ICBC Enhanced Care System (Current Model) (12:III)

This information applies to British Columbia, Canada. Last reviewed for legal accuracy by the Law Students' Legal Advice Program on July 18, 2021.

NOTE: The following portion of this chapter is meant to serve as a basic primer covering some of the key principles of the new ICBC system, which applies to claims for accidents occurring on or after May 1, 2021. Given that this no-fault system is new as of May 1, 2021, there are still certain portions of it that are being clarified, or that may adapt with implementation.

Basic coverage is mandatory for all BC vehicles. Driving while uninsured is an offence (MVA, s 24(3)(a)) which carries a maximum penalty of a fine of up to $250 and/or imprisonment of up to three months (MVA, s 24(5)(a)). Driving an uninsured vehicle is also an offence (MVA, s 24(3)(b)) which carries a fine of at least $300 and no more than $2,000 and/or imprisonment for at least seven days and no more than six months (MVA, s 24(5)(b)).

The following is included as part of Basic Coverage. Note that this is meant to be a high-level explanation, and insured individuals should refer to their policy for more detail and up-to-date information.

A. Enhanced Accident Benefits: Overview

Enhanced Accident Benefits are provided as part of basic coverage, and are outlined under Part 10 of the Insurance (Vehicle) Act [IVA]. These benefits apply to accidents on or after May 1, 2021, “in which there is bodily injury caused by a vehicle” (IVA ss 113 and 114(1)). These benefits are awarded on a no-fault basis, which means that they are paid directly by the insurer to the insured, irrespective of the fault of the insured (IVA, s 117). This also means that, under the new system, there is no longer a right of action (an ability to bring a lawsuit for damages against the other party) for injury arising from a vehicle accident (IVA, s 115). There are a few limited exceptions to this bar on actions for injury from a vehicle accident, which are outlined in Section VII: When You Can Still Sue.

1. Entitlement to Enhanced Benefits for BC Residents versus Non-Residents:

BC residents are covered by Enhanced Accident Benefits for accidents in BC, and for accidents in other jurisdictions in Canada and the United States.

For non-residents involved in an accident within BC, or one outside of BC but involving a BC-registered vehicle, particular considerations may apply to determine eligibility. See s 119 of the IVA for more detail on entitlement to benefits in these circumstances.

2. Claim deadlines and Requirement to report promptly:

As a general rule, the insured has two years from the date of the accident within which to make a claim for Enhanced Accident Benefits (Enhanced Accident Benefits Regulation, BC Reg 59/2021, s 55(1), [EABR]). However, there are certain circumstances in which the deadline for making a claim may be measured differently. S 55 (1) of the Enhanced Accident Benefits Regulation sets out claim deadlines in specified circumstances. Please do not rely on this manual chapter as an authority for claim deadlines, and be sure to consult the regulation closely or speak with ICBC directly to confirm your deadline by which to make a claim, as it may change or may be case-specific.

Note that in order to access Enhanced Accident Benefits, the insured also has a duty to, “promptly notify the corporation of the accident” when an accident occurs (EABR, s 56(1)). If an insured fails to do so, “without reasonable excuse and to the prejudice of the corporation”, then benefits may be refused (EABR, s 56(2)). For this reason, it is important to not delay in reporting an accident to ICBC, as this may affect your ability to make a claim later.

Note that there may be other deadlines related to your Enhanced Accident Benefit claim not noted here.

3. Other Sources of Compensation:

When awarding Enhanced Accident Benefits, ICBC will not pay a benefit that is available from another source as, “compensation for the same accident” (IVA, s 122(2)), although they may pay the difference between the Enhanced Accident Benefit and the other source. Other sources listed include those such as workers compensation, the Canada or Quebec Pension Plans, an employment or union plan, or other insurance (IVR, s 18(2)). Note that the above still applies even if the insured makes the choice not to access these other sources that are available to them.

4. Summary of Enhanced Accident Benefit Types:

The following is a basic explanation of some of the Enhanced Accident Benefits included. Insured individuals should refer to their policy for more details, and up-to-date information.

a) Healthcare and Rehabilitation

These benefits cover healthcare and rehabilitation for those injured in a vehicle accident. These are available on a no-fault basis, and are typically paid directly by ICBC to your medical provider (though this is not always the case).

An insured party is entitled to the following treatments if needed to treat the injury in the 12 weeks after their accident: acupuncture, chiropractic, kinesiology, massage therapy, physiotherapy, counselling, and psychology. Note that there are certain prescribed fee and appointment quantity caps for each of these treatments, which vary depending on the treatment type (see Enhanced Accident Benefits Regulation, s 19, Table 1). Once the 12-week post-accident period and/or the number of pre-authorized appointments have elapsed, the insured must show that additional treatment is needed either, “to facilitate the insured’s recovery from the insured’s bodily injury” (EABR, s 19(a)), or to, “address a decline in the insured’s physical or mental function because of the insured’s bodily injury” (EABR, s 19(b)).

Various prosthetics, other medical equipment and certain prescription and non-prescription medications are also covered by this benefit (EABR, ss 21(1) and (4), and s 23), as are, “ambulance services from the scene of the accident” in certain prescribed circumstances (EABR, s 20).

Rehabilitation benefits are also available, “to contribute to the rehabilitation of an insured and to facilitate the insured's recovery from the insured's bodily injury” (IVA, s 124), which may include modifications to the insured’s home or vehicle (EABR, ss 24 and 25). In certain specified circumstances, compensation is also available to assist with the insured’s, “activities of daily living” (IVA, s 125(1)) which they could otherwise carry out before the accident. The amount of this benefit varies depending on the type of activity and the degree of assistance that the insured needs (see EABR, ss 27-31 for detailed calculations).

Certain transportation, lodging and meal expenses are also covered if required for the insured to receive care. Note that there are relatively strict requirements for reimbursement or coverage of such expenses, which can be reviewed in detail under EABR ss 32-34.

Finally, in certain instances, reimbursement is also available to cover certain travel, lodging and meal expenses for an individual to travel to assist the insured. This applies in cases where an insured is under 16 years old, is in intensive care, requires “major healthcare” (defined in section 1 of the Health Care (Consent) and Care Facility (Admission) Act), has a “life threatening” bodily injury, or when their life is in, “imminent danger” (EABR, s 35(2). The travel must be either:

(a) to authorize treatment for the insured,

(b) to assist the insured to make a decision respecting major health care,

(c) to assist in the treatment of the insured’s bodily injury, or

(d) to assist the insured on other medical or compassionate grounds. (EABR, s 35(3))

Note that there is a cap on the amount that ICBC will cover, and that they will only cover these expenses for up to two individuals (IVA s 125(6) and EABR s 35(4)).

For all of the above benefits, make sure to consult your policy closely to see which benefits require pre-approval from ICBC, and which do not.

b) Caregiver Benefit

The IVA allows for benefits to be paid to an insured who is injured in an accident and, “whose main occupation at the time of the accident is taking care of, without remuneration, one or more persons who are under 16 years of age or who are regularly unable for any reason to hold any employment” and who is, “unable to continue providing that care because of the insured's bodily injury”. This benefit is not payable to an insured who is, “a full-time earner, temporary earner, student or minor”, as these classes of insured persons have access to other benefits (IVA, s 152 (1)).

Once 180 days have passed following the accident, the insured individual receiving the caregiver benefit may choose to transition to the income replacement benefit. They may also choose to continue receiving the caregiver benefit (IVA s 152(4)). ICBC has a legal duty to give the insured information to help them make this choice (IVA s 152(5)).

c) Income Replacement Benefit

Income replacement benefits are available to full-time, part-time and temporary earners in certain prescribed circumstances, as well as to certain non-earners (IVA, ss 131-134). The entitlement amount is, “90% of the insured’s net income” (Income Replacement and Retirement Benefits and Benefits for Students and Minors Regulation, BC Reg 60/2021, s 2(1) [IRR]), as calculated by certain formulas specified in the regulation. This amount of net income that can be used for calculation is up to a maximum of $100,000, effective until March 31, 2022. This cap will change on a yearly basis beginning on April 1, 2022 (IRR, ss 2(2) and (3)).

As set out in the Income Replacement and Retirement Benefits and Benefits for Students and Minors Regulation, s 1(1), full-time, part-time and temporary earners are defined as follows:

“full-time basis”, in respect of employment, means

(a) an insured is employed at one employment for not less than 28 hours, not including overtime hours, in each week of the year preceding the date of the accident, or

(b) an insured is employed at one employment

(i) for not less than 28 hours per week, not including overtime hours, and (ii) for not less than 2 years with periods of work not less than 8 months in duration and with gaps between periods of work not more than 4 months;

“part-time basis”, in respect of employment, means an insured is employed for less than 28 hours per week, not including overtime hours;

“temporary basis”, in respect of an insured who is a temporary earner, means the insured is employed but not on a part-time basis or full-time basis.

For part-time, temporary, and non-earners, after the first 180 days of benefits ICBC will initiate a process called determining employment (see IRR, s 13). This involves considering factors like, “education, training, work experience and physical and intellectual abilities of the insured immediately before the accident”, as well as factors like work experience and wages over the five years prior to the crash. If the insured part-time, temporary or non-earner is unable to do the determined employment as a result of the accident, then they continue to receive their benefit, and cannot receive a lower benefit amount than received prior to the determination of employment. For those able to hold their determined employment, the income replacement benefit ends (IRR, s 11(1)(b)).

Two years following the accident, if the insured is still unable to hold their pre-accident job but is able to work, ICBC will determine employment for the insured (IRR, s 14(1)). This process applies to full-time workers, as well as part-time, temporary and non-earners who have previously had their employment determined under the process above. Once employment is determined under this process, the insured has a year to search for such employment. Following the end of that year, if the insured is able to find work, and that work has a, “gross yearly employment income” lower than that used to calculate their prior income benefit, then ICBC will begin to pay the insured, “the lesser of the following”:

(a) the difference between the income replacement benefit the insured was receiving before the employment was determined…and the net income from the determined employment as calculated under this regulation;

(b) the difference between the income replacement benefit the insured was receiving before the employment was determined…and the net income the insured earns from employment.”

(IRR, s 10(1))

Some other circumstances in which income replacement benefits may end include when:

• “the insured is able to hold the employment that the insured held at the time of the accident” (IVA, s 146(1)(a))
• “the insured holds other employment from which the insured earns a gross income that is equal to or greater than the gross income that the insured earned from employment held at the time of the accident” (IVA, s 146(1)(b))

An insured who recovers from their injury and then suffers a relapse may also be entitled to re-instatement of their income replacement benefit. The calculation for this benefit varies depending on whether it has been less than two years or more than two years since the end of the prior benefit period (or since the accident if no prior income replacement benefits were received) (IRR, s 9).

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