Some Insurance Corporation of British Columbia adjusters are never short of excuses, generating excuses for late payment of benefits to victims of personal injury following car accidents, pedestrian accidents, hit and runs and the like. As a personal injury lawyer in BC injury claimant’s often call me to ask how to deal with the ICBC insurance adjuster after a car accident.
Claimants may not understand that ICBC is a for profit insurance company as ICBC often portrays itself as an institute to promote driver safety, as is evident in its’ ICBC drive safe campaign. Remember that ICBC is required by law to provide accident injury benefits to insured injury claimants after car accidents in British Columbia. So the ICBC insurance adjuster owes an insured a duty a good faith and fair dealing.
Explaining how a person without a lawyer makes an ICBC injury claim necessarily involves revealing some common excuses used by ICBC insurance adjusters to reduce exposure for paying the cost of treatment and other benefits.
I took an informal survey within my personal injury law firm and was surprised how often ICBC adjusters give excuses for not paying benefits. The biggest ICBC excuse generator may well be the adjusters that help determine a claimant’s entitlement to auto accident benefits. Incredibly, here is a shortlist of some of the excuses used to explain a delay or denial of ICBC accident benefits:
1. Due to workload demands, the adjuster is unable to respond to the claimant in a timely manner.
2. When asking for more than one form of treatment (i.e. massage and physiotherapy), the ICBC adjuster will delay further by saying he or she needs to refer the claimant for Active Rehabilitation.
3. When following up on total temporary disability benefits, after receiving benefits for some time, an adjuster said that after reviewing the file and it appeared that the client wasn’t working at the time of the accident.
4. Coverage for treatment gets delayed or denied from ICBC when they think the accident claim form, CL22, is incomplete.
5. Adjusters are denying coverage for client’s who have had “too many treatments”, despite medical notes from the family doctor.
6. The most popular one right now is that there is a lot going on here at ICBC with all the new changes or their work load is too big. So they tell you that they will get back to you at the end of the day or the end of the week, but you don’t usually hear back from them.
7. The ICBC adjuster delays approving the treatment and sends the family doctor a copy of the Official Disability Guidelines to try to get the doctor to change the course of recommended treatment.
8. ICBC refuses payment for the the treatment because the client also has an ongoing WCB claim.
9. Based on the low velocity in the collision there is no compensable injury.
10. The family doctor refuses to talk to the ICBC adjuster on the phone, despite the doctor providing a medical letter.
As a personal injury lawyer client’s tell me the excuses used by ICBC to refuse payment of benefits before I am hired and most of these excuses have no merit. For example, since the decision in Raguin v. ICBC, ICBC has had to change their massage therapy payment policy recognizing that massage therapy is a mandatory benefit just like physiotherapy and chiropractic. ICBC had to remove the the “1st 8 week post MVA” time limitation that was traditionally used to deny claims for massage therapy. They now acknowledge that there is no time limit on the referral for massage therapy.
There are many benefits that are mandatory and the injury claimant can force ICBC to pay for these benefits. However, enforcing your right to claim injury benefits can often prove difficult without a lawyer. Instead of listening to more ICBC excuses it may be best to hire a lawyer as early as possible to deal with ICBC.
Lastly, it is important to note that ICBC’s legal powers are more far reaching than accident benefits including the power to do the following: (a) carry on the business of insurance;(b) operate and administer plans of insurance, including universal compulsory vehicle insurance;(c) engage in and carry on the business of repairing insured property and of salvaging and disposing by public or private sale;(d) carry on the business of providing medical and hospital services to a person insured;(e) for its own use and benefit, acquire or expropriate, and hold or take options on land required for its business;(h) receive, hold, manage and collect, for and on behalf of the government revenue from fines in connection with violation tickets; and (i) promote and improve highway safety.
Posted by Mr. Renn A. Holness B.A., LL.B.