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ICBC Changes to Part 7 Benefits – Treatment Funding

PART 7 BENEFITS – INCREASED FUNDING

As of April 1, 2019, significant changes have been made to the funding provided by ICBC for therapy under Part 7 benefits. These changes apply to all new and existing motor vehicle accident claims.

PRESCRIBED TREATMENT PROVIDERS AND RATES

ICBC under the Part 7 Benefits will provide funding for therapy. According to the new law, ICBC will only provide funding for the prescribed list of treatment providers according to the following standard treatment payment rates:

  • Acupuncture $88 (increased from $0 prior to April 1, 2019)
  • Chiropractic $53 (increased from $17.35 prior to April 1, 2019)
  • Massage Therapy $80 (increased from $23 prior to April 1, 2019)
  • Physiotherapy $79 (increased from $23.60 prior to April 1, 2019)
  • Active Rehabilitation $78 (increased from $50 prior to April 1, 2019)
  • Counseling with a Clinical Counselor $120 (increased from $100 prior to April 1, 2019)
  • Counseling with a Registered Psychologist $195 (increased from $145 prior to April 1, 2019)

If the clinic has direct billing set up with ICBC, then ICBC will pay the clinic directly for the cost of the therapy according to the fee limits.

If the clinic does not have direct billing set up with ICBC, then you will be required to pay the full cost to the clinic to then submit to ICBC for reimbursement.

PART 7 BENEFIT APPROVAL FROM ICBC

If you wish to attend treatment within the initial 12 weeks after the motor vehicle accident, then you are pre-approved meaning that you do not require a referral note or prior approval from ICBC. The set number of pre-approved sessions is as follows:

  • Acupuncture 12
  • Chiropractic 25
  • Massage Therapy 12
  • Physiotherapy 25
  • Active Rehabilitation 12
  • Counselling with a Clinical Counselor 12
  • Counselling with a Registered Psychologist 12

If you wish to attend for treatment after the initial 12 weeks following the motor vehicle accident or after you have used the approved number of sessions, then ICBC requires a referral note from a medical doctor (i.e. family physician) to approve funding for additional sessions. The number of sessions approved at one time is within the adjuster’s discretion. Most therapy clinics will handle submitting referral notes to ICBC for approval on behalf of their patients.

OTHER IMPORTANT CHANGES FOR TREATMENT AFTER APRIL 1, 2019

While ICBC has made positive changes by increasing the funding under Part 7, it has also made changes which are extremely problematic and which will undoubtedly negatively impact injured claimants.

For motor vehicles accidents occurring before and after April 1, 2019, ICBC will not reimburse any treatment costs incurred after April 1, 2019 which are over and above the ICBC set rates. In other words, if you are charged a user fee by your therapist, then ICBC no longer has a responsibility to reimburse. This only applies to user fees from April 1, 2019 onwards. All user fees incurred until March 31, 2019 will be reimbursed in full by ICBC. This is highly problematic for injured claimants as there are numerous clinics which charge user fees. User fees can easily add up to hundreds and thousands of dollars which are now no longer reimbursed by ICBC as part of the settlement or judgment.

For motor vehicle accidents occurring after April 1, 2019, you have 60 days from the date the treatment cost was incurred to submit your receipts to ICBC for reimbursement. If the receipts are not submitted to ICBC within this 60 day time frame, then ICBC will not reimburse you at any time. This is also highly problematic for injured claimants who are unaware of this very significant limitation period. What is disturbing is that ICBC is not under any legal or ethical obligation to point this out to injured claimants.

These negative changes are yet another example of how the new ICBC changes have reduced and stripped away the rights of the injured claimants instead of focusing on financial consequences for bad drivers who cause injury.

It is misleading that ICBC advertises that as of April 1, 2019 they are now following a “care based model” and that “anyone injured in a crash will have access to significantly improved benefits to support their care and recovery”. This is simply untrue. BEFORE these changes, injured claimants were entitled to full reimbursement of their out of pocket expenses for rehabilitation. NOW, ICBC has effectively reduced the overall amount of compensation to injured claimants by only paying a set portion of treatment costs and by denying reimbursement if the ICBC enacted limitation date is not met.

Contact one of our experienced ICBC personal injury lawyers at Holness Law Group to learn more about your rights and obligations with ICBC following these significant changes made by the NDP government. We are pleased to offer a free initial consultation.

Tags: ICBC adjusters, ICBC benefits, ICBC limits on healthcare costs

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"Jacqueline A. Small is a personal injury lawyer with over 15 years of experience and a partner with Holness Law Group."

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