ICBC Injuries and your PBC benefitsMonday, Jul 25, 2022
As part of our ever-present effort to improve the health, wellbeing, and lives of our members, we’ve changed our business practice for our insured clients and will no longer ask members to execute a Reimbursement Agreement in connection with extended health, dental or wage loss claims for MVAs.
Changes implemented by ICBC in recent years have impacted the way in which insurance providers in BC process extended health and disability claims related to motor vehicle accidents (MVAs).
As of November 2018, ICBC became first payor for extended health benefit costs related to MVAs, and health benefits providers became first payor for wage loss related costs (i.e. short- and long-term disability).
Pacific Blue Cross has in the past leveraged a Reimbursement Agreement for members submitting claims for coverage when a third party such as ICBC was involved. This helped to expedite funding for losses while liability was being determined by ICBC.
Since the legislative changes in 2018 removed the right of any insurance company to subrogate against ICBC, we’ve been monitoring how this position impacts claimants and plan sponsors. As part of our ever-present effort to improve the health, wellbeing, and lives of our members, we are changing our business practice for our insured clients and will no longer be asking members to execute a Reimbursement Agreement in connection with claims for MVAs, effective March 1, 2020.
Additionally, any previously executed agreements for MVAs that occurred after November 9, 2018 will no longer be pursued by Pacific Blue Cross. This change will simplify the claim process and make it faster and easier for our members to obtain funds so they can focus on what matters most—their health and recovery.
The Third Party Liability clause in the policy wording will be updated when policies are re-issued at a later date.
For short-term and long-term disability claims related to ICBC injuries, Members should submit their claim according to their plan administrator’s regular practices. Their claims will be paid according to the standard terms and conditions of their policy. If a Member’s PBC benefits are exhausted, and they are still suffering wage loss as a result of their ICBC related injury, they may take their claim directly to ICBC adjustors for assessment.
For extended health and dental claims, our Members must submit their claims to ICBC as they are first payor for these types of claims. Claims sent to PBC that are identified as ICBC related will continue to be rejected until the Member can show that they ICBC has closed their file and there is no further reimbursement available to them.
It is also important for Members to understand that we do not pay any portion of an invoice that has already been paid in part by ICBC, according to ICBC’s schedule of costs, if the remaining balance is submitted to Pacific Blue Cross for reimbursement. This is called Balanced Billing and is excluded in all of our contracts, as part of our definition of an Eligible Expense.
Where to go for help:
As always, our customer service representatives are here to support you with your claims questions. Please refer to our contact page for information on how they can be reached.
If you are an employer and have any questions regarding this change, please contact your Pacific Blue Cross Account Executive.
Individuals without disability or extended health coverage as part of their PBC benefits can go through ICBC to receive compensation related to wage loss due to a motor vehicle accident.
Pacific Blue Cross will continue with the practice of using Reimbursement Agreements for Workers Compensation Board (WCB) and other third-party claims.