What are ICBC “no fault” benefits?


A. Entitlement

If you’ve been involved in a motor vehicle accident, you may be entitled to “No Fault” benefits, even if you are entirely at fault for your accident. These benefits fall under Part 7 of the Insurance (Vehicle) Act Regulations, and are also referred to as “Part 7 Benefits.” They include medical and rehabilitation expenses, disability benefits if you are totally disabled from your employment or homemaking, and death benefits.

Part 7 Benefits are available to anyone injured in a motor vehicle accident in British Columbia, or to a British Columbia resident injured in a motor vehicle accident anywhere else in Canada or the USA, whether or not ICBC is the responsible insurer. Benefits are also available to surviving family members of a person killed in those same circumstances. Out-of-province insurers are required by law in British Columbia to provide no-fault coverage at the same levels as ICBC would be responsible to provide, when an out-of-province vehicle is at fault for an accident that occurs in British Columbia.

If you meet the definition of “insured” as set out in Part 7 of the Regulations, then you can apply for no fault benefits if you’ve been injured in a motor vehicle accident. An “insured” includes:

  • An owner of a vehicle insured with ICBC;
  • A member of the vehicle owner’s household;
  • An occupant of a vehicle licensed in BC, or an occupant of a vehicle not required to be licensed in BC but driven by a person with a BC driver’s license;
  • A cyclist or pedestrian who collides with a vehicle described in an owner’s certificate;
  • A resident of BC who is entitled to bring an action for injury or death under the Insurance (Vehicle) Act for either hit and run collision or pursuant to the uninsured motorist provisions;
  • The personal representative of a deceased insured; or
  • A resident of BC who holds a valid driver’s certificate and members of his or her household.

B. Applying for Part 7 Benefits

To claim Part 7 Benefits, you must promptly notify ICBC of your accident. You can do this online through ICBC’s website, or you can call ICBC’s Dial-a-Claim line (604-520-8222 in the Lower Mainland and 1-800-910-4222 in the rest of British Columbia). Be sure that the information you give ICBC is completely accurate, because ICBC will keep a record of any statement or information you provide, and any inaccurate or irrelevant information could potentially be used against you.

Within 30 days of your accident, you must provide ICBC with a written report including the details of the accident and any injuries or losses you suffered as a result of the accident. You can meet this requirement by providing a brief written or typed statement to ICBC. It does not have to be signed. ICBC may ask you to provide a detailed verbal account of the accident, which will then be transcribed and presented to you for your signature. Some of the information ICBC may want to include in your statement may relate to the circumstances of your accident, your employment, your injuries, and any previous accidents, injuries or health problems you may have had. You do not have to provide a signed statement. A signed statement is more likely to be used by ICBC to defend your personal injury claim that to determine your entitlement to Part 7 Benefits. Before you sign any statement prepared in this way, you should read it through carefully to ensure it is completely accurate. If necessary, take it home and review it, or consult a lawyer for guidance.

Within 90 days of your accident, you must provide ICBC with a Proof of Claim on a form that must be provided to you by your ICBC adjuster. You are required to provide information about yourself, your employment and your injuries. Ensure that the information you provide is complete and accurate.

When you meet with your ICBC adjuster, he or she will likely ask you to sign authorizations that allow ICBC to collect personal information and records from your doctors, therapists and employer. You should be aware that these authorizations are very broad and will most certainly allow ICBC to access information about you that may be very personal and unrelated to your accident and your ICBC claim, and may even assist ICBC in defending your claim. Typically, the authorizations will allow ICBC to collect information dating back several years prior to your accident. You do NOT have to sign these authorizations.

You will, however, need to support your application for Part 7 Benefits with medical documentation. You can arrange this with your doctors, or ICBC may obtain a brief medical report from your doctor specifically addressing your accident related injuries and limitations. You are entitled to a copy of this report.

If you retain a lawyer soon after your accident, your lawyer can manage the collection of information and the provision of appropriate forms, records and information to ICBC for you.

C. What benefits are available under Part 7?

a) Medical and Rehabilitation Benefits

For most motor vehicle accidents, ICBC is liable to provide up to $150,000 for “reasonable” and “necessary” medical and rehabilitation benefits. The goal of these benefits is to restore an insured, in the shortest practical time, to the highest level of gainful employment or self sufficiency that is reasonably achievable.

Some of these benefits are mandatory and some are provided at ICBC’s discretion. Typically, these benefits will cover expenses such as chiropractic treatments, massage therapy, physiotherapy, travel to and from medical appointments, the costs of medications and other rehabilitation expenses. ICBC has developed its own guidelines which are followed by its adjusters and which limit payment of some medical and therapy expenses. For example, ICBC will not pay for user fees commonly charged for some therapies, and often limits coverage for therapies to a fairly short time frame following your accident, or will limit the number of treatments covered, even if your doctor recommends ongoing therapy.

b) Disability (Wage Loss) Benefits

An insured may be entitled to up to $1,200 per month in wage loss benefits, which are known as Temporary Total Disability or “TTD” benefits under the  Regulations. To qualify for TTD benefits, a person injured in a motor vehicle accident must have been either employed at the time of the accident, or have worked at least 26 of the 52 weeks immediately prior to the accident. The amount of benefits will be the lesser of $300 per week or 75% of an insured’s average gross weekly earnings. ICBC will require confirmation of employment status and medical evidence supporting your disability in order to pay out these benefits.

There is a seven day waiting period before TTD benefits are payable, and ICBC may also take into account EI sick benefits to which you may be entitled. It is a good idea to apply for EI benefits as soon as possible after your accident to prevent any delay in receiving the TTD benefits to which you are entitled. You may still be entitled to TTD benefits even if you have other wage disability coverage.

If you cannot do your own job because of your accident injuries, you are entitled to receive TTD benefits for as long as you are disabled, or up to two years after your accident. After the two year period, you will only be entitled to continue to receive TTD benefits if you cannot do any job that you would be suited for based on your age, education and experience. At this time, ICBC will also require you to apply for CPP Disability benefits. Because it takes a long time for CPP benefit applications to be processed and a decision to be made, you should submit your application for CPP Benefits well in advance of the two year mark, or ICBC may suspend your TTD benefits pending a decision from Service Canada. If you are eligible for CPP Disability Benefits, your TTD benefits will be reduced by the amount of CPP benefits you receive. If you do qualify for TTD benefits beyond the first two years, they are only payable to age 65.

Benefits of up to $145 per week are available to homemakers whose injuries prevent them from performing most of their household tasks on a regular basis. The benefit is meant to cover the cost of hiring someone else to do your household chores during your period of disability. ICBC will require medical evidence to support a claim for homemaker disability benefits.

c) Death Benefits

Death benefits include funeral expenses up to $2,500, as well as survivor benefits payable to family members where a “head of household” or “spouse in household” is killed. These benefits are comprised of a modest lump sum payment and weekly benefit payable for 104 weeks.

D. What if ICBC refuses to pay Part 7 Benefits?

You can sue ICBC for payment of Part 7 Benefits, but you must commence your lawsuit within two years of the date of your accident, or within two years of the date of the last Part 7 payment ICBC made to you, whichever is later.

E. If you don’t apply for Part 7 Benefits.

The amount of benefits you are entitled to receive under Part 7 will be deducted from any compensation you receive in your personal injury tort claim, even if you never received any Part 7 benefits and are prevented by the passage of time from making a claim for Part 7 Benefits. This deduction can potentially lead to hundreds of thousands of dollars of lost compensation. If you are injured in a motor vehicle accident, make sure you apply for Part 7 Benefits, even if you are unsure of your entitlement. Your lawyer can assist you in your application for Part 7 Benefits and ensure you receive the benefits you are entitled to.

Maximizing the value of a Part 7 claim is a complex task, and one which requires a great deal of skill and knowledge. Jan Fishman is a Vancouver Personal Injury Lawyer with the skill and knowledge you need to maximize a Part 7 claim.

Have you been involved in a motor vehicle accident? Contact Jan Fishman and put his experience to work for you.