Court Orders ICBC To Pay For Plaintiff’s Medical Expenses Under Part 7 Benefits Policy

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.


[19] The benefits claimed in this case are subject to s. 101(b). The 60 day period for payment allows ICBC the opportunity to review and investigate the claim. Obviously, it does not give sufficient time for the extensive investigation the corporation may undertake when defending its other insured–the allegedly at fault motorist–in the tort claim, but that is consistent with summary nature of the claim and the relaxed standard of proof required of the plaintiff.


[20] ICBC relies on s. 96(f) of the Regulation, which reads:


The corporation is not liable to pay benefits under this Part in respect of the injury or death of a person


(f) whose injury or death is caused, directly or indirectly, by sickness or disease, unless the sickness or disease was contracted as a direct result of an accident for which benefits are provided under this Part.


[am. B.C. Regs. 379/85, ss. 36, 37; 449/88, s. 17.]


[21] Section 96(f) must be read in conjunction with s. 101. If the plaintiff’s injury is caused by the sickness or disease referred to in s. 101, benefits are not payable. But in the absence of evidence that s. 96(f) applies, ICBC must pay benefits within 60 days after it receives proof of the claim.


[22] In other words, if ICBC is to reject a claim for specific benefits under s. 96(f), it must do so on the basis of evidence obtained before the expiry of the 60 day deadline. In cannot use evidence obtained long after the fact to justify a failure to comply with s. 101.

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