ICBC Enhanced Care System (Current Model) (12:III): Difference between revisions

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 [[When You Can Still Sue (12:VII)|Section VII: When You Can Still Sue]].

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

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.

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.

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:

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

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)).  

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, in which the amount is obtained by multiplying $100,000 by the ratio between (a) the sum of the industrial average wage for each of the 12 months before October 1 of the year preceding the year for which the amount of the maximum yearly insurable earnings is calculated, and (b) the same sum for each of the 12 months before October 1, 2020 (''IRR'', ss 2(2) and (3)).

''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”: