By Patrick McMurchy
No fault insurance benefits are also called Part VII benefits because the coverage was first described in Part VII of the original Act. The benefits are provided under a contract of insurance between ICBC and an “insured”.
“Insured” are owners of a vehicle licensed in BC, members of a vehicle owner’s household, occupants of a vehicle licensed in BC or a vehicle driven by someone with a BC driver’s license, and cyclists and pedestrians involved in an accident with a vehicle owned in BC.
To receive Part VII benefits the insured must “promptly” report the accident to ICBC, usually through ICBC’s dial a claim service. Second, the insured must also provide a written report of the accident to ICBC, not later than 30 days from the date of the accident. Finally, the claimant must provide a “proof of claim” form to ICBC within 90 days of the accident date.
Part VII benefits cover payment for medical treatment, wage loss, and in some cases, the provision of housekeeper services. The benefits are limited in a number of ways. Where there are other insurance available Part VII benefits may be secondary insurance, meaning that the other coverage must be used first. Other insurance includes E.I. disability benefits and MSP coverage for “free” treatments. Also, the benefits are limited to what ICBC will pay according to its’ schedule. Patient “user fees” are not covered as Part VII benefits.
To be eligible for Part VII, there should be some evidence that the treatment or the time off work is required and related to car accident injuries. Usually, this is met by providing a form completed by a doctor or healthcare professional.
In cases where treatments or time off continues for an extended period, ICBC may require the claimant to attend a medical examination by a doctor of ICBC’s choosing.
Part VII benefits are supposed to be paid while the costs are being incurred, but coverage may be denied. Denial is made on the basis of the insurer’s policies, and the decision may not always correspond with the advice of your healthcare professionals.
Court actions are sometimes necessary to get an order confirming entitlement to the benefits when the benefits have been refused. Where benefits are refused without reason, an insured may also have a claim against ICBC for acting in bad faith.
This article is for general information only, and should not be relied on as legal advice in any particular case. Consult a lawyer for advice on your case.