ICBC was recently taken to task on one of its more commonly cited accident benefit policies, which is: “ICBC is not required to pay for massage therapy.” Not true, said the BC Court of Appeal on November 29, 2011 in a case called Raguin v. Insurance Corporation of British Columbia. In this case, two children ages 11 and 12 years old were injured in a car accident. Their doctor recommended massage therapy and they attended. Despite their doctor’s recommendation, ICBC refused to pay the accounts for massage therapy totalling $742.
In refusing to pay, ICBC took the position that it does not have to pay for massage therapy because it is not a mandatory benefit. Mandatory benefits include all reasonable expenses incurred by an insured for necessary medical, surgical, dental, hospital, ambulance, professional nursing services, physical therapy, chiropractic treatment, occupational therapy, speech therapy, prosthesis (artificial body part) or orthosis (medical brace or appliance) required as a result of injury. Discretionary benefits include any other benefit that ICBC agrees to pay that is likely to promote rehabilitation.
Through their litigation guardian, the children sued ICBC for reimbursement and won. In the trial judge’s reasons he said: “The doctor 'recommended' massage therapy, which in my view is sufficient to trigger an obligation to pay.” ICBC appealed and the Court of Appeal dismissed the Appeal stating that massage therapy falls under the definition of “physical therapy” and is therefore a mandatory benefit.
As a result of this decision, ICBC is now required to pay for reasonable expenses for massage therapy that is considered necessary treatment. You are not limited to a maximum of 12 visits, nor will those visits have to occur within the first 8 weeks from the date of the accident, as is currently stated in the ICBC Payment Guide.
While the amount of money involved in this case may have been small, the principal was not. It helps clarify what treatments ICBC is obliged to pay for under the accident benefits regulations (also known as Part 7 Benefits) and it is also a good reminder that ICBC Policy does not equal the law. If you have been told by an adjuster that a benefit you are seeking is not covered, consider seeking legal advice as the information you are receiving may not be accurate.
*Important Note: The information contained in this column should not be treated by readers as legal advice and should not be relied on without detailed legal counsel being sought.