The following paragraphs answer some of the common questions with Part VII coverage.
DOES ICBC GET CREDIT FOR PART VII BENEFITS PAID?
The simple answer to this question is usually “YES”. When ICBC is faced with having to pay an injury claim or a death claim, it is entitled to seek a credit for those amounts, which have already been paid in the form of Part VII benefits to the injured person or to the family.
For example, if an injured person has $5,000 in income loss but ICBC has already paid $1,200 in TTDs, the injured person is only entitled to recover $3,800 in a claim against the driver at fault for the accident.
IF ICBC REFUSED TO PAY PART VII BENEFITS, WHAT CAN I DO?
ICBC can be sued for the payment of Part VII benefits under contract, but the lawsuit must be started within 2 years of the date of the accident or within 2 years of the date of the last Part VII payment, whichever is later. If the only issue is whether a medical or rehab expense is “reasonable”, then that question must be decided by arbitration.
You can also try your luck through the ICBC internal review procedure but usually that approach is not that productive.
WHO AT ICBC HANDLES MY PART VII CLAIM?
ICBC has a Rehabilitation Department with offices in such centres as Vancouver, Victoria and Kelowna, which deal only with Part VII claims. The adjusters in this department, who call themselves rehab coordinators, deal only with the Part VII claims and are not concerned with any additional injury or death claims. Generally, only those cases involving serious injuries with anticipated long-term problems are referred to this department.
In most cases, the same adjuster in the ICBC claims centre who is dealing with the injury claim deals with the Part VII claim. The problem with this system is that the adjuster who is providing Part VII coverage may feel that providing that coverage will make the injury claim larger or better. Hence, some adjusters tend to deny payment under Part VII so ICBC is not seen as accepting the severity of the injuries. Also, some adjusters at ICBC avoid paying Part VII benefits because the less treatment a person has the easier it is to argue the injuries are minor. Similarly, if TTDs are not paid, ICBC may be able to “starve” the injured party back to work.
While there is an obvious conflict in one adjuster handling both the Part VII and the injury claim for the same person, ICBC refuses to acknowledge this conflict. A claimant can request that his or her file be referred to the Rehabilitation Department, but there is no way to ensure that this will be done.
CAN ICBC INSIST THAT I SEE A DOCTOR OF THEIR CHOICE?
The basic answer to this question is “YES”. ICBC is entitled to have a claimant seen by a doctor of its choice to determine if the person is entitled to Part VII benefits. This right is sometime misused by ICBC as the prime purpose of the assessment is to assist with the injury claim, not to determine whether Part VII benefits should be paid. As a result, ICBC gets you in to see their doctor of choice earlier and more often then if ICBC was only dealing with an injury claim.
If you refuse to attend the assessment, ICBC can cut you off of Part VII benefits and then turn around and argue in your injury claim that they get a credit against your damages for expenses they would have paid under Part VII but did not because of your refusal to attend the assessment.
One questions the fairness of this situation because in reality you probably would have had to fight hard to get ICBC to pay anything under Part VII through the claim but yet ICBC now turns around and argues they would have paid for everything. Also, chances are that the ICBC appointed doctor is going to minimize the amount of treatment you need and suggest an early return to work. Otherwise, ICBC probably would not be using that expert for the opinion.
CAN THE ICBC ADJUSTER INSIST THAT I TAKE CERTAIN TREATMENT?
Provided that your own doctor thinks the treatment is likely to help you and ICBC offers to pay for the treatment, Regulation 90 allows ICBC to insist that you undergo this treatment and allows ICBC to cut off benefits if you refuse to undergo this treatment.
