No-Fault Accident Benefits: Getting the Most Out of Your ICBC Part 7 Benefits
When British Columbia committed to a no-fault auto insurance model in the early 1970s, the government created the Insurance Corporation of British Columbia (ICBC) as the mandatory insurer for every motorist in the province. The basic coverage for medical, rehabilitation and wage loss benefits is collectively known as Part 7 benefits and sometimes called “Accident Benefits” or “No-fault Benefits”. In theory, the ICBC Part 7 benefits are to be paid without regard to negligence or fault in each injury accident case. There are limits to these benefits but additional coverage can be purchased to supplement this basic insurance.
Protect Your Right to Medical Treatment and Rehabilitation Services
Medical and rehabilitation benefits are to be paid for reasonable and necessary costs up to $300,000 under the basic coverage. As of April 1, 2019, there are new limits on the amounts and number of treatments available. What is reasonable and necessary in the view of an ICBC adjuster can often conflict with the opinions of an injured person and the health care professionals providing treatment to them. If you’re concerned about the adequacy of the medical treatment and rehabilitative services that you or a family member is receiving after a motor vehicle accident, contact Murphy Battista for a free consultation about your right to full payment.
In motor vehicle accident claims involving serious injuries, the basic limit of $300,000 will probably fall short of what you need to cover the costs for weeks or months in hospital, additional time in a convalescent centre or nursing home, and follow-up treatment or additional surgery. Our lawyers know how to access the provisions of the ICBC regulations that can cover additional treatment needs. We are also frequently called upon to convince ICBC that its adjusters have understated an accident victim’s needs or have arbitrarily limited benefits on the basis of doubtful assumptions.
Be aware that ICBC has significantly greater discretion for the payment of rehabilitation services than it does for medical treatment. The lawyers at Murphy Battista have decades of experience with the proof of claims over an adjuster’s objection based on our ability to present a strong case for the necessity of a particular rehabilitative service.
Wage Benefits Under ICBC Regulations
If a covered injury prevents you from working, getting timely access to wage benefits under the ICBC system can be difficult. There is a seven-day waiting period before you become eligible, and other qualifications must also be met. The key issue in a claim for lost wages is whether the injury resulted in a Total Temporary Disability (“TTD”).
The legal standard for determining disability and eligibility for benefits is not whether your injuries prevent you from working completely, but whether you are unable to perform “any substantial requirement” of your ordinary job. The lawyers at Murphy Battista know how to develop and present proof of TTD should an ICBC adjuster resist payment of benefits for lost wages on the basis of disability.
Part 7 wage benefits are calculated at 75 percent of average weekly earnings, with a maximum of $740 per week under the basic coverage. Persons with higher incomes can buy optional additional coverage to protect higher wages or salaries. Those covered under private or group disability plans must exhaust those benefits before the TTD benefits are payable. TTD benefits can also supplement private wage protection, provided that the total amount received does not exceed 75 percent of average weekly earnings based on the previous 52 weeks.
Questions About British Columbia No-Fault Benefits? Call us.
Many other detailed provisions of the ICBC Part 7 regulations apply to different aspects of an injured person’s claims for medical treatment, rehabilitation services and lost wages. Coordinating these benefits with private insurance plans can raise complex and confusing issues. For dependable advice about the full range of your rights to ICBC Part 7 benefits, contact us for a free consultation.
Disclaimer: The outcome of every legal proceeding will vary according to the facts and unique circumstances in each individual case. References to successful case results where the lawyers at Murphy Battista LLP have acted for clients are not necessarily a guarantee or indicative of future results.
Stephen Gibson and Irina Kordic represented the Plaintiff who was 6 years old when he was struck by a motor vehicle and suffered a traumatic brain injury. Eight years after the accident, the Plaintiff’s mother sought assistance from the Defendant for medical benefits. The benefits were denied on the basis that the limitation period expired 2 years after the last payment made by I.C.B.C., despite the Plaintiff being a minor when the limitation expired. The Plaintiff alleged negligence against the adjuster, and bad faith against I.C.B.C. The Plaintiff was successful on a summary trial application by the Defendant to strike the Plaintiff’s claim, and the Defendant appealed. The Court of Appeal ruled that the Plaintiff’s claims would not be struck, and that they were permitted to proceed to trial on the basis that it was not plain and obvious that the Plaintiff was owed a duty of care to be informed of a lapsing limitation, or that the limitation date had expired. This was a novel finding of law in the area of potential negligence by an insurance adjuster in administering first party claims.