• if that person is able to work, but his/her capacity to do so is significantly reduced because of the accident, he/she may also be entitled to an income replacement indemnity.

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◾

Child under 16 years of age

Accident victims who fall behind in their schooling due to the accident are entitled to a lump-sum indemnity.

The amount of the indemnity is based on the level of schooling.

The indemnity ceases to be paid at the end of the school year during which the student turns 16 or is able to resume studying.

A student who has a job or jobs, or who would have held one if the accident had not occurred, may be entitled to an income replacement indemnity. For information on the amounts to which you may be entitled, see the Compensation Table.

Income replacement indemnity

An accident victim who is a child under 16 years of age may be entitled to an income replacement indemnity if

• he/she held or would have held a job had it not been for the accident; • he/she is deprived of regular Employment Insurance benefits;

• he/she is deprived of an employment-assistance allowance.

The indemnity is paid to the accident victim up until the end of the school year during which the student turns 16, for such time as

• the job would have been available and the person remains unable to hold it; • the person is deprived of regular Employment Insurance benefits due to

the accident;

• the person is deprived of an employment-assistance allowance due to the accident.

ExAmPLE: Joey is a newspaper carrier who can no longer deliver newspapers due to an accident. He can receive an income replacement indemnity for the period for which he was hired.

Starting at age 16

Starting at the end of the school year during which the student turns 16 • an accident victim who is unable to resume studying due to the accident

is no longer entitled to the lump-sum indemnity;

• an accident victim who is unable to resume studying or to work in any capacity may be entitled to an income replacement indemnity. The amount of the indemnity is based on the average weekly earnings of Québec workers; • An accident victim who is able to work, but whose capacity to do so is

significantly reduced because of the accident, may also be entitled to an income replacement indemnity.

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b

C

ompensation

for

a

d

iminished

Q

uality

of

l

ife

Injuries sustained in a traffic accident and any permanent impairment resulting therefrom can result in after-effects or consequences, such as mental suffering, pain or loss of enjoyment of life. These after-effects may be compensated by the SAAQ with a lump-sum indemnity.

• The amount of the lump-sum indemnity varies according to the severity of the injuries and their consequences.

• Accident victims are always compensated based on the maximum amount in force on the date of the decision.

• A lump-sum payment is generally made once the health condition of the accident victim is considered stable.

• Where warranted by the medical information in a person’s file, an interim payment may be made before the final assessment of the accident- related injuries.

C

r

eimbursement

of

aCCident

-

expenses

For information on the expenses covered and the conditions for reimbursement, see “Reimbursement of expenses” in the box on page 18.

Disabled parking permit

On April 1, 2003, the SAAQ began refunding the fee for a disabled parking permit paid by anyone who applies for one as the result of a traffic accident.

The Disabled Parking Permit Application form is available in SAAQ service centres.

If you are entitled to the refund, you will be sent a copy of the form entitled Disabled Parking Permit Fee Refund Application (Reserved for accident victims with a compensation claim record at the Société de l’assurance automobile du Québec), which you must fill out, sign and return to get your refund.

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II

C

ompleting

the

C

laim

for

C

ompensation

form

Accident Victim

1 ◾

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.

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Accident

3 ◾

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.

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Completing the Claim for Compensation Form

• 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.

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◾

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.

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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.

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Injuries

7 ◾

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.

Pension, Benefits, Indemnities, Compensation or Allowances Received from Another Body

11

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.

Reimbursement of Expenses

12 ◾

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.

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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 connec-tion 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 1 888 810-2525.

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▪

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.

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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.

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.

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?”

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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 • compression stockings

• gauze • “Jobst” or “Dr. Gibaud” clothing, etc.

• wadding • adhesive bandages and medical tape,

• bandages 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 www.saaq.gouv.qc.ca.

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Completing the Claim for Compensation Form

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 • nursing assistants

• audiologists • occupational therapists

• audioprosthesists • opticians

• chiropractors • pharmacists

• dental hygienists • physiotherapists

• dental technicians • psychoeducators

• denturists • psychologists

• dieticians • podiatrists

• guidance counsellors • respiratory therapists • medical technologists • social workers

• midwives • speech therapists

• nurses • 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 informa-tion 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.

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▪

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 semi-private 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 1 888 810-2525 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: 1 888 810-2525.

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Signature of the Claim for Compensation

15

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.

Authorization to Disclose Medical Information

16

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.

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Direct Deposit

17

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.

⑈001⑈ ⑆12345⑉678⑆ 123⑉456⑉7⑈

}

Cheque no.

Not always shown on a cheque

(Do not enter)

Branch no.

(5 digits) Institution no.(3 digits) Account no.(max. 12 digits)

001

VOTRE NOM

123, RUE PRINCIPALE OUEST VOTRE VILLE (PROVINCE) A2B 3C4

PAYEZ À L’ORDRE DE

/100 DOLLARS

$

}

VOTRE INSTITUTION FINANCIÈRE 345, RUE PRINCIPALE OUEST VOTRE VILLE (PROVINCE) A2B 3C4 POUR

A A A A M M J J

DATE

Void

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.

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Completing the appendices

III

C

ompleting

the

appendiCes

Accident Victim’s Social Situation

a

◾

Spouse at the time of the accident

A spouse is defined as

• a person who, at the time of the accident, was married to or in a civil union with the accident victim and was living with him/her;

• a person who, at the time of the accident, was living in a de facto union with the accident victim and had been publicly represented as that person’s spouse for at least three years;

• a person who, at the time of the accident, was living in a de facto union with the accident victim and had been publicly represented as that person’s spouse for at least one year, provided

– a child had been born or was to be born of their union; – they had adopted a child together;

– one of them had adopted one or more of the other’s children.

b

◾

Former spouse at the time of the accident

A former spouse is defined as

• a person who is legally separated or divorced from the accident victim and who, at the time of the accident, was entitled to receive spousal support (excluding child support) from the accident victim by virtue of a judgment or agreement.

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C

◾

Dependants at the time of the accident

A dependant is defined as:

• a minor child (under age 18) of the accident victim, regardless of whether that child was adopted or is the accident victim’s biological child, and any minor person to whom the accident victim stood in loco parentis (acted as parent) at the time of the accident;

• a child of full age of the accident victim, or a person of full age to whom the accident victim stood in loco parentis (acted as parent) at the time of the accident and any other person related to the accident victim by blood or adoption if, at the time of the accident, the accident victim was providing for more than 50% of that person’s basic needs and maintenance costs.

List the names and other contact information of

– all children under age 18 who were your dependants at the time of the accident;

– all your children between the ages of 18 and 25 who attended an educational institution full time and were your dependants at the time of the accident;

– all disabled individuals who were your dependants at the time of the accident;

– any other person, if you were providing for more than 50% of that person’s needs.

NOTE: If, at the time of the accident, you had more than six dependants, please provide the required information about each additional dependant on a separate sheet of paper and attach it to the form. Be sure to indicate your claim number or, if unavailable, your Health Insurance Number, at the top of the page.

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Completing the Appendices

Accident Victim’s Economic Situation

d

◾

Employment

• If you were employed as a salaried worker at the time of the accident, you must answer all the questions. Your answers will help determine the amount of the income replacement indemnity you may be entitled to receive if you are unable to work because of the accident.

Please note: If you are still disabled more than seven days after the

accident (including the day of the accident), remember to enclose with your claim for compensation Schedule 2

– Attestation of Income by the Employer, which must

be completed by your employer.

• If you are self-employed and you are still disabled more than seven days after the accident (including the day of the accident), you must provide the following for each of the three previous years:

– your Québec or federal income tax return (the Québec income tax return is preferred for Québec residents) and your notice of assessment; AND

– either your statement of income and expenses or one of the two following forms: TP-80-V, Income and Expenses Relating to a Business or Profession, or T2125, Statement of Business or Professional Activities (form TP-80-V is preferred for Québec residents); OR

– if you were not resident in Canada, any official document attesting to your income. This type of document is generally required by the fiscal authority of the country or territory concerned (equivalent to Revenu Québec or the Canada Revenue Agency).

NOTE: Remember to indicate your claim number or, if unavailable, your Health Insurance Number on each separate sheet you submit with the claim.

e

◾

At the time of the accident:

Were you working without pay in a family business?

• An accident victim is entitled to a reimbursement of the labour costs incurred in order to hire someone to replace him/her if the accident victim is in the following situation:

– The accident victim was working in a family business at the time of the accident (by “family business” we mean any business that employs a blood relative or a relative by adoption or marriage, regardless of the business’s legal status, e.g. company or partnership, registered or

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– The accident victim was working without pay.

– Due to the accident, the accident victim is no longer able to perform his/her usual work.

– Due to the accident, the accident victim has incurred labour costs in order to be replaced .

• Labour costs are reimbursed upon presentation of supporting docu-ments. To be reimbursed, enclose your receipts and invoices on which the following information is provided:

– the full name and address of the person who was hired to replace you; – the period covered by the request for reimbursement;

– the amount paid, or that you were invoiced, for the services rendered by the person who replaced you.

• The claim for reimbursement cannot cover a period that extends beyond the 180th day following the accident.

Were you receiving Employment Insurance benefits or an employment-assistance allowance?

The accident may cause the loss of regular Employment Insurance benefits or of an employment-assistance allowance. If applicable, the SAAQ will rule on the amount of any compensation you are entitled to receive for these losses.

• If you were receiving regular Employment Insurance benefits at the time of the accident and you are still disabled more than seven days after the accident (including the day of the accident), have your local Service Canada Centre complete schedule 3 – confirmation of employment

insurance Benefits lost/confirmation of an employment-assistance allowance lost.

• If, at the time of the accident, you were receiving an employment- assistance allowance that is part of active measures by Emploi-Québec and you are still disabled more than seven days after the accident (including the day of the accident), have your local employment centre complete schedule 3 – confirmation of employment insurance Benefits

lost/confirmation of an employment-assistance allowance lost.

Please note: Loss of both types of benefits due to an accident is

possible, in which case the form must be completed by both these centres.

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Completing the Appendices

◾

At the time of the accident, had an employer guaranteed

you employment?

If an employer had offered you a job that you would have held if the accident had not occurred, provide the name and telephone number of that employer.

Please note: If your period of disability began on the day of the

accident and you are still disabled more than seven days later (including the day of the accident), or if you became disabled more seven days after the accident, complete the Confirmation of Hiring form. You can obtain a copy by calling the SAAQ at 1 888 810-2525.

f

◾

At the time of the accident, were you unable to work

for a reason other than the accident?

It may be that at the time of the accident you had already been unable to work either temporarily or permanently for medical reasons (for example, as a result of a work-related accident or because you had been granted sick leave).

◾

Describe your illness or disability prior to the accident.

Describe any illness or disability that you had before the accident and that prevented you from being able to work. Indicate the name of the hospital or medical clinic where you were treated, as well as the name of the physician who has been treating you for the health issue(s) in question.

h

If you had not held full-time employment for over a year when the

accident occurred, you must provide the information below.

◾

Education

Circle only your last completed year of schooling. Indicate the diploma or degree received for the highest level of schooling you have completed.

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◾

In the five years before the accident, were there any

periods when:

Your main occupation was taking care of a child under 6 years of age without pay?

If you were looking after someone else’s child, please indicate, in addition to the information requested, the child’s name, date of birth and the reason for taking care of the child. Write this information on a separate piece of paper and attach it to the form. Remember to indicate your claim number or, if unavailable, your Health Insurance Number, at the top of the page.

You were unable to hold a job due to illness, an accident, etc.?

If you answer “Yes” to this question, please indicate the period(s) during which you were unable to work and explain why (type of illness, disability or accident).

◾

Professional qualifications

A certificate of qualification is the basic document a worker must have in order to practice a trade. For this qualification to be taken into consideration, your certificate must have been valid at the time of the accident. The same applies to professional corporations of which you are a member. You must have been a member in good standing of such a corporation on the day the accident took place.

◾

Employment history

It is important to report all the jobs you have held in the past five years, beginning with the most recent one. This information will help the SAAQ determine an employment for you and establish the amount of any income replacement indemnity to which you may be entitled.

If you have not worked in the past five years, please list the last three jobs you have held and provide the dates they began and ended.

NOTE: If you do have enough space, use a separate sheet of paper and attach it to the Claim for Compensation form. Remember to indicate your claim number or, if unavailable, your Health Insurance Number, at the top of the page.

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Completing the forms

IV

C

ompleting

the

forms

Schedule

2 ◾

Attestation of Income by the Employer

This form must be completed by your employer if you are in either of the following situations:

• You had a full-time or part-time job at the time of the accident and you are still disabled more than seven days after the accident (including the day of the accident).

• You had a job but were temporarily incapable of working before the accident and you are still disabled more than seven days after the accident (including the day of the accident).

schedule 2 – attestation of income by the employer must be sent to the

SAAQ within six days after the SAAQ asks that it be completed. Please note: Remember to complete the first part of the form entitled

“accident Victim.”

Schedule

3 ◾

Confirmation of Employment Insurance Benefits Lost/

Confirmation of an Employment-Assistance Allowance Lost

This form must be completed by

• your local Service Canada Centre if you have lost regular Employment Insurance benefits as a result of the accident and you are still disabled more than seven days after the accident (including the day of the accident); • your local employment centre if you have lost an employment-assistance

allowance as a result of the accident and you are still disabled more than seven days after the accident (including the day of the accident).

NOTE: Loss of both types of benefits due to an accident is possible, in which case the form must be completed by both these centres.

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Schedule

4 ◾

Attestation of School Attendance

This form must be completed by the educational institution if the accident victim is a full-time student 16 years of age or older.

Please note: Remember to complete the first part of the form entitled “accident Victim.”

Schedule

5 ◾

Expenses for Travel to Receive Care

To claim expenses incurred for travel to receive care or undergo treatment, • provide the information requested;

• enclose the original receipts, where applicable.

Expenses for transportation by private automobile qualify for reimburse-ment. 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.

Travel details

Reason for travel

Specify the reason for travel.

Means of transportation

Use the following letters to identify the means of transportation used: A : Automobile

C : Public transit

I : Bus, plane, train T : Taxi

Round-trip distance

If you used an automobile, indicate the number of kilometres to and from the place where you received care or underwent treatment (use your residence as the starting point).

Parking

(36)

Completing the Forms

amount claimed

If you used an automobile as a means of travel, you do not have to enter the amount claimed. This amount will be calculated on the basis of the distance indicated.

On the other hand, if you used another means of transportation, enclose your receipts and enter the amount claimed.

Meals and lodging

Where the cost of meals or expenses for an overnight stay were incurred to receive care, enter these expenses in the space provided and specify the reason for travel. You must also enclose the original invoices or receipts.

Please note: Remember to complete the first part of the form entitled “accident Victim.”