Disputing an ICBC Decision on Your Injury Claim

Under Enhanced Care, most people injured in a BC crash claim benefits from ICBC instead of suing. That makes ICBC's decisions about treatment, income replacement and other benefits central to your recovery.

If you think ICBC got a decision wrong, there is a set path for disputing it. This guide walks through the steps, the role of the Civil Resolution Tribunal, the time limits and the evidence that matters.

Which ICBC decisions you can dispute

For crashes on or after 1 May 2021, Enhanced Care pays benefits such as treatment costs, income replacement and permanent impairment compensation, and it bars most injury lawsuits. Our article on whether you can still sue under Enhanced Care covers the narrow exceptions. For everyone else, the dispute is usually about benefits.

The Insurance (Vehicle) Act says a claimant may dispute a determination or decision ICBC makes about these benefits. Common examples are a refused treatment or equipment request, income replacement that is reduced or stopped, and a finding that your injury is a "minor injury". The Act lets ICBC reduce, suspend, cancel or refuse benefits in listed situations, for example where someone knowingly gives false or inaccurate information or does not comply with a requirement ICBC is entitled to make.

ICBC also has a legal duty to advise and assist you in making a benefits claim and to try to make sure you know about, and receive, the benefits you are entitled to. It is reasonable to ask ICBC to explain what you may be missing.

Step 1: understand the decision

Before you argue with a decision, find out exactly what it is and why it was made. Ask for it in writing, along with the reasons and the reports or records it relied on. Many refusals come down to whether the medical records show that you need the treatment, service or item, so a gap in those records is often the real problem.

Step 2: ICBC's internal escalation

ICBC's injury benefit disputes page sets out these steps:

• The person handling your claim. Start with the ICBC staff member managing your file, who can explain the decision and the factors considered.
• The claims manager. If you still have concerns, ask to speak with the manager overseeing your claim (ICBC lists 1-800-910-4222).
• The Fair Practices Office. If the manager's response does not resolve things, this office can look into a decision or process you believe was unfair, explain decisions and suggest ways to resolve the dispute. ICBC asks you to speak with a claims manager first.
• The Civil Resolution Tribunal. If you are still not satisfied, you can file a dispute with the tribunal, which is independent of ICBC.

Keep notes of every call and copies of every letter. Internal steps can resolve a dispute quickly, but they do not stop the clock on your legal deadline.

Step 3: the Civil Resolution Tribunal

The Civil Resolution Tribunal Act gives the tribunal exclusive jurisdiction over disputes about an insurer's decision on entitlement to benefits under the Insurance (Vehicle) Act, and about whether an injury is a minor injury. For those disputes the tribunal, not a court, is the place to go. The tribunal's accident claims jurisdiction does not cover accidents before 1 April 2019.

The tribunal says applications can take several months to reach the Dispute Notice stage because of high volumes, although claims about accident benefits may be prioritized. Its process is mainly online and in writing, so the documents you file carry a lot of weight. Our overview of where a BC dispute belongs explains how the tribunal fits with the courts.

Deadlines that apply

ICBC warns that time limits apply to disputes, and specific limitation periods apply to benefits claims. Section 17 of the Insurance (Vehicle) Act says an action or proceeding against ICBC about benefits under its compulsory insurance must be started within one year after the loss or damage happened or the cause of action arose, or within a different period the regulations set for that coverage. The Civil Resolution Tribunal Act applies the Limitation Act to tribunal claims, but that Act's general two-year period does not apply where another enactment sets its own limitation period. Accident benefits claims under the regime that applied before Enhanced Care follow separate rules in the regulations.

The deadline that applies depends on the insurance regime and the circumstances of your claim, so do not assume you have two years from ICBC's decision. Get advice promptly, and do not assume that ICBC's internal review or a complaint to the Fair Practices Office extends the deadline for filing with the tribunal.

After the tribunal decides

A tribunal decision can be challenged only by judicial review in the BC Supreme Court, which must be started within 60 days of the date the decision is given (the court can extend this in limited circumstances). For benefits disputes, the Act tells the court to defer to the tribunal: its findings of fact or law and its exercise of discretion can be set aside only if they are patently unreasonable, and questions of procedural fairness are decided on whether the tribunal acted fairly. In practice, the tribunal hearing is usually the main chance to make your case, so it pays to prepare it well.

Building the evidence

Strong benefits disputes are usually won on documents. Useful steps include:

• asking your treating doctor or other practitioners for reports that address the specific benefit ICBC refused, not just your diagnosis;
• gathering employment and income records if income replacement is in issue;
• keeping a simple log of symptoms, appointments and what you can and cannot do;
• continuing to attend treatment and answering ICBC requests, so non-compliance cannot be used against you;
• keeping every ICBC letter, email and decision in one place.

Think ICBC got your benefits decision wrong?

Our litigation lawyers can review ICBC's decision and your file, prepare and present a Civil Resolution Tribunal claim with the evidence it needs, and advise on judicial review of a tribunal decision.

Call 604-259-2844 or send us a message to arrange a consultation at our Vancouver office.