Why Am I Paying for Treatment if I Have Accident Insurance in BC?

Posted on March 16, 2016February 23, 2024 by Spraggs Law

Many injured victims are perplexed to find out that they have treatment costs after a personal injury accident in British Columbia. Ongoing medical treatment can be expensive and might not be covered or reimbursed by accident insurance for many years, especially if your recovery process is slow.

Accident Insurance Benefits Cover Auto Accidents Only

Accident benefits in BC are mandated by law for auto insurance only. Part 7 no-fault accident benefits are available, regardless of fault, to anyone injured in an automobile accident, even if you were a driver, passenger, pedestrian or a bicyclist in the accident.

By contrast, if your injury resulted from an accident that did not involve an automobile, you will not be entitled to accident benefits coverage. For other types of accidents, or if you sue an individual who has a home insurance policy or a business who has a business insurance policy, then your medical and rehabilitation expenses will instead form out-of-pocket expenses for a third party liability claim.

Part 7 Medical & Rehabilitation Benefits from ICBC

If you were injured in a car accident and submitted the completed Accident Benefits Application Form accurately within 30 days upon receipt, then you should qualify for statutory accident benefits. A signed statement is not required as part of the process.

The Insurance Vehicle Regulation sets out the Part 7 accident benefits, which includes up to $150,000 coverage for medical and rehabilitation expenses. Part 7 benefits also entails wage benefits, homemaker disability benefits and, in the event of death, payment of funeral expenses and loss of support benefits.

For medical expenses, under regulation 88(1), ICBC is required to pay for all “reasonable” and “necessary” medical costs, therapy and any needed prosthesis or orthosis. Sometimes, ICBC will deny a claim, questioning whether it is “reasonable.” You can dispute any denied claim and have the reasonableness determined by an arbitrator.

For rehabilitation expenses, under regulation 88 (2), ICBC has more discretion and may pay for a variety of treatments or items if they are “likely to promote the rehabilitation” of the injured person. ICBC has some discretion with respect to what rehab expenses they will cover and, while the expenses that may be covered are unlimited, the ICBC adjuster will often interpret the coverage narrowly.

Does Your Accident Insurance Cover That?

Payment for services such as chiropractor treatment, massage therapy, physiotherapy, traveling to and from medical appointments, the costs of medications and other rehabilitation expenses recommended by your doctor can be disputed by ICBC. If this is the case, you should consider paying for the expenses yourself if you can until the matter is resolved. You should anticipate that ICBC might also seek to limit payment for medical or therapy expenses, such as paying for a limited number of treatments, especially if these treatments are taken shortly after the accident.

Keep in mind that ICBC will not pay the user fees charged by most therapists. The reason for this is that ICBC will only pay for the price of treatment costs at the cost that they are covered under BC’s Medical Service Plan. Most treatment providers charge much more than that, so you may be responsible for paying the difference. However, if you have extended health care, you can submit the receipts to that provider for reimbursement.

The actual amount covered by ICBC for your medical and rehabilitation expenses may seem low if you have little income to live from. You may also face a high amount of uncovered expenses if you have no private disability plan.

Recovering Your Losses Through a Car Accident Lawyer Serving the Lower Mainland

Obtaining legal advice after incurring a personal injury accident is highly recommended. A personal injury lawyer serving the Lower Mainland can advocate for you and help you obtain accident benefits if they are legally applicable and/or any other fair compensation. If you were not fully at fault for the accident, then a personal injury lawsuit may help you to recover your losses.

Receive Help From Our Injury Lawyers at Spraggs Law

At Spraggs Law, our personal injury lawyers provide free, no-obligation consultations for car accident cases. We understand the challenging road ahead with the medical and rehabilitation expenses you can expect to face. We work on a contingency fee basis, which means that we only charge fees if we recover losses for you. Our legal advice can be critical to your case and help you to obtain the correct compensation. We can also coordinate insurance for treatments.

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