There are two categories of medical benefits that ICBC covers:
- necessary medical, surgical, dental, hospital, ambulance, professional nursing services, physical therapy, chiropractic treatment, occupational therapy, speech therapy, or for prosthesis or orthosis; and
- benefits that are likely to promote rehabilitation.
ICBC is required to pay for benefits in the first category, whereas they can choose whether to pay for benefits in the second category. Why would ICBC ever pay for the second category? If the rehabilitation is expected to reduce the cost of mandatory medical and income loss benefits.
The first category of benefits initially sounds impressive, but the key word is ‘necessary’. It only applies if the treatment is made necessary due to the injuries suffered in the accident. Early on, ICBC will generally defer to the opinion of your family doctor as to what is necessary. If your doctor writes a note that recommends treatment for injuries suffered in the accident, ICBC will usually accept this as sufficient evidence. However, they are not required to accept your family doctor’s opinion, and they often challenge it once the treatment gets to be expensive, often by an independent medical examination.
Independent Medical Examination
ICBC has the right to require you to attend an independent medical examination by a doctor of their choice as a condition of paying your benefits. Once you attend, the doctor will write a report and ICBC will use it to make a decision about whether the treatment is ‘necessary’.
Is Anything Else Covered?
While it is not listed, psychological counseling may be covered if it is necessary to address the injuries caused by the accident or as part of an overall treatment program. Reasonable travel expenses to attend medical treatment can be considered necessary for treatment. A private MRI may be covered where it is necessary for treatment. However, ICBC is not required to pay for daycare while the patient attends medical treatment, even if there is a doctor’s note.
ICBC often refuses to fund alternative treatments (e.g. acupuncture, herbal medicine) and experimental procedures (e.g. prolotherapy, pulsed signal therapy). To challenge ICBC’s decision, you must show that those treatments are medically necessary. However, you can still claim the cost of these treatments as part of your tort claim.
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