If you are injured due to the operation of a motor vehicle in BC, you are most likely entitled to recovery benefits through your own insurance coverage with ICBC called “Part 7” coverage. It is very important for you to begin treatment of your accident injuries at the earliest possible time. Therefore, it is important to understand your car accident recovery benefits.
Who is Covered?
To be covered for car accident recovery benefits, it does not matter if you were the driver, passenger, bicyclist, motorcyclist, or pedestrian. It also does not matter if the accident was your fault.
The basic eligibility requirements are that:
- You were injured;
- The injury was as a result of the operation of a motor vehicle; and
- You or someone in your household has a valid BC drivers’ license or an ICBC insured vehicle.
What is Covered?
Car accident recovery benefits in BC are payable under Part 7 of the Insurance (Vehicle) Act and Regulations. Part 7 benefits include:
- Medical and rehabilitation benefits (medicine and medical treatments);
- Disability benefits for employed persons up to $740/wk;
- Homemaker benefits (cleaning, cooking) up to $280/wk;
- Funeral costs at to $7,500; and
- Death benefits up to $30,000.
How Do I Access My Benefits?
ICBC has established new rules as of April 1, 2019, for how you access the medical treatment benefits and they have some very important timelines you should be aware of.
To access these benefits, you must report the accident and injury to ICBC and obtain a claim number. You will be assigned an ICBC adjuster who should explain your benefits to you, but in some cases that can take a while to happen.
Part 7 has now pre-approved some recovery treatments if you attend for those treatments within 12 weeks of the accident date. Pre-approved means you do not need your ICBC adjuster’s approval to attend and have the treatments covered by part 7: physiotherapy, registered massage therapy, chiropractic, psychologist, clinical counseling, acupuncture, and kinesiology. You must attend for treatments within 12 weeks of the accident in order to be eligible for further treatment coverage if you do not recover in that span of time.
ICBC will pay your treatment provider directly for Part 7 recovery benefits but if your treatment provider does not have direct billing with ICBC, you must submit your receipts to your adjuster within 60 days or you will not be reimbursed.
If you do not have a regular family doctor to assist you with your recovery plan or if your injuries are complicated, you can ask your adjuster to have an occupational therapist assess you and direct your treatment plan. This is especially important in communities where it is difficult to access a family doctor.
Part 7 will pay for treatments upfront, but only up to a certain amount after which you must pay the additional cost out of pocket. These are often referred to as ‘user fees’. It is important to ask the treatment provider if their charges will be completely covered by your ICBC Part 7 coverage.
If you are not at fault for the accident, user fees will be reimbursed by ICBC at the end of your claim but only if you do not have extended health insurance. If you do have extended health insurance, you must submit your user fees to that insurance company first for reimbursement.
What if I’m Being Denied Coverage?
Finally, if you have difficulty getting coverage from ICBC and your accident happened after April 1, 2019, you must file a dispute with the Civil Resolutions Tribunal. Lawyers often charge a smaller flat fee to provide you with advice or assistance with that process. Legal advice is encouraged to make sure the playing field is fair between you and ICBC, who will most certainly have the benefit of legal and professional advice for every dispute that arises.
If you would like advice or for more information please contact one of the knowledgeable lawyers at Priddle Law Group. Call (250) 434-8911 or email reception@priddlelaw.ca to book a consultation.
