If you are injured in an accident in Canada or the US that involves the use or operation of a vehicle licensed in BC then you are likely entitled to ICBC Accident Benefits, also known as Part 7 Benefits and No Fault Benefits ("Accident Benefits"). Whether you qualify, what you qualify for, and what information you must provide to ICBC to receive Accident Benefits is often confusing.
Your entitlement to Accident Benefits is governed by Part 7 of the Insurance (Vehicle) Regulation (the "Regulation"). Accident Benefits are not the same as damages. They are available regardless of who is at fault for the accident or regardless of whether you choose to commence legal action for damages arising from your accident.
Because there are limits to what benefits are available under the Regulation, some accident victims choose to pursue additional compensation, sometimes referred to as compensatory damages, through negotiation with ICBC or commencing legal action (Note: for information on the types of compensatory damages available see my column titled "What is my case worth?"). It is important to note that if you qualify for Accident Benefits, the amounts to which you are entitled may be deducted from any damages payable, regardless of whether you made a claim for benefits.
There are three types of Accident Benefits that you may be entitled to: Medical and Rehabilitation Benefits, Wage Loss Benefits, and Loss of Homemaking Capacity Benefits. Before you will be entitled to any of these benefits you need to: 1) promptly advise ICBC of the accident; 2) within 30 days from the date of the accident, provide ICBC with written notice of the particulars of the accident including the consequences; and 3) within 90 days from the date of the accident, fill in an ICBC Form called a CL22 – Insurance Claim Application Form. If you hire a lawyer, he or she will be able to help you adhere to these requirements as well as prevent any potential harm to your damages claim.
In addition to the above requirements, you will generally be required to have your doctor or caregiver provide ICBC with a medical certificate or report in a form specified by ICBC. Typically this involves an ICBC Form called a CL19 – Medical Report, however they may also request a letter, phone call or some other form from your doctor or caregiver which will set out the nature and extent of your injuries, treatment, current condition and prognosis. This request will be made directly to your doctor or caregiver. In addition, they may require you to see a medical expert of their choosing. Failure to comply with these requests may result in termination of your Accident Benefits.
The following is a summary of the three types of benefits. However, it is important to note that ICBC is not liable for any benefit which is recoverable by you through another insurance provider, including but not limited to private insurance plans, WorksafeBC, Canada Pension Plan, or Employment Insurance.
Medical and Rehabilitation Benefits - You will generally be entitled to claim any necessary medical or rehabilitation expenses related to your injuries caused by the accident to a maximum of $150,000. Examples include: medication, ambulance fees, dental bills, nursing services, physiotherapy, etc. Alternative care (example: homeopathy) is typically not covered. There are also limits to the number of treatments and the amount of money ICBC will pay for each treatment. For example: ICBC is not obliged to pay for more than 12 physiotherapy treatments unless ICBC's medical advisor or your doctor certifies to ICBC in writing that the treatment is necessary. Even with this information, ICBC may resist paying for these benefits.
Wage Loss Benefits – You will generally be entitled to partial compensation (75% of your gross wages or $300 per week, whichever is less) for wage loss caused by the accident if you are totally disabled from working after your accident. Your total disability must last for a minimum of 7 days and occur within 20 days of the accident. You are not entitled to any benefits for the first 7 days.
Loss of Homemaking Capacity Benefits – If you are a homemaker and you are substantially and continuously disabled from regularly performing most of your household tasks then you will generally be entitled to recover reasonable expenses for hiring help (other than family), to a maximum of $145 per week, to perform these tasks during the period of your disability. The substantial and continuous disability must last for a minimum of 7 days and occur within 20 days of the accident. You are not entitled to any benefits for the first 7 days.
Wage Loss Benefits and Loss of Homemaking Capacity Benefits can be reviewed by ICBC every 12 months and terminated by ICBC on the advice of their medical advisor. They will also be terminated at the end of the duration of disability, or where the disability continues beyond 104 weeks, at age 65.
If ICBC requires you to undergo a specific treatment or program which is recommended by their medical advisor or vocational advisor and you refuse, they may terminate your benefits after providing you with 60 days notice of their intention to do so. If you disagree with their decision, you have 60 days to appeal their decision to the BC Supreme Court for an injunction preventing them from terminating the benefits.
A claim against ICBC for damages for failing to provide Accident Benefits in accordance with the Regulations must be commenced within 2 years after: 1) the date of the accident; 2) where some benefits have been paid, the date you received the last benefit payment; or 3) the date on which ICBC received notice from you or your lawyer in the prescribed form sent by registered mail to the claim office dealing with your claim of your intention to commence an action for benefits, provided that the notice is sent within 2 years from the date of the accident.
*Important Note: The information contained in this column should not be treated by readers as legal advice and should not be relied on without detailed legal counsel being sought.