Medical reports and medical examinations under Part 7

There are various sections of the Insurance (Vehicle) Regulation which give ICBC the power to require the claimant to provide documentation in support of disability or the need for treatment, or to submit to a medical examination by a medical practitioner appointed by ICBC. These provisions are designed to allow ICBC to distinguish claimants who are truly entitled to benefits from those who are not.

 

ICBC may require medical report from the claimant’s health care professional

Under s. 98 of the Insurance (Vehicle) Regulation ICBC has a right to require a claimant to provide a medical certificate or report as to the nature of the claimant’s injury, treatment plan, current condition and prognosis for recovery. The purpose of such reports is to allow ICBC to assess the validity of the claimant’s claim for Part 7 benefits.

 

Depending on the nature of the injury the report may be from a medical practitioner, dentist, physiotherapist or chiropractor.

 

Section 98(2) of the Insurance (Vehicle) Regulation provides that failure to provide a medical report may result in a refusal of Part 7 benefits by ICBC.

 

ICBC may require the claimant to attend an examination by a health care professional appointed by ICBC

Section 99 of the Insurance (Vehicle) Regulation provides that ICBC may require a claimant to submit to a medical examination by a health care professional selected by ICBC. Repeated examinations can be requested and failure by the claimant to attend may result in termination of benefits:

 

(1) An insured who makes a claim under this Part shall allow a medical practitioner, dentist, physiotherapist or chiropractor selected by the corporation, at the expense of the corporation, to examine the insured as often as it requires.

(2) The corporation is not liable to an insured who, to the prejudice of the corporation, fails to comply with this section.

(Insurance (Vehicle) Regulation, s. 99).

 

Although s. 99(1) of the Insurance (Vehicle) Regulation states that ICBC may require the claimant to submit to medical examinations “as often as it requires” counts have held that ICBC cannot unreasonably demand too many medical examinations:

 

The Regulations are clear that ICBC was entitled to require Mr. Smith to submit to an independent medical examination. No doubt, the Court could find otherwise should ICBC abuse the right it has under Regulation 99 by demanding too many independent medical examinations. In this case, however, ICBC had not had an independent medical examination for over a year and it cannot be said that ICBC acted unreasonably in requesting a new examination.

(Smith v. Insurance Corp. of British Columbia, 1992 CanLII 914 at para. 14 (BCCA)).

 

The fact that the claimant has submitted to a Part 7 medical examination does not mean that ICBC will not be entitled to a medical examination for the purposes of the tort claim, although it may be a factor for consideration when exercising discretion with respect to further examinations: Vorasarn v. Manning, 1997 CanLII 2351 (BCCA). In Roberge v. The Canada Life Assurance Co., 2002 BCSC 783 it was held that it would be unduly restrictive to automatically disallow defendants the right to further medical examinations on the grounds that they had been granted pre-litigation examinations.

 

 

 

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