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ICBC’s No-Fault Insurance Model: Can You Claim Out-Of-Pocket Expenses?

February 4, 2022

If you have been injured in an accident, you need medical care and treatment to help you recover. Expenses add up quickly, and rehabilitation can take weeks, months—or even years if you have been seriously injured. Will you be out-of-pocket for these costs? Who pays for medical care and treatment under ICBC’s no-fault model?

ICBC Claim for Treatment Expenses: Can You Get Your Money Back? 

ICBC’s new “Enhanced Care” auto insurance model came into effect on May 1, 2021. ICBC has said that getting coverage for treatment is easier under the new no-fault regime, but the reality is that not much has changed. You, as the accident victim, may end up out-of-pocket for medical expenses and you may not get reimbursed. Here are the basics:

⦿For the first 12 weeks after the accident, you may be eligible for “pre-approved” treatment from a physiotherapist, chiropractor, registered massage therapist (RMT), kinesiologist, psychologist, clinical counsellor, acupuncturist, or occupational therapist. Other expenses such as medication, supplies and equipment, personal care assistance, and travel expenses to and from treatment need to be pre-authorized by ICBC. Coverage may be denied, leaving you without reimbursement.

⦿ICBC limits both the number of treatments covered and the amount it will pay per treatment. For example, the maximum number of approved RMT treatments is 12 in the first 12 weeks after the accident. The standard treatment fee is capped at $83, which ICBC has deemed to be the current “market rate.” If you need more than 12 treatments in the initial period following the accident, or the RMT you go to charges more than $83, you are out-of-pocket for the excess cost.

⦿Treatment providers have the option of billing ICBC directly for your treatment, but some choose not to. That means you have to pay out-of-pocket and then submit receipts to ICBC to see if you are eligible for reimbursement. ICBC will only reimburse you up to its established rates for treatments and will not reimburse you at all if your receipts aren’t submitted within 180 days after the date of treatment.

⦿If you have coverage from another provider (e.g., extended health care through your employment or disability insurance that you purchased on your own), ICBC considers your other insurance as the primary payer for most medical expenses and income replacement. So even if you weren’t at fault for the accident, you have to claim against your own coverage first when you bring an ICBC claim.

Can You Get Your Money Back For Expenses After 12 Weeks?

Your recovery may take longer than 12 weeks, especially if you were seriously injured in the accident. If you need ongoing treatment beyond 12 weeks after the accident, it must be authorized by ICBC as “reasonable and necessary” to your recovery. If ICBC does not authorize additional treatment, you will be out-of-pocket for the expense.

STA Lawyers Can Provide You with the Guidance You Need

Don’t hesitate to contact us to receive guidance about your claim. Call Simpson, Thomas & Associates at 604-243-5825 or fill out our online form to request a free initial legal consultation with one of our experienced personal injury lawyers.

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