31/07/2019 0 Comments
Role of a “Registered Care Advisor” in ICBC Claims
As of April 1, 2019, a person injured in a motor vehicle accident in BC may be referred for a consultation with a “registered care advisor.” What exactly is a “registered care advisor” and how might a consultation with a registered care advisor impact ICBC reporting and the outcome of an ICBC claim?
What is a “registered care advisor”?
On November 9, 2018, the BC government announced a number of changes and additions to the Insurance (Vehicle) Regulations with respect to the classification and treatment of motor vehicle accident injuries. One of the changes allows for the creation of a list of medical care consultants called registered care advisors. In a nutshell, a registered care advisor (“RCA”) is a BC doctor can be engaged to provide an expedited medical consultation. To be an RCA, a doctor should have experience with motor vehicle accident injuries such as musculoskeletal injuries, acute and chronic pain, occupational medicine, and/or mental health issues.
What types of ICBC claims will RCAs be involved in?
The rules relating to RCAs were made under the new Minor Injury Regulation, which attempts to draw a line between “minor injuries” and “serious impairments” (see here for our ICBC lawyers’ discussion of the significant problems with the definitions created by the new regulations).
It is expected that registered care advisors will be asked to consult in ICBC claims deemed at the outset to involve “minor injuries” – which includes injuries such as abrasions, concussions, contusions, lacerations, pain syndromes, psychological conditions, sprains, strains, TMJ disorder, and/or whiplash.
How does an RCA become involved in an ICBC claim?
A registered care advisor is engaged to provide an expedited medical consultation. The process (which is not mandatory for ICBC claims) is initiated by the injured person’s treating physician in consultation with the injured person. At any time within 90 days of the accident that caused the injury, a treating physician may refer the injured person with an ICBC claim to an RCA for assessment if:
• the treating physician is unable to make a clear diagnosis;
• the injured person is not recovering as expected by the treating physician; or
• there are factors complicating the recovery from the injury.
Note that the treating physician – not ICBC – initiates the consultation with a registered care advisor when it is felt that a second opinion on the diagnosis or treatment plan is required. ICBC is not involved in directing patients or physicians to initiate an RCA referral, or in directing treatments (though ICBC pays for the RCA assessment visit and report in accordance with a fee schedule set out in the Regulation). That is one of the features that distinguishes an RCA consultation from an Independent Medical Evaluation (“IME”). Another distinguishing feature is that the fee schedule for RCA assessments is a fraction of what doctors currently charge for IMEs.
What is the RCAs role?
The role of the RCA is to support the treating physician when a person injured in a BC motor vehicle accident has not reached expected recovery goals. The registered care advisor is to provide recommendations on appropriate treatment options based on best practice guidelines. RCAs can provide a second opinion on diagnosis and treatment plans when the initial care and recovery plan is not working. The injured person’s treating physician remains the primary care provider.
What are an RCAs reporting requirements?
When an RCA accepts a referral from a treating physician, they must assess the patient’s injury within 15 business days after the date of the referral. Within 10 business days after the RCA assessment date, the RCA is required to produce a written report that provides advice to the treating physician about the diagnosis or treatment of the patient’s injuries. A written report should include diagnosis of the injuries, any diagnostic investigation, the prognosis, and recommended treatments. Recall that the referral to an RCA, if warranted, must be done within 90 days after the date of the accident that caused the injuries. These tight timelines clearly show that the intention is for a very expedited consultation process. This may mean more timely treatment recommendations and funding from ICBC to help accident victims recover from their injuries. However, it remains to be seen whether these timelines are workable in practice.
What if the injury is not really “minor”?
Under the new Regulation, damages for pain and suffering for injuries classed as “minor” is capped at $5,500. The burden of proof that the injury is not a minor injury is on the person who says that it is not a minor injury. In other words, it will generally fall to the accident victim to prove that their injury is not “minor” despite being one of the types of injuries in the “minor injury” definition. This is something to keep in mind if referred for an RCA consultation. It is important for an accident victim to carefully document and explain to the treating physician and the RCA how the injuries are affecting essential tasks such as employment, schooling, and/or activities of daily living, and whether or not the impairments are improving. Injuries that meet the definition of “serious impairment” are not subject to the cap on damages for pain and suffering.
Legal Guidance & More: From Injury to Recovery
Bronson Jones & Company’s ICBC claim lawyers have extensive trial experience and extensive experience in negotiating fair settlements for clients injured in car accidents. We have also developed an extensive network of medical and occupational specialists, therapists, rehabilitation specialists, and others to help you deal with the impact of your injury on your physical health, family life, finances and future. Reports from these experts or from registered care advisors may be essential in the development of your case. If you or a loved one has sustained injuries as a result of a motor vehicle accident, call any of the 13 Bronson Jones locations in the Lower Mainland for our expertise and advice. All of our cases are handled on a contingency (percentage) basis and you don’t pay until we collect.