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The Automobile Accident Insurance (Injury) Regulations - PDF
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1 1 INSURANCE (INJURY) A-35 REG 5 The Automobile Accident Insurance (Injury) Regulations being Chapter A-35 Reg 5 (effective January 1, 2003) as amended by Saskatchewan Regulations 71/2007 and 77/2007. NOTE: This consolidation is not official. Amendments have been incorporated for convenience of reference and the original statutes and regulations should be consulted for all purposes of interpretation and application of the law. In order to preserve the integrity of the original statutes and regulations, errors that may have appeared are reproduced in this consolidation.
2 2 A-35 REG 5 INSURANCE (INJURY) Table of Contents PART I Title, Interpretation and Application 1 Title 2 Interpretation 3 Application PART II Determining Who is a Resident of Saskatchewan 4 Persons resident in Saskatchewan 5 Loss of status as resident 6 Retention of status 7 Status of minor child PART III Calculation of Death Benefits 8 Manner of determining insured s net income 9 Maximum yearly employment income 10 Industrial average wage not published 11 Change in method by Statistics Canada 12 Calculation of yearly employment income not derived from self-employment 13 Calculation of yearly employment income self-employed insured 14 Calculation of net income 15 Dependant benefit 16 Capitalization PART IV Calculation of Permanent Injury Benefits 17 Compensation for permanent impairments - Schedule of Permanent Impairments 18 Evaluation of impairment to symmetrical parts of the body 19 Application of section Percentage fixed for deficit existing prior to the accident 21 Computation of more than one permanent impairment 22 Section 21 not to be applied to percentage based on enhancement factor 23 Enhancement factor to be added after computation of successive remainders PART V Indexation of Benefits 24 CPI not published 25 Change in method of Statistics Canada PART VI Coming into Force 26 Coming into force
3 3 INSURANCE (INJURY) A-35 REG 5 CHAPTER A-35 REG 5 The Automobile Accident Insurance Act PART I Title, Interpretation and Application Title 1 These regulations may be cited as The Automobile Accident Insurance (Injury) Regulations. Interpretation 2(1) In these regulations: (a) Act means The Automobile Accident Insurance Act; (b) catastrophic injury means: (i) paraplegia or quadriplegia within the meaning of Division 2, Subdivision 2, Part 1 or Part 2 of the Schedule of Permanent Impairments; (ii) amputation resulting in two or more impairments within the meaning of: (A) Division 1, Subdivision 1, Parts 1, section 1.1 of the Schedule of Permanent Impairments; or (B) Division 1, Subdivision 2, Part 1, section 1.1 or Part 2, section 2.1 of the Schedule of Permanent Impairments; (iii) total loss of functional vision resulting in an impairment of 80% or more of the entire visual system; (iv) a functional alteration of the brain within the meaning of Division 2, Subdivision 1, Parts 4.6, 4.7 and 4.8 of the Schedule of Permanent Impairments resulting in a determined impairment of 50% or more; (v) a total impairment of 80% or more calculated using the table of successive remainders based on a combination of one or more of the following: (A) those impairments identified in subclauses (i) to (iv); (B) a Division 1, Subdivision 1, Part 2.1 or 3.1(a) impairment; (C) a Division 1, Subdivision 2, Part 3.1 impairment; (D) a Division 2, Subdivision 2, Part 3 impairment; (E) an impairment identified in clause (a) of Division 4; (F) an impairment of 50% or more from Division 4; (G) an impairment of 30% or more from Division 2, Subdivision 1, Parts 4.6, 4.7 and 4.8;
4 4 A-35 REG 5 INSURANCE (INJURY) (c) educational institution means: (i) a school within the meaning of The Education Act; (ii) a technical or vocational school; (iii) a university or college; (iv) any other educational institution designated by the Lieutenant Governor in Council of a province or territory of Canada pursuant to the Canada Loans Act as a specified educational institution for the purposes of that Act; (v) an institution in another province or territory of Canada or the United States that is in the opinion of the insurer similar to one mentioned in subclauses (i) to (iv); (vi) an institution recognized by the Minister of Education of the Province of Quebec for the purposes of An Act respecting Financial Assistance for Educational Expenses (Quebec); or (vii) an institution certified by the Minister of Employment and Immigration to be an educational institution providing courses, other than courses designed for university credit, that furnish a person with skills for an occupation, or that improve a person s skills in an occupation; (d) net business income means the income derived from self-employment, by way of a proprietorship or from a partnership interest, less any expense that relates to that income and that is allowed pursuant to the Income Tax Act (Canada) and The Income Tax Act, 2000, but does not include: (i) any capital cost allowance or allowance on eligible property; (ii) any capital gain or loss; (iii) any loss deductible pursuant to section 111 of the Income Tax Act (Canada); or (iv) any mandatory or optional inventory adjustments pursuant to section 28 of the Income Tax Act (Canada); (e) Schedule of Permanent Impairments means the Schedule of Permanent Impairments as set out in Appendix B to The Personal Injury Benefits Regulations; (f) Table of Successive Remainders means the Table of Successive Remainders as set out in Appendix C to The Personal Injury Benefits Regulations. (2) For the purpose of subclause 25(1)(b)(ii) of the Act, practitioner means a physician or surgeon.
5 5 INSURANCE (INJURY) A-35 REG 5 (3) For the purposes of subsection 41(1) and section 51.1 of the Act, a Part VIII beneficiary, as it refers to a Saskatchewan resident, includes a corporation that: (a) has its registered office in Saskatchewan; (b) is not a Crown corporation or government agency; and (c) is registered pursuant to The Vehicle Administration Act as the owner of the motor vehicle involved in the accident. (4) The Schedule of Permanent Impairments and the Table of Successive Remainders apply, with any necessary modification, to these regulations. (5) Every non-highway motor vehicle is prescribed as a prescribed motor vehicle for the purposes of subclause 20(3)(b)(vii) of the Act. (6) For the purposes of subsection (5), non-highway motor vehicle means a member of a class of motor vehicles that cannot be operated on a highway because, as a result of their design and construction, they do not meet the requirements of The Vehicle Equipment Regulations, 1987, but does not include any of the following motor vehicles: (a) a fire engine or a fire department apparatus, including a command bus, water truck or any other vehicle used to support firefighting at the scene of a fire; (b) a motor vehicle for which a permit or certificate of registration has been issued in another jurisdiction. 13 Dec 2002 ca-35 Reg 5 s2; 24 Aug 2007 SR 71/2007 s3; 7 Sep 2007 SR 77/2007 s2. Application 3 These regulations apply to persons and to bodily injuries caused by a motor vehicle arising out of an accident that are governed by Part II of the Act. 13 Dec 2002 ca-35 Reg 5 s3. PART II Determining Who is a Resident of Saskatchewan Persons resident in Saskatchewan 4 For the purpose of Part II and section 40.2 of the Act and these regulations, person resident in Saskatchewan means an individual who is lawfully entitled to be in or remain in Canada and who makes a home or is ordinarily resident in Saskatchewan, but does not include: (a) a student from another province or territory of Canada, unless that student has established a residence in Saskatchewan; or (b) a student from another country. 13 Dec 2002 ca-35 Reg 5 s4.
6 6 A-35 REG 5 INSURANCE (INJURY) Loss of status as resident 5 A person resident in Saskatchewan loses that status: (a) as soon as that person maintains a residence outside Saskatchewan; (b) where that person is absent from Saskatchewan for more than 12 consecutive months, from the last day of the 12th month following the date of that person s departure from Saskatchewan; or (c) as soon as that person leaves Saskatchewan having manifested a clear intention to cease to reside in Saskatchewan. 13 Dec 2002 ca-35 Reg 5 s5. Retention of status 6(1) Notwithstanding section 5, a person resident in Saskatchewan retains that status in the following circumstances: (a) the person is registered as a student on a full-time basis in an educational institution and is pursuing a program of studies outside Saskatchewan; (b) the person is studying outside Saskatchewan as a full-time, unpaid trainee at a university, an institution affiliated with a university, a research institute or a governmental or international agency; (c) the person is outside Saskatchewan in the employ of the Government of Saskatchewan or any agency of that government, unless the person establishes a permanent residence outside Saskatchewan; (d) the person is staying outside Saskatchewan for fewer than 12 consecutive months if: (i) his or her spouse and minor children remain in Saskatchewan or he or she maintains a residence in Saskatchewan; and (ii) the purpose of the stay is to assume a temporary employment or fulfil a contract; (e) the person is ordinarily a resident in Saskatchewan for at least 183 days per year. (2) Notwithstanding section 5, if a person resident in Saskatchewan leaves Saskatchewan to establish his or her residence in another province or territory of Canada or in a state of the United States and that person is designated as the owner of a vehicle in a valid certificate of registration for that vehicle issued pursuant to The Vehicle Administration Act, that person retains his or her status as a person resident in Saskatchewan until he or she is required by the laws of the other province, territory or state to have the vehicle registered or licensed in that other province, territory or state. (3) The spouse and any minor children of a person mentioned in subsection (1) or (2) having the status of a person resident in Saskatchewan retains that status while they accompany and reside with the person. 13 Dec 2002 ca-35 Reg 5 s6.
7 7 INSURANCE (INJURY) A-35 REG 5 Status of minor child 7 A minor child is presumed to be a person resident in Saskatchewan when the person with whom he or she usually lives is a person resident in Saskatchewan. 13 Dec 2002 ca-35 Reg 5 s7. PART III Calculation of Death Benefits Manner of determining insured s net income 8(1) In this section, maximum yearly employment income means the amount prescribed in subsection (2) as adjusted in accordance with section 9. (2) For the purposes of these regulations, the maximum yearly employment income is $57,825. (3) For the purposes of subsection 27(2) of the Act, an insured s weekly net income is the amount WNI calculated in accordance with the following formula: WNI = YEI D WNI = YE 52 where: YEI is the lesser of: (a) the insured s yearly employment income as determined in the manner set out in section 12 or 13 of these regulations; and (b) the maximum yearly employment income; D is the amount calculated by the insurer in accordance with section 14 that is payable by the insured for income tax pursuant to The Income Tax Act, 2000 and the Income Tax Act (Canada), premiums pursuant to the Employment Insurance Act (Canada) and contributions pursuant to the Canada Pension Plan. 13 Dec 2002 ca-35 Reg 5 s8. Maximum yearly employment income 9(1) The amount of the maximum yearly employment income prescribed in section 8 shall be adjusted on January 1 of each year in the manner set out below. (2) The maximum yearly employment income in 2003 and each year after 2003 is the amount MYEI calculated in accordance with the following formula: MYEI = $50,000 x IAWY IAW95 where: IAWY is the average of the average industrial average wage for the 12 months before July 1 of the year before the year for which the maximum yearly employment income is being calculated; and IAW95 is the average of the industrial average wage for the 12 months before July 1, 1994.
8 8 A-35 REG 5 INSURANCE (INJURY) (3) For the purposes of this section, the insurer shall use the most recent data available from Statistics Canada on October 1 of the year before the year for which the maximum yearly employment income is being calculated. (4) For the purposes of this section, if no figure for the industrial aggregate average weekly earnings for all employees in Saskatchewan is published by Statistics Canada for a month, the insurer shall determine a figure for that month in accordance with section 10. (5) For the purposes of this section, if, after the day this Part comes into force, Statistics Canada uses a new method to determine the industrial aggregate average weekly earnings for all employees for Saskatchewan for a particular month and the new method results in a change of more than 1% when compared with the former method, the insurer shall determine a figure in accordance with section Dec 2002 ca-35 Reg 5 s9; 24 Aug 2007 SR 71/2007 s4. Industrial average wage not published 10(1) For the purposes of subsection 9(4), where no figure for the industrial aggregate average weekly earnings for all employees in Saskatchewan is published by Statistics Canada for a month, the insurer shall determine a figure for that month in accordance with the following formula: M = S 12 where: M is the industrial aggregate average weekly earnings for that month; and S is the sum of the industrial aggregate average weekly earnings, as published by Statistics Canada, for the 12 months before that month. (2) The insurer may adjust the amount calculated pursuant to this section to take account of any exceptional circumstances that occurred during the 12 months before the month for which the amount is being calculated. 13 Dec 2002 ca-35 Reg 5 s10. Change in method by Statistics Canada 11(1) For the purpose of subsection 9(5), the insurer shall determine a figure for the industrial aggregate average weekly earnings based on the lower of the actual change created by the new method and the average of the new method and former method for the 12-month period before the introduction of the new method. (2) After the new method has been utilized by Statistics Canada for 12 months, the insurer shall calculate a figure based on the new method. 13 Dec 2002 ca-35 Reg 5 s11.
9 9 INSURANCE (INJURY) A-35 REG 5 Calculation of yearly employment income not derived from self-employment 12(1) In this section, work cycle means the length of time or the number of hours of work, as determined by the insured s employer, that an insured must complete to earn the insured s regular salary or wages. (2) An insured s yearly employment income not derived from self-employment is to be calculated on the sum of the following: (a) the greater of: (i) the salary or wages regularly payable, excluding the benefits or commissions mentioned in clauses (b) and (c), earned in the work cycle immediately before the accident in which the insured is entitled to a weekly benefit multiplied by the number of work cycles in a normal 12- month period; and (ii) the salary or wages regularly payable, excluding the benefits or commissions mentioned in clauses (b) and (c), earned in the 12 months before the accident; (b) any of the following benefits, to the extent that the benefit is not received as a result of the accident and is regularly payable to the insured: (i) a bonus earned in the 12-month period before the accident; (ii) tips, in the amount that is the greater of: (A) the amount reported in the insured s personal income tax return in the calendar year before the accident; and (B) the amount reported in the insured s personal income tax return for the calendar year in which the accident occurred; (iii) remuneration for overtime hours that is earned in the 12-month period before the accident; (iv) the cash value from a profit-sharing plan allocation earned in the 12-month period before the accident; (v) the value of the personal use of a motor vehicle provided by an employer at the date of the accident, in the amount reported in the insured s personal income tax return in the calendar year before the accident or, if no amount was reported, in an amount calculated pursuant to clause 6(1)(e) of the Income Tax Act (Canada) as an annualized benefit; (vi) the cash value of premiums of employer-funded benefit plans paid to the insured in the 12-month period before the accident; (vii) the cash value of any other benefit received or that the insured was entitled to receive in the 12-month period before the accident, excluding employer-funded benefit plans;
10 10 A-35 REG 5 INSURANCE (INJURY) (c) commissions, in the amount that is the greatest of the commissions earned or to which the insured was entitled: (i) for the 12-month period before the accident; (ii) for the calendar year before the accident; or (iii) for the three calendar years before the accident divided by three. (3) Notwithstanding clauses (2)(b) and (c), if an insured did not hold the employment held at the date of the accident in the 12 months before the accident and the insured can prove that he or she would have earned in the year after the accident a regular benefit or commission, the insurer shall include that benefit or commission in the calculation of the insured s yearly employment income. 13 Dec 2002 ca-35 Reg 5 s12. Calculation of yearly employment income self-employed insured 13(1) In this section fiscal year means the insured s fiscal year. (2) The insured s yearly employment income derived from self-employment is the greatest amount of net business income that the insured earned within the following periods: (a) the 12 months before the accident; (b) the fiscal year before the year before the accident; (c) if the insured has been self-employed for not less than two fiscal years before the date of the accident, the two fiscal years before the year before the accident divided by two; (d) if the insured has been self-employed for not less than three fiscal years before the date of the accident, the three fiscal years before the year before the accident divided by three. (3) For the purposes of subsection (2): (a) the insured s net business income must be determined in accordance with generally accepted accounting principles; and (b) the net business income for each period set out in subsection (2) must be calculated in a consistent manner. 13 Dec 2002 ca-35 Reg 5 s13; 24 Aug 2007 SR 71/2007 s5. Calculation of net income 14(1) In this section: (a) taxable income means an insured s yearly employment income less any amount of yearly employment income that would have been exempt from the insured s income tax pursuant to paragraph 81(1)(a) of the Income Tax Act (Canada) as that paragraph existed at the date of the accident; (b) yearly employment income means an insured s yearly employment income calculated pursuant to section 12 or 13 of these regulations.
11 11 INSURANCE (INJURY) A-35 REG 5 (2) In these regulations, the net income of an insured is the insured s yearly employment income less all of the following deductions: (a) any income tax payable by the insured calculated pursuant to subsection (3); (b) any premiums payable by the insured respecting employment insurance calculated pursuant to subsection (4); (c) any contributions payable by the insured pursuant to the Canada Pension Plan calculated pursuant to subsection (5). (3) For the purposes of clause (2)(a), income tax payable by an insured is the amount payable in accordance with the Income Tax Act (Canada) and The Income Tax Act, 2000 for the insured s taxable income allowing only the following credits: (a) the credits allowed pursuant to section of the Income Tax Act (Canada) and section 28 of The Income Tax Act, 2000, where B in that section is the total of: (i) the premium payable by the insured mentioned in clause (2)(b); and (ii) the contributions payable to the Canada Pension Plan mentioned in clause (2)(c); (b) the credits allowed in: (i) sections 11, 12, 13, 14, 15, 17, 19, 20, 23 and 29 of The Income Tax Act, 2000; and (ii) subsections 118(1) and (2) and sections and of the Income Tax Act (Canada). (4) For the purposes of clause (2)(b), the premiums payable by the insured are the yearly contributions payable pursuant to the Employment Insurance Act (Canada) that an insured would be obligated to pay if the insured s yearly employment income was considered insurable earnings pursuant to that Act, and those premiums: (a) must be based on the rate established at the time the insured s net income is calculated; and (b) must not exceed the maximum amount payable pursuant to that Act. (5) For the purposes of clause (2)(c), the contributions payable by the insured are the yearly contributions payable pursuant to the Canada Pension Plan that an insured would be obligated to pay if the insured s yearly employment income was considered pensionable earnings pursuant to that Act, and those contributions: (a) must be based on the rate established at the time the insured s net income is calculated; and (b) must not exceed the maximum amount payable pursuant to that Act.
12 12 A-35 REG 5 INSURANCE (INJURY) (6) For the purpose of determining an insured s net income, the amounts of the deductions mentioned in clauses (2)(a) to (c) must be deducted from the insured s yearly employment income in the manner set out in these regulations whether or not the insured: (a) has already deducted and paid those amounts; or (b) is obligated by law to deduct those amounts and has yet to pay those amounts. 24 Aug 2007 SR 71/2007 s6. Dependant benefit 15 If there is more than one dependant entitled to death benefits pursuant to section 27.1 of the Act, the insurer shall calculate and pay the death benefits in accordance with the following rules: (a) the death benefit mentioned in subsection 27(2) of the Act must be calculated on the basis of the youngest dependant being considered the spouse; (b) the death benefits payable in clause (a) are payable until the youngest dependant reaches 21 years of age and each dependant is entitled to an equal share of the death benefits as along as that dependant remains under 21 years of age; (c) the death benefits mentioned in subsection 27(5) of the Act must be calculated on the number of dependants, not including the youngest dependant, and must be paid until the second youngest dependant reaches 21 years of age; (d) a dependant is entitled to an equal share of the death benefits mentioned in clause (c) as long as that dependant remains under 21 years of age. 13 Dec 2002 ca-35 Reg 5 s15. Capitalization 16 For the purposes of section 27.2 of the Act, the insurer shall determine the capitalized value of the spouse s benefit based on standard mortality tables published by Statistics Canada using a discount rate of 3% per year. 13 Dec 2002 ca-35 Reg 5 s16.
13 13 INSURANCE (INJURY) A-35 REG 5 PART IV Calculation of Permanent Injury Benefits Compensation for permanent impairments - Schedule of Permanent Impairments 17 Compensation for permanent impairment is to be determined on the basis of the Schedule of Permanent Impairments set out in Appendix B to The Personal Injury Benefits Regulations. 24 Aug 2007 SR 71/2007 s7. Evaluation of impairment to symmetrical parts of the body 18 Subject to sections 19 and 20 and the Schedule of Permanent Impairments, if a permanent anatomical or physiological deficit resulting from an accident impairs symmetrical parts of the body, or impairs a part of the body that is symmetrical to a part of the body that was permanently impaired before the accident, the percentage of the permanent impairment for that deficit for the purposes of Division 4 of Part II of the Act is determined in accordance with the following formula: P = PB + (TB x 0.25) where: P is the percentage to be used pursuant to Division 4 of Part II of the Act; PB is the percentage attributed to the deficit arising from the accident; and TB is the total percentage of anatomical or physiological deficits impairing the more severely impaired symmetrical part of an insured s body. 13 Dec 2002 ca-35 Reg 5 s18. Application of section Section 18 does not apply to an anatomical or physiological deficit that: (a) affects an internal organ; (b) affects an organ controlling vision, balance or hearing; or (c) results from an injury to the central nervous system. 13 Dec 2002 ca-35 Reg 5 s19. Percentage fixed for deficit existing prior to the accident 20 For the purposes of section 18, the percentage of an anatomical or physiological deficit existing before an accident is to be determined using the Schedule of Permanent Impairments or, if the anatomical or physiological deficit does not appear in the Schedule of Permanent Impairments, by using the Schedule of Permanent Impairments as a guideline. 13 Dec 2002 ca-35 Reg 5 s20.
14 14 A-35 REG 5 INSURANCE (INJURY) Computation of more than one permanent impairment 21(1) In this section: (a) Appendix B means Appendix B to The Personal Injury Benefits Regulations; (b) Appendix C means Appendix C to The Personal Injury Benefits Regulations. (2) In calculating the percentage of permanent impairment to be assigned to an insured who has more than one impairment: (a) the impairments within each subdivision of a particular Division in Appendix B are to be added together; or (b) if a Division in Appendix B has no separate subdivision, the impairments within the Parts of a Division are to be added together. (3) If an insured has more than one impairment as calculated in the manner set out in subsection (2), the percentage of the most severe impairment must be computed on the basis of 100% and the percentage of the other impairments, starting with the highest, must be computed in accordance with the Table as set out in the Combined Value Impairment Rating as found in Appendix C. (4) Before using the Table in accordance with subsection (3), the insurer shall round the percentage of impairment within each subdivision or Division, as the case may be, to the nearest percentage. 24 Aug 2007 SR 71/2007 s8. Section 21 not to be applied to percentage based on enhancement factor 22 Section 21 does not apply to the percentage obtained by applying the enhancement factor mentioned in section Dec 2002 ca-35 Reg 5 s22. Enhancement factor to be added after computation of successive remainders 23 Where sections 17 to 21 apply to an insured, the percentage resulting from the enhancement factor mentioned in section 18 is added to the other percentages of deficits after the computation on successive remainders has been made. 13 Dec 2002 ca-35 Reg 5 s23. PART V Indexation of Benefits CPI not published 24(1) For the purpose of subsection 30(3) of the Act, if no figure for the all-items Consumer Price Index for Saskatchewan is published by Statistics Canada for a month, the insurer shall determine a figure for that month in accordance with the following formula: CPI SCPI 12 where: CPI is the consumer price index to be used in the month; and SCPI is the sum of the all items Consumer Price Index for Saskatchewan, as published by Statistics Canada, for the 12 months before that month.
15 15 INSURANCE (INJURY) A-35 REG 5 (2) The insurer may adjust the amount calculated pursuant to this section to take account of any exception circumstances that occurred during the 12 months before the month for which the amount is being calculated. 13 Dec 2002 ca-35 Reg 5 s24. Change in method of Statistics Canada 25(1) For the purposes of subsection 30(4) of the Act, the insurer shall determine a figure for the all-items Consumer Price Index for Saskatchewan based on the lower of the actual change created by the new method and the average of the new method and former method for the 12-month period before the introduction of the new method. (2) After the new method has been utilized by Statistics Canada for 12 months, the insurer shall calculate a figure based on the new method. 13 Dec 2002 ca-35 Reg 5 s25. PART VI Coming into Force Coming into force 26(1) These regulations come into force on the day on which section 9 of The Automobile Accident Insurance Amendment Act, 2002 comes into force. (2) If these regulations are filed with the Registrar of Regulations after the day on which section 9 of The Automobile Accident Insurance Amendment Act, 2002 comes into force, these regulations come into force on the day on which they are filed with the Registrar of Regulations. 13 Dec 2002 ca-35 Reg 5 s26.
16 16 A-35 REG 5 INSURANCE (INJURY) REGINA, SASKATCHEWAN Printed by the authority of THE QUEEN S PRINTER Copyright 2007
1 AUTOMOBILE ACCIDENT INSURANCE c. A-35 The Automobile Accident Insurance Act being Chapter A-35 of The Revised Statutes of Saskatchewan, 1978 (effective February 26, 1979) as amended by the Statutes of
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