As of May 1, 2021, British Columbia has moved to a no-fault system. BC residents are entitled to receive benefits for their injuries and wage loss after a motor vehicle crash regardless of who is at fault. An injured person, in most cases, will no longer recover damages from an “at-fault” driver through a law suit. This means that members of the public impacted by a car crash will navigate any dispute directly with an ICBC adjuster, and if not satisfied with a decision, may attend the Civil Resolution Tribunal to resolve their claim.
Claims under Part 7 benefits are made through the Civil Resolution Tribunal.
What are Enhanced Accident Benefits?
Recent changes to the auto insurance industry in BC led to an Enhanced Care Model. As noted under the Guide to Enhanced Care, it states:
If you’re injured in a crash, Enhanced Accident Benefits from your own policy (first party coverage) will pay for medical care and treatments to support your recovery. There’s also an income replacement benefit for the period of time you’re too injured to work.
ICBC staff will work with you, your doctor and your health care providers to help you access the services and recovery benefits you need for as long as you need them.
Under Enhanced Accident Benefits, benefits are improved and one now has access to significantly better care and recovery benefits. You can learn about Enhanced Care by reviewing the Guide to Enhanced Care.
Civil Resolution Tribunal
There are multiple cases published under “Decisions” on the website of the Civil Resolution Tribunal. Most claimants are navigating this process on their own, without the benefit of a lawyer.
In Smith v. ICBC, the claimant is seeking additional physiotherapy treatments, including a lump sum payment of $12,000 for future health care services under Part 7 accident benefits. The claim at the Civil Resolution Tribunal failed.
If you do not show evidence at the Tribunal that your health care services are “necessary” you will fail in your argument that you are entitled to the benefits.
If you can establish that the health care service is “necessary”, ICBC will need to pay for those health care services you are claiming. To prove that a specific treatment is necessary, the insured’s doctor must certify in writing that the treatment is necessary.
Section 88 (1)(a) under Part 7 of the Insurance (Vehicle) Regulations state:
If an insured is injured in an accident for which benefits are provided under this Part, the corporation must, subject to this section, pay as benefits all reasonable expenses incurred by the insured as a result of the injury for necessary
(a) health care services listed in Column A of Table 1 or Table 2, as applicable, of Schedule 3.1 and provided by the applicable health care practitioner.
Under the Insurance (Vehicle) Regulations, treatment provided more than 12 weeks after the accident date is automatically deemed NOT a necessary health care service.
Therefore, a claimant must seek evidence from your physician in writing that the health care service being claimed is reasonable and necessary, and if you attend the tribunal without this medical evidence, your request for funding of the treatment you seek will be denied.
Section 88(1.01) of the Insurance (Vehicle) Regulations state:
(1.01) For the purposes of subsection (1) (a), a treatment
(a) that is in addition to the number of treatments listed in Column D of Table 1 of Schedule 3.1 corresponding to that health care service, or
(b) that is provided more than 12 weeks after the date of the accident
is not a necessary health care service unless the corporation’s medical advisor or the insured’s physician certifies to the corporation in writing that, in the opinion of the medical advisor or physician, the treatment is necessary for the insured.
How do you seek evidence to show that your treatment is necessary?
Your physician must certify in writing that the treatment is necessary. The note should also indicate that the treatment is required as a result of a motor vehicle crash dated [date of car crash].
In the case above, the claim failed due to the following reasons:
- There is no evidence before the CRT that the claimant’s health care practitioners have recommended additional physiotherapy or any other Part 7 benefits; and
- ICBC, although may make a lump sum payment of benefits under Section 102 of the Insurance (Vehicle) Regulations, this is discretionary, and in this case declines this claim. ICBC’s position was that it is paying for benefits as the treatment is being incurred and therefore a lump sum is not required in this case. The CRT agreed.
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