“Should I be using my extended medical benefits if I’ve been injured in a car crash?”
The short answer: Absolutely.
This is confusing stuff. I’ll do my best to explain.
An extended medical plan is an insurance policy. A premium is paid in exchange for an insurance company’s commitment to reimburse medical expenses that are incurred over the term of the policy.
Plans come in all shapes and sizes. Variations include the types of medical expenses covered, percentage of reimbursement and maximum annual amounts.
If you are injured tripping over your shoelaces and require physiotherapy to treat that injury, of course you submit your receipts to the plan for reimbursement.
The difference in a car crash, where another driver is at fault, is that you have a separate set of rights related to the exact same physiotherapy expense. The “at fault,” negligent driver is responsible to provide fair, financial compensation for all of the injuries and losses suffered by their victim. Those losses include medical expenses.
ICBC steps in as the negligent driver’s liability insurance company. The rights you have against the negligent driver are passed on to ICBC.
So shouldn’t ICBC reimburse that expense? Why should you have to access your own extended medical plan that you (directly or through an employment benefit) paid the premiums for?
Yes, ICBC should reimburse that expense. The law does not allow ICBC to side step their obligations on behalf of the negligent driver because you happen to have bought and paid for extended medical benefits.
But the same thing goes for your extended medical provider. You paid a premium requiring them to reimburse medical expenses. Why should they be able to side step their obligation because you happen to have separate rights against ICBC?
Unless your plan policy says otherwise, you are entitled to reimbursement whether your injury was your fault (falling over your shoelaces) or someone else’s fault (a negligent driver).
Am I saying that you can be reimbursed twice for the same expense?
In some cases, yes. You bought and paid for that entitlement.
But extended medical insurers have become better and better at being the ones to “double dip.” More and more, they have been adding clauses in their policies requiring beneficiaries to pay back whatever is recovered from ICBC.
So they collect premiums from you but don’t end up having to pay the benefits!
My advice is to collect whatever reimbursement is available from your extended medical plan. And then at the end of your claim, ensure ICBC reimburses every dollar of your expenses, disregarding what your plan might have reimbursed.
If your plan policy wordings require you to reimburse them, then you do that.
As with all things in a personal injury claim, ensure you are 100% up front and honest with all involved. Don’t keep the existence of your extended medical plan secret from ICBC and don’t keep your ICBC claim secret from your extended medical plan.
This is complicated stuff. And you don’t want to make a costly mistake. Imagine, for example, having to reimburse your extended medical plan for benefits you do not end up recovering from ICBC.
Get legal advice about anything you are the least bit uncertain about. Many personal injury lawyers are willing to provide some level of free advice at absolutely no obligation to you.
You might also enjoy:
- If extended medical benefits are available to you, use that lifeline
- Be proactive about your medical care