When a patient walks into your clinic after a motor vehicle accident (MVA), the first 90 days of care are critical. As a massage therapist, chiropractor, physiotherapist, or other healthcare provider, you play a vital role not only in their physical recovery but also in guiding them through the accident benefits system. Your actions during this window can significantly impact both the patient’s long-term outcomes, their ability to access and sustain insurance-funded treatment, and the patient’s injury claim. 

This article outlines how you can support a car accident injury victim during the first 90 days, including assessment, treatment planning, communication with insurers, and assistance with paperwork. A practical checklist is provided at the end.

1. Understanding the Context: Accident Benefits in Atlantic Canada

Every automobile insurance policy includes mandatory accident benefits coverage. These benefits provide funding for medical and rehabilitation services regardless of fault. The key framework is set out under the Section B benefits of the Standard Automobile Insurance Policy. In the first 90 days, treatment is typically guided by the Diagnostic and Treatment Protocols Regulation (Protocol), which outlines specific processes for common injuries such as whiplash-associated disorder (WAD) I and II.

If the patient qualifies under the Protocol (e.g., they have a soft tissue injury), the insurer is required to fund 12 weeks of care—including chiropractic, physiotherapy, or massage therapy, without requiring prior approval, provided the protocol steps are followed correctly.

What follows below is an example of an optimal assessment and treatment schedule. Of course, so many injury victims can’t get assessed right away. It isn’t the end of the world. Of course, when I’m giving advice as a personal injury lawyer, I’m always encouraging my clients to start treatment right away!

2. Day 1–7: Intake, Assessment, and Immediate Actions

A. Conducting a Thorough Assessment

Your primary responsibility is to assess the patient thoroughly. This includes:

  • Subjective history: Mechanism of injury, onset of symptoms, current complaints, past medical history. (Don’t skip this!!) 
  • Objective assessment: Range of motion, strength, postural alignment, neurological screening, palpation, and functional assessments. 
  • Injury classification: Determine if the patient meets criteria for WAD I or II (neck pain with/without musculoskeletal signs but no neurological signs). 

B. Determining Protocol Eligibility

If the patient has:

  • No red flags (e.g., fracture, neurological deficit, TBI), 
  • A diagnosis consistent with soft tissue injury (e.g., WAD I or II, sprains, strains), then they likely qualify for care under the Protocol. 

Tip: Physiotherapists and chiropractors are designated as “care coordinators” under the Protocols. Massage therapists can be involved but require care to be coordinated by one of the other disciplines.

C. Paperwork and Communication

This step is essential for early access to Accident Benefits funding. You must submit:

  • Form AB-2: Notice of Claim and Treatment Plan, to be completed by the care coordinator within 10 business days of initial assessment. This form outlines the treatment plan and injury classification. 
  • Provider Invoice Form: Used to bill the insurer directly under the protocol guidelines. 

Encourage the patient to:

  • Notify their insurer promptly of the accident, 
  • Provide you with the insurance adjuster’s name and contact details, 
  • Sign any necessary consent forms for communication. 

3. Week 2–4: Delivering Treatment and Adjusting Plans

A. Initiating Treatment

Once eligibility is confirmed and the AB-2 form submitted, you can proceed with up to 21 treatment visits over 90 days under the Protocol. These visits may include:

  • Manual therapy (massage, mobilization), 
  • Active rehabilitation exercises, 
  • Education (e.g., posture, self-care, sleep positioning), 
  • Reassurance and psychological support (especially with anxiety related to driving or reinjury). 

Massage therapists may be part of the care team but must work in coordination with the primary provider. Treatments should be goal-focused, time-limited, and thoroughly documented.

B. Monitoring Progress

Track and document:

  • Functional improvements, 
  • Pain reduction (use a sacle that is trackable, like VAS or NPRS), 
  • Return-to-work status or modifications, 
  • Any new or worsening symptoms. 

If the patient deteriorates or fails to improve by week 4, a re-evaluation should be done. Consider referring for:

  • Physiotherapy if massage alone isn’t achieving goals, 
  • Psychology if mood or anxiety symptoms persist, 
  • Family physician/ nurse practitioner or medical specialist if red flags emerge. 

4. Week 4–8: Re-Evaluation and Mid-Protocol Adjustments

A. Reassessment Milestone

Around week 4 or after approximately 10–12 visits, reassess and consider:

  • Are the patient’s symptoms improving as expected? 
  • Is additional care needed beyond the 21 visits? 
  • Is there a need for referral for further imaging or consult? 

If the patient does not show improvement, they may need to exit the protocol system and seek approval for extended care via the insurer’s Section B adjuster. This may require a physician referral or more formal reporting.

B. Documenting Limitations and Barriers

At this stage, it’s critical to document:

  • Persistent functional limitations, 
  • Barriers to return to work or daily activities, 
  • Psychological overlays (e.g., catastrophizing, avoidance behaviours). 

This documentation helps support the patient’s case if further treatment, income replacement benefits, or legal action becomes necessary.

5. Week 8–12: Discharge Planning or Transition to Extended Care

A. Discharge Criteria

A patient may be ready for discharge if:

  • They’ve met treatment goals, 
  • Functional capacity has returned, 
  • Pain is stable and manageable, 
  • They’ve returned to normal work and activity levels. 

Prepare a discharge summary to the insurer, noting outcome measures and recommendations.

B. Extended Care Application

If the patient still requires care:

  • Provide a clinical summary outlining medical necessity, 
  • Liaise with the family physician to support a Section B treatment extension request, 
  • If denied, consider Section B appeal procedures or involve legal counsel. 

Tip: Your clinical notes and charts will become vital if the patient later requires legal action to resolve medical benefit issues or their injury claim. Consistent, objective documentation is your best tool.

6. Patient Advocacy and Referral Responsibilities

Throughout the first 90 days, your role extends beyond hands-on care. You may need to:

  • Help the patient complete Form 1 (Notice of Claim for Accident Benefits). 
  • Missing time from work? Help the patient complete Form 1A, which is required for weekly indemnity benefits. 
  • Refer for mental health support if psychological symptoms impair recovery. 
  • Update the patient’s employer about return to work timing, if possible. 
  • Guide them in navigating the insurance process (e.g., how to communicate with adjusters, what receipts are needed). 

7. Checklist for the First 90 Days

Task Who Does It? Deadline/Timing
Take full injury history and perform objective assessment You Day 1
Determine protocol eligibility You Day 1–3
Submit AB-2 (Treatment Plan) Chiropractor or Physiotherapist Within 10 business days
Coordinate care with other providers You + team Ongoing
Educate patient about Section B and timelines You Early visits
Submit direct billing invoices (HCS form) Clinic admin or you As treatment occurs
Reassess for progress You Week 4
Refer out if poor recovery You Week 4–6
Discharge planning or extension request You Week 8–12
Prepare final report or summary You Upon discharge
Ensure documentation is detailed and supports functional outcomes You Every visit

8. Common Pitfalls to Avoid

  • Being late with insurance forms: This may delay approval and funding. 
  • Assuming coverage without confirmation: Always verify protocol eligibility. You need to get paid by the insurance company. Tip: If there is no insurance in place or problems with getting paid for treatment you should contact the patient’s lawyer for help.
  • Neglecting to coordinate with other providers: Protocol care is team-based! Use it to help inform your treatment and optimize health outcomes. 
  • Poor documentation: If it’s not written down, it didn’t happen—insurers rely heavily on chart notes.  
  • Failing to refer: Watch for red flags, psychological distress, or signs of a more serious injury. 

9. Final Thoughts

As a treatment provider, your skill, insight, and diligence can set the tone for a car accident injury victim’s entire recovery process. From easing pain and restoring function to helping them navigate insurance and legal systems, your early involvement has ripple effects that extend far beyond the clinic walls.

Remember, your notes may one day be read aloud in a courtroom, your assessments scrutinized by insurers, and your recommendations used to approve or deny ongoing care. Make the first 90 days count—because for the patient, it’s often the most overwhelming and vulnerable period of their recovery.

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Still have questions? Don’t hesitate to reach out and call our team at NOVA Injury Law today! For more information on car accident and injury law, feel free to check out our previous article on Nova Scotia minor injury caps.