The no-fault system comes into effect on April 1, 2019. It will govern all new motor vehicle claims and expand the coverage for medical benefits to existing claims. The major stages of typical new “minor injury” claims are outlined below. There will undoubtedly be variations in this procedure based on the type of injury, changes in the injured claimant’s state, etc. but the basic structure contemplated by the legislation is set out below.
Treatment procedures – as with the old system, an injured person is required to give ICBC notice of their claim at which point they are automatically entitled to a set number of treatments.
The legislation prohibits a healthcare provider from charging a higher fee than what is set out in the Regulation. If the person requires more treatment after the initial sessions are used up, they must produce a certificate from their treating family doctor setting this out. At any time, ICBC can request a report, which the healthcare provider must produce as soon as possible. If the injured person is not recovering as expected in 90 days, their physician must consider referring him/her to a registered care advisor (RCA), a physician who has registered with the government. The RCA is required to see the patient in 15 days and prepare a full report outlining diagnoses and prognoses.
Under the tort system, if ICBC stopped paying for rehab treatment, an innocent injured accident victim could bring a tort action to recover the shortfall as well as future care costs that he/she may need in the future. The no-fault legislation changes this by (a) restricting the right to sue, (b) restricting the cost of health costs to the then current rate, (c) in non-minor injuries where there is a right to sue, requiring the court to deduct future benefits that are “payable” even if they are unlikely to be paid in the future, and (d) preventing extended health insurers from clawing back what they paid to the person.
Claim procedure – all those people who have suffered a “minor” injury (see earlier newsletter) are required to seek compensation through the Civil Review Tribunal (CRT). The CRT procedure has two stages: a case management stage and a hearing stage. In the case management stage, people are expected to gather documentation of their injuries and resolve their claims. Settlement discussions can be conducted in person, in writing, by phone, using videoconferencing or email. If the claim cannot be resolved in this manner, a CRT case manager can allow the matter to go to a hearing, which can also be conducted in writing, by phone, videoconferencing or email. A tribunal is required to make a decision promptly. The maximum amount the tribunal is allowed to pay is $50,000. The legislation does not give the injured person a right to appeal a tribunal’s decision. It can only be reviewed by courts on extremely narrow grounds.
Issues to consider –the expediency of resolving simple claims is offset against the concern of overlooking more serious claims. What is troubling about this no-fault system is the broad definition of “minor injury”, which is quite likely to result in more complicated injuries being closed down prematurely and without adequate support to the claimant. The legislation appears to make no provision for re-opening a claim once it has been closed. Injured people are often at a disadvantage because of their injuries. If English is their second language, or if they fail to adequately communicate what they are experiencing (i.e. if an injury is not adequately recognized) or if losses increase (i.e. the person cannot continue to work) after the person has settled their claim, it will be important to explore what, if anything, can be done to address these ongoing concerns.