When British Columbia moved to a no-fault auto insurance model in the early 1970s, the government created the Insurance Corporation of British Columbia (“ICBC”) as the mandatory insurer for every motorist in the province. These Part 7 benefits provide for the basic medical, rehabilitation and wage loss benefits coverage, also known as “Accident Benefits” or “No-fault Benefits”. By design, the ICBC Part 7 benefits are meant to be applied without regard to negligence or fault in each injury accident case. While there are limits to these benefits additional coverage can be purchased to supplement this basic insurance.
Under basic coverage the limit to medical and rehabilitation benefits for all “reasonable” and “necessary” to be paid is $150,000. Often though what is reasonable and necessary in the view of an ICBC adjuster can be different from the opinions of an injured person and the health care professionals providing treatment to them. Contact Hauer and Company for a free consultation if you’re concerned about whether the amount of medical treatment and rehabilitative services that you or a family member is receiving after a motor vehicle accident is sufficient.
In motor vehicle accident claims giving rise to serious injuries, the basic limit of $150,000 will probably not be enough to cover you for the costs for weeks or months in hospital, additional time in a rehabilitation centre or nursing home, and additional treatment or surgery. Our personal injury lawyers know how to access the provisions of the ICBC regulations that can provide for additional treatment needs. We are also often able to convince ICBC that its adjusters have understated an accident victim’s required care or have arbitrarily limited his or her benefits on the basis of weak assumptions.
One additional fact to be aware of is that ICBC has much greater discretion for the payment of rehabilitation services than it does for medical treatment. The lawyers at Hauer and Company have experience with the proof of claims based on presenting a strong case for the necessity of one or more rehabilitative services.
If an insured injury prevents you from working, obtaining access in a reasonable amount of time to wage benefits under the ICBC system can be difficult. You must wait seven days before becoming eligible, besides meeting additional qualifications. The key principle for any claim to lost wages is whether the injury resulted in a Total Temporary Disability (“TTD”).
The legal standard for determining disability and eligibility for benefits is whether you are unable to perform “any substantial requirement” of your ordinary job, as opposed to whether your injuries prevent you from working completely. The lawyers at Hauer and Company know how to develop and present evidence of TTD should an ICBC adjuster substantially refuse payment of benefits for lost wages on the basis of disability.
Part 7 wage benefits are calculated at 75 percent of average weekly earnings, with $300 being the maximum permissible per week under the basic coverage. Individuals with higher incomes can buy optional additional coverage as well. Those covered under private or group disability plans must apply those amounts first before the TTD benefits are payable. Finally, TTD benefits can supplement private wage protection if the total amount received does not exceed 75 percent of average weekly earnings based on the previous 52 weeks.
The provisions outlined above are but one part of the ICBC Part 7 regulation. Many other provisions apply to different aspects of an injured person’s claims for medical treatment, rehabilitation services and lost wages. Enabling the full possible application of these benefits with private insurance plans can raise some complex issues. For full advice about the entire range of your rights to ICBC Part 7 benefits, contact us for a free consultation.