Accident
An accident is an unexpected, sudden, and external event that causes bodily injury, occurring independently of any illness or pre-existing condition. In the context of health and dental insurance, an accident typically refers to physical harm resulting from an unforeseen incident such as a fall, collision, or blow to the body. Accidents are distinct from sickness or degenerative conditions because they are caused by an identifiable event rather than a gradual process.
How It Works
In health and dental insurance, an accident is distinct from sickness or degenerative conditions because it is caused by an identifiable event rather than a gradual process. Under Canada's Insurance Companies Act, accident and sickness insurance includes insurance against loss resulting from bodily injury to, or the death of, a person caused by an accident. In Canadian common law the term accident is given its ordinary meaning, denoting an unlooked-for mishap or untoward event that is not expected or designed, unless a policy contractually defines it. Accident insurance is complementary to provincial health insurance, which does not cover additional costs associated with an accident such as physiotherapy, home care, or medical equipment. Personal accident insurance provides a tax-free benefit if the insured suffers an injury in an accident or dies in an accident, and benefits are not deducted from amounts received from other sources such as group insurance or a government plan. Accidental dental coverage in Canada is typically included under extended health benefits rather than standard dental coverage, and helps pay to repair or replace natural teeth damaged by an external blow to the mouth rather than by decay or normal use.
Example:
If you slip on ice in a Canadian winter and break your wrist, the event qualifies as an accident because it was sudden, external, and unintended. Because provincial health insurance does not cover the follow-on costs, your accident or extended health coverage may reimburse related expenses such as physiotherapy, depending on your plan's terms and exclusions.
What to Watch For:
To qualify for accident coverage, the injury must be directly caused by the accident and not related to illness, self-inflicted harm, or hazardous activity exclusions listed in the policy, and the accident should be reported and treated promptly. Insurers generally require treatment for an accidental dental injury to begin within a set timeframe, such as 90 or 180 days after the incident, with ongoing approved work continuing for up to a year or more. Because the term accident carries its ordinary meaning unless a policy defines it contractually, review how your own plan describes a covered accident.
