They know how the system works... do you?

The answer below is based on material in the Auto Accident Survivor's Guide for BC.   A more complete discussion of this topic is in the book. See Table of Contents and Book Index for topics covered in the book.

Will ICBC reimburse all my accident-related expenses - and what options do I have if they won't do this?

If you or someone in your household has Autoplan insurance, or you were in a BC-licenced car when your accident happened - or you were hit as a pedestrian or cyclist by a BC-licenced car - you're entitled to accident benefits from ICBC, regardless of who was at fault. As part of your no-fault accident benefits - also known as Part 7 (Part VII) accident benefits or "Part 7's" - ICBC is supposed to cover the cost of up to $150,000 in reasonable medical, rehabilitation and related expenses. If you weren't at fault, ICBC should also reimburse you for other accident-related expenses.

To get your accident-related expenses reimbursed, you'll need to submit dated receipts to your adjuster that clearly show what each expense is for. Keep a copy of all submitted receipts even after being reimbursed. You may need these later in settling your claim. You should be reimbursed within 60 days of submitting a receipt, but in practice this rarely happens. You might have to wait until your claim settles to be fully reimbursed.

The more serious your injuries are, the harder it usually is to get your expenses promptly repaid. It's usually easier for health-care providers and medical equipment suppliers to get paid than for claimants to be reimbursed, so try to get your health-care and equipment providers to bill ICBC directly whenever possible.

It can be hard to get your medical-rehab treatment paid for when you have subjective injuries or were in a Low Velocity Impact accident. (Soft tissue injuries including whiplash are considered subjective conditions as are mild brain injuries, headaches, chronic pain, insomnia, PTSD, and other psychological disorders.) You may need to take ICBC to court to prove that your injuries were caused by your accident, or go through arbitration to prove that the treatment your doctors recommend is both necessary and reasonable in cost. Your adjuster may accept that you're entitled to accident benefits, but still refuse to reimburse you for items and services he didn't pre-approve, even when pre-approval isn't required.

If you were in breach of your insurance when your accident happened, or your adjuster decides that your claim is fraudulent or exaggerated, you may need to sue ICBC to get accident benefits.

If you can't get ICBC to reimburse your accident-related expenses, you can initiate a Part 7 legal action against them. When a lawyer files a tort claim for damages, a Part 7 legal action is usually filed automatically as well. You have two years from your accident date - or two years from the date that ICBC first refuses to provide you with accident benefits - to initiate a Part 7 legal action.

Unfortunately, a successful Part 7 legal action doesn't mean that ICBC will pay for future rehab treatment. At most, it confirms that you're entitled to accident benefits and that a particular type of treatment is warranted on the day the decision is made.

Unpaid accident expenses for which you have valid dated receipts become part of your "special damages" (or "specials") in a tort claim for damages. Whether your claim goes to trial or settles out of court, you should be reimbursed for your expenses upon settling. If the amount of your specials can't be negotiated between the two sides, a judge can be asked to rule on this.

It's in your lawyer's interest NOT to get your accident-related expenses reimbursed on an on-going basis. He'll earn a commission on your special damages unless your contract with him specifies otherwise. Make sure your legal contract protects your interests, not just your lawyer's.

When you're solely at fault in an accident, closing your injury claim essentially means buying out your right to future Part 7 benefits. As part of your settlement negotiations, you should be able to get your accident-related medical and rehab expenses reimbursed.

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Auto Accident Survivor's Guide for British Columbia

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If you don’t undergo all treatment your doctors recommend, ICBC may deny you accident benefits or compensation, claiming you haven’t made a sufficient attempt to recover.

Keep detailed records of your out-of-pocket expenses or you won’t be reimbursed.

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