In this twelve-part blog series, personal injury lawyers Bree Hankins and Adrienne Staley discuss important steps to follow after a motor vehicle accident and what you need to know about making a personal injury claim. Part 4 focuses on the medical benefits you are entitled to after an accident.
Part 4: I have rehabilitation and medical expenses for my injuries after my accident, what benefits am I entitled to?
Regardless of who is at fault for a motor vehicle accident, if you are injured in a motor vehicle accident you are entitled to medical or rehabilitation benefits, provided for under Part 7 of the Regulations to the Insurance (Vehicle) Act. These benefits are usually referred to by ICBC and lawyers as “Part 7 Benefits.”
As mentioned in part 3 of our blog series anyone who is injured in a motor vehicle accident is entitled to Part 7 Benefits. In order to be eligible for Part 7 Benefits, you need to tell ICBC about the accident and make a claim for the benefits. Usually, although not always, the injured person fills out an Accident Benefits Application Form. This is a form that has been developed by ICBC. ICBC may also ask you to provide a signed statement regarding the accident when you make a claim for Part 7 Benefits. It is important to know that you do not have to provide a signed statement in order to be eligible for Part 7 Benefits.
“Reasonable” and “Necessary” Expenses
Under Part 7 ICBC is required to pay for all “reasonable” and “necessary” expenses for medication and therapy. These benefits are meant to cover medical expenses and treatment expenses related to injuries suffered in an accident, including such treatments as physiotherapy, massage therapy, chiropractic treatment and other types of treatments recommended by your doctor.
Many clinics will be able to direct bill to ICBC through a program known as Teleplan. Unfortunately ICBC does not cover the whole cost of treatments such as physiotherapy and you will be required to pay what is called a “user fee” to the clinic. If you have extended health care benefits you may be entitled to coverage of the user fee through your provider. If ICBC does not pay directly for treatment through Teleplan, you will have to submit your receipts to your ICBC adjuster for reimbursement. If you have receipts for treatments not covered by ICBC and/or for user fees it is important to keep those receipts as these costs may be recoverable when you settle your claim.
Your ICBC adjuster will advise you what treatment benefits they have approved for you. At first ICBC may only approve a certain number of treatments. However, sometimes after these sessions many people still need more treatment as they have continuing symptoms. In order to maintain your treatment and to continue to receive your benefits, you will need to attend at your doctors for a referral for ongoing treatment and submit this referral to ICBC. Under Part 7 Benefits treatments will only be covered if they are “reasonable” and “necessary” expenses for medication and therapy. Therefore, you may need your doctor to recommend treatment in order to continue to receive benefits and coverage.
Under Part 7, ICBC may also cover the cost of a variety of treatments or items if they “are likely to promote the rehabilitation” of the injured person. The types of items covered under this section include, one-time alterations to a home, attendant care at home, wheelchairs and various other equipment items. Unfortunately ICBC has a lot of discretion with respect to these types of rehabilitation expenses and you may need clear medical evidence that the items will promote rehabilitation.
The current lifetime limit for medical and rehabilitation benefits under Part 7 is $150,000, however the BC Provincial Government recently announced an increase in the limit to $300,000 for claims that have occurred since January 1, 2018.
If ICBC has denied your benefits under Part 7 for rehabilitation and medical expenses recommended by your treatment providers or if you continue to suffer ongoing symptoms but ICBC has denied you ongoing coverage for treatment, then it may be time for you to seek legal advice. Reinstating Part 7 Benefits and ensuring that you continue to receive the benefits you are entitled to is an important part of what lawyers do once we are hired to assist you with your claim. Contact us to schedule a free 30-minute consultation. To learn more, come back to read the rest of our blog posts or visit our service pages.The information provided above is for educational purposes only. This information is not intended to replace the advice of a lawyer or address specific situations. Your personal situation should be discussed with a lawyer. If you have any questions or concerns, contact a legal professional.