I have been a personal injury lawyer in Vancouver since 1995 and have witnessed the change in how the Insurance Corporation of British Columbia, ICBC, pays for physiotherapy. I have written and dealt extensively with ICBC accident benefits and explain how ICBC accident benefits work for people that are injured in car accidents in British Columbia. Take some time to read my other articles on this subject.
Physiotherapy is considered a mandatory benefit that ICBC must pay if you are insured and the treatment is medically necessary. If you are a BC resident and your vehicle is registered in BC then you should be covered by these injury benefits after you have been injured in a car accident. The best way to ensure ICBC will pay for your physiotherapy is to get your doctor to confirm in writing the need for the treatment and the fact the the need arises for your car accident injuries.
ICBC is only required to pay for 12 physiothary treatments unless a medical practitioner confirms in writing that more treatments are needed. If ICBC does not think that the expense is reasonable and refuses to pay for the treatment the dispute has to be submitted to arbitration. In my personal injury practice we do very few if any arbitrations given their cost and delay.
Section 88(1) of the Insurance (Vehicle) Regulation, B.C. Reg. 447/83, provides that the Insurance Corporation of British Columbia shall pay an insureds benefits defined as “all reasonable expenses incurred by the insured as a result of the injury for necessary” services, therapy, or treatment as set out in the Regulation. Physical therapy is one of the included therapies. Payments under s. 88 are commonly referred to as “no-fault benefits”.
If ICBC does not start the arbitration process within a reasonable time after the denial, you can sue ICBC in Supreme Court to get a court order forcing ICBC to pay.
Most claimants call me frustrated that the ICBC adjuster refuses to pay for physiotherapy despite the family doctors recommendation. Section 88(1) does not confer on the ICBC adjuster the power or right to decide whether the claimant is legally entitled to accident benefits. Regardless of the adjuster’s view, it is open to you to sue ICBC for its failure to provide benefits. It is, however, open to ICBC, to challenge the claimant’s assertion that the treatment is necessary and reasonably priced. That position might be taken, for example, based on separate medical evidence obtained by ICBC (see Tiessen v. ICBC, 2008 BCSC 1822).
An ICBC adjuster is not qualified to express a medical opinion and if your benefits have been denied despite the opinion of your doctor you should contact a personal injury lawyer right away. Consider hiring a lawyer to prosecute your injury claim so you can focus on your recovery. Posted by Mr. Renn A. Holness
