What Are ICBC Part 7 Benefits?
ICBC Part 7 Benefits apply to accidents involving an insured motor vehicle in British Columbia. These “no-fault” benefits are designed to provide short-term relief to any injured accident victim, regardless of who was to blame for causing the collision, and to reduce potentially costly litigation. While the process of compensation is designed to be fairly straightforward, you may need the help of a personal injury lawyer to maximize your benefits.
Do you qualify for ICBC Part 7 Benefits?
In order to receive Part 7 Benefits, you must be either:
- The owner of the ICBC insured vehicle and members of his or her household.
- A licensed BC driver and members of his or her household.
- An occupant of a vehicle licensed in BC or driven by a licensed BC driver.
- A cyclist or pedestrian struck by an ICBC-insured vehicle.
- A BC resident or personal representative entitled to bring legal action for personal injury or wrongful death caused by an uninsured motorist or hit-and-run.
In other words, anyone injured or killed in a B.C. motor vehicle accident can bring a Part 7 Benefits claim.
What Part 7 Benefits can a BC motor vehicle accident receive?
Part 7 benefits include compensation for:
- Medical and rehabilitation expenses
- Lost wage replacement
- Homemaker services
- Death-related costs
ICBC Part 7 Medical and Rehabilitation Benefits
Medical and rehabilitation benefits include expenses like:
- Ambulance rides and hospital stays
- Doctor’s visit copays and medication
- Chiropractic treatment, massage therapy, physiotherapy
- Travel expenses to obtain treatment
- Home attendant care
- Occupational therapy services
- Wheelchairs, modified vehicles, specialized equipment, or home renovations to accommodate a disability
Under regulation section 88(1), ICBC is required to pay for all “reasonable” and “necessary” expenses, but the ICBC adjuster has broad discretion to limit payment for certain types of medical expenses. For instance, they may not cover massage or physiotherapy unless they are taken within 12 weeks of the accident. Even when they do cover these therapies, they may only pay for up to 12 visits.
As of April 1, 2019, the ICBC has added some clarity to what they will or will not cover:
- $88-$105 for up to 12 acupuncture sessions
- $53-$199 for up to 25 chiropractic sessions
- $120-$210 for up to 12 counselling sessions
- $78-$135 for up to 12 kinesiology sessions
- $80-$107 for up to 12 massage sessions
- $79-$250 for up to 25 physiotherapy sessions
- $195-$340 for up to 12 psychotherapist sessions
The fee limit variance depends on whether the treatment is considered “standard” (the low end) or as part of a “specialist referral” (the high end). These new limits pose a number of issues for benefit recipients. What if the provider charges more than what ICBC pays? What if you require more sessions? What if you are referred to one of these therapies more than 12 weeks after the accident? What if your physician has not provided a certified opinion in writing that states you need the recommended treatment? What if you need alternative medicine that isn’t covered? You might need a lawyer in these cases.
ICBC Part 7 Wage Loss Benefits
You may be entitled to wage loss benefits up to $740/week ($2,960 per month) if you cannot work due to the severity of your motor vehicle accident injuries. The maximum wage loss benefit increased from $300/week and $1,200/month as of the April 1, 2019 reforms. However, the actual amount you receive is calculated as 75 percent of your average weekly earnings, based on the 52 weeks prior to your accident. If you are a student who was previously working part-time, a recent retiree, or someone who had recently taken family leave, this calculation could be problematic for you.
To qualify for Total Disability Benefits (TTD), you must have been employed or worked at least 50 percent of the year at the time of the accident. You will be subject to a seven-day waiting period, which can be extended if you are entitled to sick leave benefits through your employer’s private benefit plan. Part 7 Benefits are considered secondary to any other insurances you carry. Even so, it is best to apply for ICBC wage replacement right away, though you may have to wait a while for EI and ICBC coverage to eventually kick in.
There is much room for dispute in providing full wage benefits. Sometimes TTD is cut off when you attempt to return to reduced capacity or part-time work. The adjuster may also dispute that you cannot perform the requirements of your ordinary job. Standard benefits can be accessed for up to two years following the accident, but after that, you must prove that you cannot perform ANY type of work, given your disability, age, education, and experience. If approved, you could receive disability benefits up to age 65.
ICBC Part 7 Homemaker Benefits
If you are an injured homemaker, you may be entitled up to $280/week for accidents that have occurred after April 1, 2019. Prior to this increased limit, homemakers were able to receive up to $145/week.
ICBC adjusters generally resist paying for homemaker services, except in cases of very serious injury where a friend, family member, or other caretaker must visit daily or actually move into the household for a time to help cover duties like laundry, cooking, cleaning, and childcare.
ICBC Part 7 Death Benefits
Death benefits include funeral expenses, burial costs, and survivor benefits. As of April 1, 2019, ICBC will cover up to a maximum of $7,000 – which increased from a previous maximum of $2,500. Beneficiaries may be asked to provide receipts to obtain full coverage. Sections 92 through 95 provide up to $30,000 (up from $15,000) in additional death benefits to surviving family members, depending on the relationship.
When the “head of the household” or “primary breadwinner” dies and leaves behind dependent children, the family will generally receive a larger lump sum than a spouse earning relatively equal pay. Any money payable to a child under 19 goes to the Public Guardian and Trustee.
ICBC commonly pays out benefits in a lump sum, rather than splitting them over the course of 104 weeks.
Can ICBC deny Part 7 Benefits?
Part 7 Benefits can be reduced or outright denied based on:
- A perceived failure to provide all documentation required for coverage.
- Claims that an uninsured person or someone not from British Columbia caused the crash.
- Failure to file the claim within the required time frame of two years from the date of the accident.
- The belief that someone else, like an employer or the at-fault driver, should pay benefits.
How to maximize Part 7 Benefits
You are entitled to an appeal if you are unhappy with the decision of the ICBC adjuster. Working with an ICBC law firm may be the best way to present the strongest possible case. Sometimes it makes more sense to file a personal injury lawsuit to seek additional benefits like pain and suffering and the payment of future expenses. Preszler Injury Lawyers can help you with either type of claim. Contact us to discuss your options.