While this post may provide you with a basic overview, it is not a replacement for the expertise of our lawyers here at Umbrella Injury Law. We encourage you to contact us after reading through this information to ensure your questions are fully answered and to protect your rights as you navigate your personal injury claim.
No doubt, you have heard about the changes that the Insurance Corporation of British Columbia (“ICBC”) made effective April 1, 2019; however, you might not have had the opportunity to fully understand what these changes meant for you until you found yourself injured as a result of an accident.
A medical professional – not ICBC – will diagnose your injury, and this diagnosis will determine whether it is minor or not. If ICBC advises that your injury has been defined as ‘minor’, this only affects your compensation for pain and suffering which is only one part of your claim. It is separate from the medical treatments and benefits available to assist in your recovery.
British Columbia’s minor injury definition includes sprains, strains, general aches and pains, cuts, bruises, road rash, persistent pain, minor whiplash, temporomandibular joint disorder or TMJ (pain in your jaw joint and in the jaw muscles), mild concussions and short-term mental health conditions.
As of April 1, 2019, a limit of $5,500 will apply to pain and suffering payouts for minor injuries.
Why did ICBC make this change?
British Columbia was the last province in Canada to apply a cap on injuries defined as “minor”. The BC government was facing a $935 million dollar loss in the first nine months of the 2017-18 fiscal year and advised that due to decisions made by previous governments, was now in the position of having to make drastic changes in order to keep ICBC financial viable. BC Attorney General David Eby reported in early 2018 that the province projected a $1.3-billion loss in the 2017-18 fiscal year citing the example that the average claim for minor injuries has gone up from $8,220 in 2012 to $30,038 in 2016. In 2018 alone, ICBC handled approximately 50,000 minor injury claim injury files. Mr. Eby stated that changing ICBC to a “care-based model” and moving more money towards treatment and support rather than cash payouts will keep insurance affordable while also providing the requisite care and treatment for those injured.
What will this new legislation mean for my claim?
If you choose not to attend upon a doctor in the 90 days following your accident and subsequently decide to pursue a claim, ICBC will automatically classify your injury as minor. That could mean a limited $5,500 ICBC payout, even for serious, permanent life-long injuries.
Depending on the course of action you and your physician determine is best to assess and treat your injuries, keep in mind that ICBC has set in place limits on the amounts they will reimburse for the following treatment modalities: acupuncture, chiropractic, counselling, kinesiology, massage therapy, physiotherapy, and psychology, outlined in the table below:
|SERVICE||FEE LIMIT FOR ASSESSMENT VISIT/REPORT||FEE LIMIT FOR STANDARD TREATMENT||NUMBER OF PRE-AUTHORIZED TREATMENTS|
Your treating physician will provide a diagnosis and treatment plan with the goal of recovery of your injuries within 12 weeks*. Within this timeframe, your doctor may recommend additional treatments or new ones, or may refer you to a Registered Care Advisor (“RCA”), especially if your recovery is taking longer than expected. RCAs are medical professionals who provide independent consultations to those injured as a result of an accident and must be an independent assessor, not hired by ICBC or your lawyer. The RCA must have no financial interest in the treatment. If your doctor refers you to an RCA, this appointment generally takes place within 15 business days of your doctor’s referral.
After examining you, the RCA will provide a report to your physician within 10 days of the examination. This report may offer additional diagnoses or treatment options that assist your doctor in helping you get better. It is important to note that the RCA report may also be used to determine that your injury falls under the definition of a minor injury.
* In the case of concussions or mental health conditions, the limit on pain and suffering will not apply if there is significant impairment beyond 16 weeks.
As a result of the change in legislation, if you are disabled as a result of your injuries, you may be eligible for disability benefits. You will be required to provide your ICBC claim representative with written confirmation from a doctor or nurse practitioner that you are unable to work and confirmation of employment from a current or previous employer. If you have other insurance coverage, that coverage must be accessed before ICBC benefits are payable.
Payments are calculated based on your income prior to the crash, up to a $740 weekly maximum for the duration of the time you are medically advised not to work.
If you are unable to attend to your housekeeping duties (ie: cleaning, cooking/meal prep, grocery shopping) ICBC may reimburse certain expenses, such as cleaning services, to a maximum of $280 per week. To qualify, a physician or nurse practitioner must certify your inability to attend to these duties and you will need to provide this information to your ICBC claim representative.
What if my injuries are determined to be ‘major’?
The new legislation requires that your injury results in serious impairment for longer than 12 months and that the injuries need to be chronic and significantly disabling. For example, if you are unable to go to work or attend school, if you must modify your work hours or duties, or you are unable to care for yourself – your injury will no longer be considered minor.
What else do I need to be aware of?
As a result of the new legislation, BC has established the Civil Resolution Tribunal (CRT) in order to address disputes between injured persons and ICBC, including minor injury determination disputes, injury claim settlement amount disputes and medical service or device, supply disputes. The CRT has been set up to re-route the dispute process in most instances from small claims or the supreme courts to the CRT.
We hope this summary answers some of your questions. It is now more important than ever to contact the lawyers at Umbrella Injury Law to discuss your accident and the options you have, especially given the changes enacted in early 2019. At Umbrella Injury Law, We Got You Covered.