Source: http://vealelaw.com/category/benefits-no-fault/
Timestamp: 2019-04-26 04:29:51+00:00

Document:
In Olson v. Farran, the Plaintiff was injured in a motor vehicle accident, and subsequently advanced an ICBC claim for non-pecuniary damages, as well as various other types of damages, including special damages and the cost of future care.
At trial, the Court awarded the Plaintiff damages under numerous categories, including special damages and the cost of future care.
ICBC’S lawyer took issue with the amounts awarded under these categories, and sought a deduction pursuant to Section 83 of the Insurance (Vehicle) Act, which allows the Court to reduce the awards if a claimant has received or is entitled to receive benefits from ICBC. For example, if a claimant is awarded a sum of money for future treatment, however ICBC would pay this anyways in the future under Part 7 benefits, then this amount can be deducted from the court award. However, there is not always a guarantee that ICBC will make such payments in the future, which is an important factor for a Court to consider when hearing applications pursuant to Section 83 of the Insurance (Vehicle) Act. Certain benefits can be mandatory, however certain benefits are only discretionary. When benefits are only discretionary in nature, this means that ICBC does not have to pay such benefits in the future. This uncertainly is typically the key issue in Section 83 applications for deductions of trial awards.
In the case at bar, ICBC had actually paid out the entire amount of the judgement to counsel for the Plaintiff, who deposited the funds into a trust account. Shortly thereafter, however, ICBC’S lawyer gave notice of an intention to apply for a deduction in the awards for special damages and the cost of future care. Plaintiff’s counsel then filed and delivered an acknowledgment of payment of the judgment in full, and then paid out the judgment funds to the Plaintiff.
In addition to invoking the doctrines of mootness, estoppel, and abuse of process, counsel for the Plaintiff argued that the benefits that ICBC’S lawyer sought to deduct were discretionary, and that there was some uncertainty as to whether or not ICBC would even pay any future benefits.
The Court did not allow for any deductions from the special damages trial award on the basis of mootness, but did allow for a partial deduction from the cost of care award at trial. The Court was concerned with ICBC’S history of actually paying for the Plaintiff’s treatment, leading to serious concerns as to whether future benefits would be paid by ICBC.
In Powell v. ICBC, the Plaintiff was injured in a rear end motor vehicle accident, and subsequently commenced an ICBC claim.
After the accident, the Plaintiff was totally disabled from working for a period of time of just under one month. She then returned to work part-time for a period of time of approximately 32 months, at which point she became totally disabled again. Given this timeline, the Plaintiff was not considered to be totally disabled at the point of time of 104 weeks after the accident. The previous British Columbia Court of Appeal decision in Symons v. ICBC had ruled that temporary total disability benefits (“TTD benefits”) can be revived after the 104 week mark if the accident related injuries which were originally disabling once again triggered a total disability after the 104 week mark.
The Plaintiff applied for TTD benefits again, but ICBC denied payment, stating that she was no longer entitled to such benefits.
The Plaintiff brought an application for summary judgment for a declaration that she was entitled to TTD benefits, and for judgment in accordance with entitlement to the cumulative total of such benefits.
ICBC’S lawyer argued that the matter was not suitable for a summary judgment application because of the competing experts, then argued that if the matter is suitable for such a type of application, then the matter should be dismissed, as the evidence does not show that the Plaintiff is unemployable because of accident related injuries.
The Plaintiff relied on the Symons case, which the Court found applied directly to the facts of the case at bar.
 ……. in Symons where the issue on appeal was whether the chambers judge erred in concluding that Mrs. Symons was entitled to disability benefits under s. 86 of the Regulation. ICBC argued that an insured must have an ongoing disability and be receiving benefits at the end of the 104 week period in order to receive benefits. Because Mrs. Symons was not receiving benefits at the end of the 104 week period and because her disability did not flare up until after that period, the Regulation did not permit for the reinstatement of s. 86 benefits. The plaintiff urged a contextual and purposive approach to statutory interpretation of s. 86 that would not result in absurd results as urged by ICBC.
 The decision in Symons applies directly to the facts in this case. The plaintiff was an employed person who sustained injury in an accident which totally disabled her within 20 days after the accident. She is entitled to disability benefits for the initial period of disability. Although the plaintiff returned to part time work for a time and did not apply for TTD benefits within or at the 104 week mark, if is accepted that she is totally disabled as a result of injuries sustained in the accident, then Symons supports her position that it is not necessary that she be actually receiving benefits or that her disability had been ongoing at the 104 week mark. The issue then becomes whether the plaintiff has satisfied the onus upon her to show that she is totally disabled as a result of injuries sustained in the accident.
In Symons v. ICBC, the Plaintiff was seriously injured in a rear end motor vehicle accident, and consequently advanced an ICBC claim. The Plaintiff claimed for and was granted income loss benefits from ICBC under section 80 of the Insurance (Vehicle) Regulation. At a later point in time, she returned to work, thus disentitling her to such benefits.
More than two years after the accident, the Plaintiff’s injuries that were caused by the motor vehicle accident in question resurfaced, leaving her once again totally disabled and incapable of working. However, ICBC refused to reinstate the disability benefits.
The trial judge ruled that the Plaintiff was eligible for section 86 benefits under the Insurance (Vehicle) Regulation, and ordered ICBC to pay such benefits. ICBC’S lawyer appealed.
The position of ICBC’S lawyer on appeal was that the Plaintiff was not entitled to long term disability benefits under section 86 of the Insurance (Vehicle) Regulation, as she was not receiving benefits under section 80 on the triggering date when such benefits transition into section 86 benefits, that being 104 weeks after the accident.
The Court of Appeal dismissed the appeal, ruling that a revival of benefits can occur when the original injury later causes total disability, even if this occurs past the 104 week mark.
 ICBC argues that that was a case where the plaintiff was already entitled to s. 86 benefits when they were stopped, and then reinstated. I think this cuts too fine a line. Brewer says a person receiving s. 80 benefits can be reinstated if he later becomes disabled from the original injury and Halbauer says a person receiving s. 86 benefits is entitled to have them reinstated if he or she is subsequently disabled because of the original injury. In my view, if the sections are read, as ICBC suggests, to mean that only a person who is disabled “at” the 104-week mark can obtain benefits after that period, that interpretation does not accord with the context and object of the legislation, nor within the reasoning of Halbauer.
 Reading the words of this legislative scheme in its entire context, harmoniously with the whole of the scheme and purpose, leads to the conclusion that if a person who was disabled as a result of an accident returns to work, and then, because of setbacks or otherwise, is again totally disabled due to the accident, she qualifies for benefits under s. 86, even if she was not disabled on the “magic” day at the end of 104 weeks. This interpretation is consistent with the object of the Act—to provide no-fault benefits for persons injured in motor vehicle accidents.
 Thus, the trial judge did not err in his conclusion that Ms. Symons was entitled to be reinstated for disability benefits under s. 86.
A plaintiff who has received a court award which includes a cost of future care component can have this award reduced to reflect benefits that the Plaintiff received, or would have been entitled to receive, under Part 7 of the Insurance (Vehicle) Regulation. A main reason for this is to prevent double recovery. Also known as “no fault” accident benefits, Part 7 benefits cover two main types, those being mandatory benefits under section 88(1) of the Insurance (Vehicle) Act, and discretionary benefits under section 88(2).
In Park v. Targonski, the Plaintiff sustained injuries in a motor vehicle collision, and brought an ICBC claim for numerous heads of damages, including pain and suffering, out of pocket expenses, and the cost of future care. At trial, the Court determined that the Plaintiff suffered from chronic pain disorder, with a strong psychological component, and awarded damages for numerous categories, including future care. As part of the award for future care, the Court awarded $8,500 for attendance at a pain clinic.
At a later application, ICBC’S lawyer argued that there should be a deduction for certain items that were the subject of the future care award. Among these items was an $8500 award for treatment at a pain clinic. Counsel for the Plaintiff argued that the Court should take a cautious approach when applying possible deductions, and that uncertainty over whether or not the benefit will in fact be paid in the future is a factor that should be considered. An affidavit from ICBC stated that if the Plaintiff attended at a pain clinic, then ICBC would pay for up to $8500 in coverage. However, counsel for the Plaintiff still took the position that there was some uncertainty, as for example, ICBC may not pay in full if the Plaintiff had alternate coverage that would cover some of the cost.
The Court would eventually rule that payments for the pain clinic are mandatory under section 88(1) of the Insurance (Vehicle) Regulations. Further, ICBC had given a guarantee that such payments would be made in the future. As such, the amount originally granted to the Plaintiff for future care in the form of the pain clinic was deducted from the future care award.
 The mere fact that psychological and/or cognitive obstacles to optimal physical rehabilitation are likely to arise in the administration of what amounts, at its core, to a physical rehabilitation program does not negate the fact that the program is designed to achieve “necessary physical therapy.” The law must take cognizance of our growing awareness of the intersection between physical and mental therapy. Indeed, it is difficult to envision aggressive implementation of the sort of active rehabilitation Back in Motion has in mind without necessarily engaging psychological and/or cognitive issues, particularly for an individual in the plaintiff’s situation. Looking at the issue this way, it is unnecessary and unrealistic to hold that a physical therapy program that incidentally engages psychological and/or cognitive issues ought not to be characterized as a s. 88(1) benefit in circumstances where the language of the provision does not dictate this result. Further, it is undesirable for courts to embark upon the impossible task of deciding which discrete components of a holistic pain program constitute s. 88(1) benefits because they are purely given to physical therapy, and which components fall outside the scope of s. 88(1) because they engage psychological issues that stand as barriers to the successful implementation of an active rehabilitation program. Such an approach is not only artificial, it is one that would breed uncertainty and spawn further litigation in an area already beset by what the Court of Appeal in Raguin charitably described as “jurisprudential inconsistencies”.
 As I am satisfied in this case that the pain clinic is a mandatory benefit and that ICBC is obliged to reimburse the plaintiff for all reasonable expenses associated with her attendance at the clinic, there is no uncertainty as to whether this benefit will be paid.
 Even if I am wrong in this, and a pain clinic of the sort Back in Motion proposes is properly characterized as a discretionary benefit under s. 88 (2), the issue is academic in this case since ICBC has agreed to pay the full amount of the expenditures that can reasonably be expected to arise. As I understand ICBC’s position on this point, the corporation will not disqualify from payment any portion of the plaintiff’s participation in a pain clinic program up to a maximum of $8,500. The assurance given by ICBC has no temporal limitations. ICBC has, through its authorized representative, Ms. Muzzin, provided its guarantee of payment to this extent. As I have found there is no risk of non-payment for any expense that might reasonably arise in connection with the plaintiff’s attendance at a pain clinic, I deduct the fixed amount of the pain clinic ($8,500) from the tort award in accordance with s. 83 of the Act.
In Middleton v. Heerlein, the Plaintiffs were US citizens injured in a motor cycle accident in British Columbia. An ICBC claim was commenced. The Plaintiffs were insured by Progressive Insurance with respect to medical benefits, and received over $100,000 in this regard. Normally the amount would not be so high, but Progressive Insurance was a signatory under a Power of Attorney and Undertaking, which sees non-BC residents receive the same amount of compensation for medical benefits as permitted by the laws and jurisdiction of B.C., even though the Plaintiffs’ were non-residents of B.C. and had their insurance through Progressive. Progressive Insurance then sought to reclaim the amounts paid, arguing that they had rights of subrogation, however the argument was dismissed.
 The Court of Appeal in Matilda stated that the issue turned on the application of s. 25(1) and (2) of the Insurance (Motor Vehicle) Act. Progressive had argued that its policy of insurance provided it a right of subrogation, and that British Columbia had no jurisdiction to modify by statute a contract of insurance written outside British Columbia.
 Although there is no argument in these applications that the current version of the statute purports to modify extra-provincial contracts, the underlined portions above would appear to offer no comfort to Progressive, as there is no material difference in wording between the section before the court in Matilda and s. 83(1) and (2) invoked by the defendants in these cases.
 The court in Matilda then dealt with an argument, also made in these cases, that the purpose of s. 25(2) was to avoid a double recovery, where the insured could claim damages from a tortfeasor for a loss for which he or she had already been compensated as an accident benefit. Progressive argued there, as here, that s. 25(2) was intended to prevent the insured from being paid twice for the same loss, but was not intended to prevent an insurer, that had made its insured whole through payment of benefits, from recovering those payments from the tortfeasor.
 After canvassing authorities, some of which are also cited on these applications, the court concluded that “the application of s. 25(2) is not limited to cases of double recovery” (para. 10).
In Kozhikhov v. Insurance Corporation of British Columbia, the Plaintiff was injured in a motor vehicle collision, and consequently brought an ICBC claim for damages for pain and suffering, as well as other heads of damages. The “tort” action was settled, however there was still the matter of Part 7 Benefits. The Plaintiff had submitted more than $10,000.00 in medical expenses, however ICBC refused to pay these, claiming that the Plaintiff’s injuries were caused directly or indirectly by a pre-existing condition, which would disentitle the Plaintiff to coverage. ICBC did not have evidence within the applicable 60 day period to support their position. The Court ruled that ICBC had to pay the Plaintiff for the medical costs.
In Redl v. Sellin, the Plaintiff was injured in a motor vehicle collision, and brought an ICBC claim for damages for chronic pain, as well as several other heads of damages, such as loss of past and future earning capacity, cost of future care, and special damages. The Plaintiff sought more than $46,000.00 in “special damages” (out of pocket expenses), however, despite the Court finding the Plaintiff to be very credible, the Court largely rejected the amount, stating that there was no medical justification for many of the expenses.
Even prior to the Supreme Court’s endorsement of the restitution principle [in Andrews v. Grand & Toy Alberta Ltd. and Arnold v. Teno], in the area of special damages the courts had been prepared to allow optimum care, and damages were awarded for expenses of a character that stretched far beyond the resources of even an affluent Canadian.
That being said, and while Dr. Frobb’s paradigm of the patient becoming their own physician may have at least a superficial appeal, plaintiffs are not given carte blanche to undertake any and all therapies which they believe will make them feel good.
 In the present case, Ms. Redl undertook an extraordinarily wide variety of therapies, some without advice, and some less conventional than others. She did so at considerable expense. It is probable, in my view, that she undertook this course of action in part through a desire to recover quickly and in part on the basis of her positive past experience, pre-accident, with massage therapy and chiropractic. However, her firm beliefs notwithstanding, there is no medical evidence that the therapies she undertook accelerated her return to work or have otherwise improved her physical condition. With regard to the palliative effect of the therapies, Ms. Redl did not experiment with trying one modality at a time. She did not experiment with lengthening the time between appointments. There is no evidence that the palliative effect of these therapies was any greater than what may have resulted from the use of over-the-counter medications. Ultimately, the evidence does not persuade me on a balance of probabilities that Ms. Redl’s physical or mental well-being is or could reasonably have been expected to be any greater as a result of undertaking these frequent therapies, than it would be if she had stuck to her pre-accident pattern of weekly or bi-weekly massage and monthly chiropractic treatments.
When a Plaintiff is awarded damages as a result of injuries arising from a motor vehicle accident, ICBC’S lawyer will often invoke Section 83(2) of the Insurance (Vehicle) Act and argue for a reduction in the amount of “no-fault” accident benefits (Part 7 benefits) that has been awarded to the Plaintiff, arguing that the Plaintiff could or would have been entitled to such benefits under their insurance policy. This can sometimes lead to a very harsh reduction in damages.
In Stanikzai v. Bola, the Plaintiff was injured in a motor vehicle accident, and brought an ICBC claim for damages. At trial, the Plaintiff was awarded damages for loss of income and cost of future care. ICBC’S lawyer submitted that there should be deductions from these amounts to reflect benefits that the Plaintiff had received, or was entitled to receive. The Court allowed for a minor deduction, but otherwise rejected the submission from ICBC’S lawyer.
 The award to the plaintiff included amounts for past income loss and cost of future care. The defendants seek to deduct $14,825.40 for benefits in respect of employment insurance as well as future physiotherapy treatments and fitness programs. The Act and Part 7 of the Regulations provide for payment of certain disability, medical and rehabilitation benefits. Where a plaintiff has been awarded a judgment, deductions are to be made for benefits the plaintiff has received or is entitled to receive.
 ….. There is no evidence on this application that the employment insurance authorities would have accepted any claim for benefits the plaintiff might have made. The defendants have not met the onus of proving that this deduction is appropriate.
 Some benefits are therefore mandatory under s.88(1), while others are discretionary under s.88(2). Physiotherapy is a mandatory benefit and the affidavit from the adjuster says that “ICBC will pay” for two physiotherapy sessions a year for 18 years at a cost of $17.65 a session, totalling $635.40.
 I agree that a deduction for physiotherapy is required and rely particularly on the adjuster’s clear statement under oath that ICBC will pay for these treatments. That is one factor that distinguishes this case from Paskall v Scheithauer, 2012 BCSC 1859 (CanLII), 2012 BCSC 1859, where an adjuster merely said that he “expects” the corporation to pay certain benefits in the future.
 However, I note that the adjuster has calculated the total deduction simply by multiplying the cost of a single physiotherapy session by the number of sessions over an 18 year period. An award for cost of future care is made on the basis of the present value of the goods and services that will be required over the relevant period. The amount that the defendant is entitled to deduct should be similarly discounted to reflect the present value of those future payments. I leave it to counsel to agree on that calculation.
In Paskall v. Scheithauer, the Plaintiff was injured in a motor vehicle accident, and brought an ICBC claim for damages. The Plaintiff was awarded about $65,000.00 by a jury, and ICBC’S lawyer argued for deductions from this amount for mandatory and discretionary benefits. The Court rejected these submissions.
“Rehabilitation” means the restoration, in the shortest practical time, of an injured person to the highest level of gainful employment or self-sufficiency that, allowing for the permanent effects of his injuries, is, with medical and vocational assistance, reasonably achievable by him.
(j) the court is to take into account ICBC’s discretion with respect to whether certain amounts will be paid in addition to restrictions in the Regulation with respect to amounts payable.
 The examiner’s stated expectation falls far short of the evidence required. Before discretionary benefits can be paid, s. 88(2) requires an opinion from “the corporation’s medical advisor”. No evidence from any such person has been put forward. The expert who provided a care opinion for the defendant at trial is an occupational therapist. There is no evidence that ICBC accepts her in the capacity of its “medical advisor” for purposes of s. 88.
 Although the opinion of a medical advisor is a precondition to the payment of discretionary benefits, the corporation is still not bound to pay them. The examiner’s expectation is no more than an opinion about what his employer will do in the future. There is no evidence that he has the authority to make that decision and no explanation of the basis on which he feels able to express an opinion on what the corporation will do for the remainder of the plaintiff’s life.
 At this stage of the proceeding, I believe it is appropriate to acknowledge the fact that in cases such as this the corporation has conduct of the defence on behalf of its insured. There is certainly no evidence that the corporation now disavows the position it instructed counsel to take at trial.
 Accordingly, I find that the defendant has failed to meet the onus of proving the plaintiff is entitled to the benefits for which deduction has been sought.
In Wepryk v. Duraschka, the Plaintiff was injured in a motor vehicle accident, and brought an ICBC claim for damages. An issues that arose was reimbursement of certain traveling expenses, such as parking and mileage costs. The Court held that such costs are “an integral part of necessary treatment” and, as such, should be awarded under Part 7 of a claimant’s policy.
 I also agree that $22.50 for parking should be deducted as a component of travelling expenses for treatment. Travelling expenses are an integral part of necessary treatment and as such are a benefit subject to deduction: Petersen v. Bannon, (1991) 1 C.C.L.I. (2d) 232 (B.C.S.C.).
 The plaintiff also claimed car expenses for driving to and from medical appointments at a rate of .50¢ per kilometre, and I awarded the entire amount of $1,368.90 claimed by the plaintiff on the basis of her calculations. The defendants originally submitted that the entire amount of $1,368.90 should be deducted, but now say the deduction should be $684.45. According to ICBC’s Claims Procedure Manual for Accident Benefits, ICBC will only reimburse the use of one’s own vehicle at a rate of .25¢ per kilometre. Therefore, one half of the $1,368.90 awarded at trial, or $684.45, should be deducted for driving expenses.

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