ICBC Part VII expense coverage after April 1, 2019Posted on by Mussio Goodman
There is a lot of confusion with the adjusters about how part VIIs work post April 1, 2019. There are three points:
- Under Part VII, ICBC will only compensate treatment expenses incurred after April 1, 2019 at “prescribed rates”, regardless of when the accident occurred;
- The requirement to furnish ICBC with receipts within 60 days of the service/treatment only applies to accidents that occur on or after April 1, 2019; and
- For accidents before April 1, 2019, the claimant can still claim “user fees” when a treatment costs more than the “prescribed rates”. However, for accidents on or after April 1, 2019 the recovery of “user fee” is no longer recoverable.
The reasons behind the above are set out below.
Section 88 deals with medical and rehabilitation benefits. Subsection (1) outlines the benefits that must be paid by ICBC. Subsection (1.2) provides that the benefits paid under subsection (1) must not exceed the fee limit set out in table 1 of schedule 3.1 (i.e., the new prescribed rates). :
(1.2) Subject to subsection (1.3), the benefits paid under subsection (1) must not,
(a) for each health care service referred to in subsection (1) (a), exceed the fee limit set out in Column B or C, as applicable, of Table 1 of Schedule 3.1 corresponding to that health care service,
(b) for occupational therapy, exceed the fee limit of $112 per hour, and
(c) for each health care service referred to in subsection (1) (a) that is provided by a physician, exceed the fee limit set out in Column B of Table 2 of Schedule 3.1.
Section 88.01 provides that receipts for benefits under s. 88 must be submitted to ICBC within 60 days.
Requirement for receipts
88.01 (1) If an accident occurs for which benefits are provided under section 88, the insured must provide to the corporation a receipt for the expenses incurred that will be compensated as benefits under that section no later than 60 days from the date that those expenses are incurred.
(2) The corporation is not liable to an insured who, without reasonable excuse, fails to comply with this section.
The transitional provisions for section 88 and 88.01 are at section 104.2 and 104.21 respectively. Section 104.2 says that the new section 88 as it currently reads applies to expenses incurred after April 1, 2019 regardless of the date of the accident. Conversely, section 88.01 only applies in respect of accidents that occur after April 1, 2019.
Transitional — medical or rehabilitation benefits
104.2 Section 88 as it reads on April 1, 2019 applies in relation to medical or rehabilitation benefits payable under section 88 for expenses incurred on or after April 1, 2019 regardless of the date of the accident.
Transitional — receipts
104.21 Section 88.01 applies in respect of an accident that occurs on or after April 1, 2019.
For accidents before April 1, 2019, claimants can still claim “user fees” when treatment costs more than the “prescribed rates”. Section is 82.2 (4) clearly restricts coverage for accidents on or after April 1, 2019 so the “user fee” is no longer recoverable.Tweet