ICBC’s New Accident Benefits Coverage: What you Need to Know.

BC Brain Injury Association (BCBIA), a non-profit provincial organization in BC committed to improving the lives of people who live with acquire brain injury, recognizes that these changes will impact a significant number of people. We also know the claims process can be challenging to navigate. We can help. Having the right knowledge can make the difference in your claims process to ensure you receive all of the care and support — when you need it most.

We have created a series of blog posts with user-friendly language to describe these changes. Our goal is to help individuals, especially ABI survivors and their supporters, navigate the new system.

This first post is an introductory overview of the changes to ICBC’s Accident Benefits. Below you will find answers to questions you may have about ICBC’s new coverage and claims process. If you are a BC resident and were injured in a car crash after April 1st, 2019, this is everything you need to know.

Future posts will focus on the different stages of the process – ranging from early days after the accident, to the middle of the process where treatment is taking place, to the end of the process where settlements are occurring.

If you’ve been in a crash, you can report your claim online or by phone.

After you first report your crash, if you are injured, a Customer Claim Specialist will be assigned to you. ICBC representatives are available to answer your questions and guide you through your claim from start to finish.

In some cases, a Customer Recovery Specialist may be assigned to provide additional recovery support.

We will refer to these supports as your “Claim Representative(s)” in this article.

ICBC’s new benefit increases are in addition to the increase in overall allowance for medical care and recovery expenses (from $150,000 to $300,000) that took place in January 2018. For further information, please visit ICBC’s web page on the new and increased benefits.

Other benefits have also increased, such as disability payments for employed persons and benefits to support you at home. If you think you are eligible, please click on the links to read more.

Pre-Approved Treatments

Yes. ICBC now covers more types of pre-approved treatments, including: physiotherapy, chiropractic, massage therapy (RMT), kinesiology/active rehab, psychological counselling, clinical counselling and acupuncture. You can seek care from these health care practitioners for pre-approved numbers of treatments within the first 12 weeks following a crash without a written referral from a doctor.

Choosing Your Healthcare Practitioner

ICBC does not currently have an approved, or preferred health care provider list. This allows you the flexibility of choosing your own healthcare practitioner. While ICBC wants to ensure continuity of care as much as possible, you may change your medical provider at any point during the recovery process.

Fee Increase

Fees for pre-approved treatments that occur after April 1^st, 2019 are now set at the fair market rate. Pre-approved treatments include: physiotherapy, chiropractic, massage therapy (RMT), kinesiology/active rehab, psychological counselling, clinical counselling and acupuncture. The updated fee increase is applicable to all claims regardless of when the accident occurred, and regardless of fault. This means that in most cases, crash survivors will not be out of pocket for treatment costs.

Please note:

Customers who seek treatment from healthcare practitioners who charge more than the regulated fees will not be able to recover their out of pocket expenses from ICBC. If you have extended or private health plan coverage, you can apply for reimbursement through your plan to cover excess cost of treatment sessions” See the ICBC Recovery and Treatment Payment Guide for information about submitting your receipts.

Ongoing Treatment

If you require ongoing treatment beyond 12 weeks after a crash, you or your healthcare practitioner may contact the Claim Representative. In most cases, a doctor’s note is not required in advance of the approval for more treatment. To prevent gaps in the treatment plans, your healthcare practitioner can also request approval for additional treatments from the Claim Representative using a web-based application.

The Claim Representative will approve additional treatments when they are ‘reasonable and necessary’ to the recovery process. To help with the decision process, the Claim Representative may request additional information from your healthcare practitioner by way of a telephone conversation, or a reassessment report if required.

Please note:

Some treatment providers choose not to bill ICBC directly and may ask that you cover treatment costs and seek reimbursement by ICBC. ICBC will pay up to the established rates for treatments. However, expenses must be submitted to the Claim Representative within 60 days of the treatment date of date the expense was occurred.

ICBC will not diagnose your injury. Your doctor or healthcare practitioner must diagnose your injury, and together with your functional capacity, the diagnosis will help ICBC determine whether or not your injuries call within the minor injury definition. Doctors or healthcare practitioners can update a diagnosis at any time.

ICBC’s minor injury definition includes sprains, strains, general aches and pains, cuts, bruises, road rash, minor whiplash, temporomandibular joint disorder (TMJ) – pain in your jaw joint and in the muscles that control jaw movement, as well as Short term changes related to concussions and mental health conditions.

If your injury meets the definition of a minor injury, this will only impact the general damages portion of your claim settlement. General damages is the term for payments received to compensate you for such things as pain and suffering and the inability to perform certain activities. This is one component that makes up a claim settlement.

Whether or not an injury falls within the minor injury definition does not impact your entitlement to the $300,000 Accident Benefits coverage available for medical care and treatment.

The determination of an injury falling under the definition of minor only affects your compensation for pain and suffering. This is just one part of your claim and is separate from your medical treatments and benefits to help you recover. As of April 1, 2019, a limit of $5,500 will apply to pain and suffering payouts for injuries that fall under the definition.

For concussions or mental health conditions, if there is a substantial inability to perform essential tasks beyond 16 weeks, the limit on pain and suffering will not apply. See the next section “Are there specific considerations for concussions?” for more details.

If the injury results in serious impairments to your life for more than 12 months [e.g., you’re still not able to go to work or school, you have to modify your work hours or duties, or you’re unable to care for yourself] it will no longer comply with the minor injury definition. As such, there will be no limit on pain and suffering.

ICBC considers a concussion to fall within the minor injury definition when it does not result in an incapacity beyond 16 weeks after the initial symptoms. Incapacity^[1] refers to your ability to perform the activities of daily living, which include but aren’t limited to: going to work or school, preparing your own meals, driving or taking transit, managing personal finances, performing personal hygiene, and managing personal medication.

If your concussion or brain injury impacts your life for more than 16 weeks [e.g., you’re still not able to go to work or school, you have to significantly modify your work hours or duties, or you’re unable to care for yourself] it will no longer be considered to fall within the definition and the limit on pain and suffering will not apply.

Whether or not your concussion falls within the definition, it does not change your entitlement to the $300,000 Accident Benefits coverage available for medical care and treatment.

^[1] Insurance (Vehicle) Act. R.S.B.C. 1996, c.231. Minor Injury Regulation, 234/2018 amended by 60/2019 (effective April 1, 2019), pg. 14. http://www.bclaws.ca/civix/document/id/oic/oic_cur/0595_2018

Registered Care Advisors (RCAs) are medical professionals whose role is to support family doctors on best practices, as well as appropriate diagnosis and treatment pathways. They are available for a second opinion in the following scenarios:

• Your doctor is unable to make a clear diagnosis
• Your recovery isn’t going as expected
• Various factors are complicating your recovery

Around the 90-day mark after a motor vehicle accident, your doctor will consider whether your recovery could benefit from the involvement of an RCA. If your doctor recommends this, you can expect to meet with the RCA within 15 business days of your doctor’s referral. The RCA may offer additional diagnoses or treatment options that assist your doctor in helping you get better.

If your doctor or healthcare practitioner is reluctant to refer you to an RCA at 90 days, you can contact your ICBC Claim Representative to request that they discuss this with your doctor. Remember, you retain the power to choose your primary care doctor and can switch at any time to ensure the best quality care.

A limit (of up to $5,500) on pain and suffering for minor injuries came into effect for accidents occurring on or after April 1st, 2019. The pain and suffering component of a claim settlement is a recognition of the inconvenience and emotional distress of being in a crash, but it is just one part of your claim. This one-time payment is totally separate from your medical treatments and benefits.

The limit does not apply to major and catastrophic injuries, and the limit on the pain and suffering component of the injury claim settlement is separate from any treatment or benefits required for recovery. For example, if you sustain a concussion, you are eligible for a pain and suffering settlement, but you are also eligible for the treatment benefits that are available.

If you’ve been injured in a crash, you may be wondering whether you can, or should get a lawyer to help you with your claim. Given the recent changes to ICBC insurance, please ensure you read all the information available carefully. However, whether or not you retain a lawyer is entirely your choice. Consider time, cost and the complexity of your claim before hiring a lawyer for legal advice or to represent you in a claim.

In British Columbia, individuals who suffer injury because of someone else’s fault may be entitled to compensation. If choosing to seek legal advice, it is important that you seek a qualified legal professional experienced in representing brain injury survivors. Lawyers who specialize in brain injury cases have the knowledge to assist with accessing funding for the necessary private professional services, life-long care, and compensation for lost income and/or earning capacity.

Brainstreams has developed some questions designed to help select legal counsel that specialize in brain injury work.

Legal counsel can assist with disputes and advocates can also provide you with more information and guidance during your recovery journey.

For crashes that occurred on or after April 1st, 2019, including minor or major injury (up to $50,000), the Civil Resolution Tribunal (CRT) is an independent dispute resolution service focussed on helping parties reach an agreement wherever possible. The CRT can look into disputes between customers and ICBC on matters such as minor injury determination, settlement offers, benefit entitlements, and responsibility (fault) assessments.

Personal injury lawyers are not excluded in the CRT process. Some cases reviewed by the CRT may be referred to the Supreme Court for judicial review.

Click on these links for more information:

• ICBC Changing Car Insurance
• ICBC Injury Claims 
• ICBC Information for Health Care Practitioners 1
• ICBC Information for Health Care Practitioners 2
• ICBC Recovery and Treatment Payment Guide
• BC Vehicle Insurance Legislation

Your feedback and questions are important to us! Has this been an informative read? Are they any questions you would like to see answered that may help others navigate the new changes as well? Please leave a comment through our contact form!

If you are a crash survivor navigating the new ICBC process, please take some time to complete our survey that will be coming out shortly as we work towards providing you with the best source of information possible.

• Make sure you review ICBC’s website in addition to this post. It includes information about why the changes have been made, and covers a host of topics ranging from changes in benefits to a more detailed description of the claims process. You can also find more detail in the Q & A for Health Care Providers and Q & A for Health Partners.
• If your crash was prior to April 1st, 2019, please talk to your Claim Representative. The changes to insurance that came into effect on April 1st, 2019 may affect your coverage.
• Please use our Contact form to share your thoughts with us about the changes to insurance and their implications.
• Sign up for our newsletter to receive the online survey we will be sending out in the near future. We want to collect meaningful stories that reflect survivors’ experiences in navigating the new ICBC claims process.

Coming soon…in our next post we’ll provide more detail about the early stages of the personal injury claim process.

Future posts will describe a scenario where recovery isn’t going as planned, and touch on the final stages of the process when you might be looking at a settlement.