You’ve been in an accident and may be at fault. Unfortunately, you’ve sustained injuries, need treatment, and cannot return to work. Are there any benefits through ICBC that you can receive for your own care?
Part 7 of the Insurance (Vehicle) Regulation provides for benefits for insureds that sustain injury and loss as a result of a motor vehicle accident regardless of who is at fault. These benefits are also known as “accident benefits” or “no fault benefits”. However, just because you were involved in an accident, and even may have caused the accident, does not automatically entitle you to any or all of the available benefits.
AM I ENTITLED TO THESE BENEFITS?
To become entitled to these benefits, you must first meet the definition of insured. Insured means:
- (1) a person named as an owner in an owner’s certificate,
- (2) a member of the household of a person named in an owner’s certificate,
- (3) an insured as defined in section 42 who is not in default of premium payable under section 45,
- (4) a member of the household of an insured as defined in section 42 who is not in default of premium payable under section 45,
- (5) an occupant of a vehicle that
- is licensed in the Province and is not exempted under section 43 or 44 of the Act, or
- is not required to be licensed in the Province, but is operated by a person named in a driver’s certificate,
- (6) cyclist or pedestrian who collides with a vehicle described in an owner’s certificate, or
- (7) resident of the Province who is entitled to bring an action for injury or death under section 20 or 24 of the Act,
- and includes the personal representative of a deceased insured;
For example, you and your spouse are involved in an accident. You are named as the owner in an owner’s certificate for the vehicle. Your spouse is not, but is a member of your household. Both you and your spouse would meet the definition of insured. Further, your spouse would also meet the definition as an occupant of a licenced vehicle. Both you and your spouse, on the basis of definition alone, would be entitled to Part 7 benefits.
A further requirement is that the accident must have occurred in Canada or the United States or on a vessel traveling between Canada and the United States. So the couple in the above scenario would be entitled to Part 7 benefits if the accident occurred in Kamloops, BC, or alternatively, if the accident occurred in Seattle, WA.
While you may meet the initial requirements for Part 7 benefits, you may be disentitled if you are in breach of s. 55(3) of the Regulation, which includes: operating a vehicle while not authorized or qualified; for an illicit or prohibited trade or transportation; to escape or avoid arrest; or in a race or speed test. For example, driving a vehicle without a valid driver’s licence may mean that you are not entitled to Part 7 benefits.
WHAT ARE THE BENEFITS?
There are various benefits that you may have access to if you meet the requirements under Part 7. These include medical and rehabilitative benefits, disability benefits, homemaker benefits, and death benefits.
- Medical and Rehabilitative Benefits
- Mandatory benefits
- Permissive benefits
- funds to purchase one motor vehicle equipped as necessary and appropriate for use and operation by the insured; and
- funds to alter the insured’s residence to make it accessible, including necessary ramps, lifts, and/or bathroom alterations
- Disability Benefits
- Employed or actively engaged in an occupation for wages or profit;
- Employed or actively engaged in an occupation for wages or profit for any six months during the last 12-month period immediately preceding the date of the accident.
- Homemaker benefits
- Death benefits
These benefits are divided into two groups: mandatory and permissive. Mandatory benefits are those that ICBC must pay an insured. Permissive benefits are benefits that ICBC has the discretion to pay an insured.
Mandatory benefits include the cost for all reasonable expenses for necessary medical, surgical, dental, hospital, ambulance, professional, nursing services, physical therapy, chiropractic treatment, occupational therapy, speech therapy, or for prosthesis or orthosis. However, the total cost of mandatory benefits may not be compensated to the insured and the insured may be responsible for paying “user fees” associated with that treatment.
Travel expenses are also a benefit that an insured can be compensated for. It is therefore also important to keep track of mileage when driving to your treatment appointments if you wish to receive payment for your driving costs.
Permissive benefits can include treatment costs that, in the opinion of an ICBC medical advisor, would promote the rehabilitation of the insured. These benefits can include the costs of attendant care where the insured cannot live independently, a wheelchair, medically prescribed bowel and bladder equipment, a prescribed bed, and transfer equipment.
Some permissive benefits are restricted to only once during the lifetime of the insured. These include:
In order to obtain disability benefits as an employed person, the insured must, on the date of the accident, be:
Payment of disability benefits is made if, within 20 days after the accident, an injury has prevented an employed person from engaging in employment for which he or she was reasonably suited. ICBC will pay the insured the lesser of $300 per week or 75% of the insured’s average gross weekly earnings. This payment will be made for the duration of the insured’s disability up to 104 weeks (two years). Proof of disability and actual loss is required to receive these benefits. However, disability payments are not payable if the disability is for less than seven days.
If an insured does return to work but, because of his or her injuries, cannot earn the same amount of income as he or she did prior to the accident, ICBC will pay the difference.
ICBC can also pay benefits to homemakers who, because of injuries from an accident, can no longer complete the housekeeping tasks for the household. A “homemaker” is defined as a male or female member of the household who, without payment, does the majority of the housekeeping for the household. Alike to disability payments, if within 20 days after an accident, an injury disables a homemaker from performing his or her household tasks, ICBC will pay the homemaker for reasonable expenses incurred to hire someone to perform the chores up to a maximum of $145 per week.
Homemaker benefits are only payable if the insured actually hires someone to complete the household chores. Having a family member complete the chores for the insured does not entitle the insured to homemaker benefits. Alike to disability benefits, the homemaker must show that he or she is disabled for more than seven days.
In the unfortunate circumstance that the death of an insured is caused by an accident, ICBC will reimburse the costs for the burial and funeral expenses up to $2,500 per insured.
If the deceased insured is survived by a spouse or a dependent child, ICBC will pay lump sum benefits to the first survivor. This is usually the spouse, or if no spouse, the eldest dependent. Likewise, if the deceased insured is a dependent child who is survived by his or her parent, lump sum benefit payments will be paid to the parent. These payments are determined by the age and status of the deceased and range between $500 to $5,000.
However, if the deceased is survived by a spouse and dependent children, ICBC will pay an additional $1,000 to each survivor, other than the first survivor (in this case, the spouse). ICBC also pays weekly benefits to survivors, including $145 to the first survivor and $35 per week to each other survivor for 104 weeks.
In order to receive these death benefits, the survivor must have survived the deceased insured by at least 60 days.
WHAT SHOULD YOU DO TO CLAIM PART 7 BENEFITS?
Now that you know what Part 7 benefits are and that you may be entitled to them, how can you claim them? An insured can claim Part 7 benefits by doing the following:
- promptly giving ICBC notice of the accident;
- giving a written report of the accident to ICBC not later than 30 days from the date of the accident; and
- providing ICBC with proof of claim on the appropriate form (CL-22) within 90 days from the date of the accident.
It is important that you complete the above tasks as your failure to do so may affect your ability to recover any benefits from ICBC. If you are denied benefits, you may have a claim to be made against ICBC for declaration of your entitlement to benefits and payment of those benefits.
If you have been in a car accident and feel that you are entitled to compensation, including Part 7 benefits, you may have a legal problem we can help you with. Please contact us at (250) 374-4463 for more information on how we can assist you with your claim.