CRT Dismisses Applicant Request for ICBC To Pay Lump Sum Part 7 Benefits

Reasons for judgement were published earlier this month dismissing an applicants claim at the BC Civil Resolution Tribunal asking for ICBC to pay physiotherapy treatment expenses as a lump sum.

In the recent case (Smith v. ICBC) the self represented applicant was injured in a October, 2019 collision.  He required physiotherapy which ICBC paid for directly to the service provider.  The Applicant asked the CRT to award him $12,000 as a lump sum for treatment expenses.  The claim was dismissed with the CRT noting that while ICBC can pay a lump sum for treatment expenses doing so is entirely discretionary and continued payment of necessary treatments as they are incurred is acceptable.  In dismissing the claim Tribunal Member Kristen Gardner provided the following reasons:

13.   Section 88(1)(a) of the IVR says that if an insured is injured in an accident for which Part 7 benefits are payable, ICBC must pay as benefits all reasonable expenses incurred by the insured as a result of the injury for necessary health care services. These health care services include, among other things, acupuncture, chiropractic, counselling, kinesiology, massage therapy, physiotherapy, and psychology.

14.   Section 88(1.01) of the IVR says that treatment provided more than 12 weeks after the accident date is not a “necessary health care service” unless the insured’s doctor certifies in writing that the treatment is necessary.

15.   ICBC does not dispute that Mr. Smith is entitled to Part 7 benefits. It says that it received Mr. Smith’s physiotherapy referral and, as of October 8, 2020, it has funded 16 physiotherapy treatments and 8 visits with his family doctor under Part 7 benefits. ICBC says Mr. Smith has not provided it with any other receipts or evidence of expenses incurred that Mr. Smith claims should be covered as Part 7 benefits.

16.   I understand that ICBC has been funding Mr. Smith’s physiotherapy treatment directly through the provider. There is no evidence before me that that Mr. Smith’s health care practitioners have recommended additional physiotherapy or any other Part 7 benefits, which ICBC has refused to fund, that would require me to decide Mr. Smith’s benefit entitlement.

17.   While section 102 of the IVR provides that ICBC may make a lump sum payment of benefits, I find whether to do so is within ICBC’s discretion. Here, ICBC argues that it is paying Mr. Smith’s Part 7 benefits as they are incurred and there is no need for a lump sum payment. I agree. Mr. Smith has not made any submissions about why a lump sum payout is necessary, reasonable, or otherwise to his benefit. He has also not proven that he is entitled to more health care benefits at this time. Therefore, I dismiss Mr. Smith’s claim for a payout of Part 7 benefits.

18.   To be clear, Mr. Smith’s entitlement to Part 7 medical benefits remains ongoing, subject to the conditions set out in the IVR. I make no findings in this decision about Mr. Smith’s future entitlement to Part 7 benefits. Should ICBC deny Part 7 benefit coverage to Mr. Smith in the future, he may bring a new CRT dispute to determine his entitlement to any future benefit.

bc injury law, Civil Resolution Tribunal, CRT, lump sum part 7 payment, section 88 insurance (Vehicle) Regulation, Smith v. ICBC, Tribunal Member Kristin Gardner

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ERIK
MAGRAKEN

Personal Injury Lawyer

When not writing the BC Injury Law Blog, Erik is the managing partner at MacIsaac & Company, based in Victoria, B.C. He is also involved with combative sports regulatory issues and authors the Combat Sports Law Blog.

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