ICBC's No-Fault Scheme's New Register Care Advisors - Wes Mussio
ICBC has established a new group of doctors called Registered Care Advisors (RCA). There is a required “buy-in” from physicians, which has caused skepticism
ICBC, ICBC Claim, Register Care Advisors, ICBC No Fault, Personal Injury Lawyer, ICBC claim dispute lawyer,
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ICBC’s No-Fault Scheme’s New Register Care Advisors

ICBC’s No-Fault Scheme’s New Register Care Advisors

Who are these Register Care Advisors and how do they impact your claim

 

With the introduction of the No-fault scheme of ICBC starting April 1, 2019, the government has established a new group of doctors to assess injured claimants called Registered Care Advisors (“RCA”). There is a healthy degree of skepticism as to the viability of this program as it requires a lot of “buy-in” on the part of physicians in British Columbia.

 

The role of the RCA is to provide expedited medical consultations to injured parties with the stated role of providing advice to family physicians on “best practice and appropriate diagnosis and treatment pathways”. In reality, the RCA program is there to allow ICBC to generate medical evidence to cap most injury claims at $5500 for pain and suffering on the basis that the injury is a “minor injury”.

 

Where the RCA comes into play is if the treating doctor, within 90 days of the accident, needs a second opinion because of one of the following scenarios:

 

  1. The treating doctor is unable to make a clear diagnosis;
  2. The claimant is not recovering as expected; or
  3. There are factors complicating the patient’s recovery.

 

The RCA program gives family physicians an “out” to not deal with ICBC as the physician is able to pass on the responsibility to an RCA. Also, for many injuries, a “clear diagnosis” in the first 90 days after injury is not possible as the injury is still in the initial state of recovery. That fact will result in a lot of RCA referrals except for straightforward minor claims.

 

The stated rationale behind the policy is to get early intervention for injured claimants, which is a good thing, to try to prevent the person from having a lasting injury. The idea is that the injured claimant’s earlier recovery will save ICBC money on the final payout. However, the more important reason is the program will give ICBC access to medical evidence they can use to cap the injury claim as minor.

 

Medical doctors that wish to participate in the program can apply to become an RCA through the College’s Annual Licence Renewal Form. The doctor has to be in clinical practice so not retired. The doctor has to be a member in good standing with the College and further, have competence in one of the three categories:

 

  1. Musculoskeletal injuries;
  2. Acute and chronic pain; or
  3. Mental health issues and other psychosocial issues

 

The RCAs may be family physicians or physicians who have experience in addiction and sport medicine, or specialties such as pain medicine, otolaryngology, psychiatry, orthopedic surgery, rheumatology, occupational medicine, physiatry, etc. They must make a declaration to the College and further, register with ICBC.

 

It remains to be seen how many physicians decide to participate in this program. On the one hand, the rates that ICBC are providing ($380 for the initial assessment and $120 for a follow-up) are very low compared to what doctors are currently receiving when they conduct an independent medical assessment (“IME”) so it’s doubtful many seasoned assessors in the field of ICBC claims will jump on board for these low rates. However, the rates are higher than MSP pays so some doctors trying to enter the realm of ICBC assessments may well join up.

 

ICBC is required to maintain a list of RCAs and that register is available to the public. It is anticipated, with time, that there will be favourable doctors for injured parties on the registry and unfavourable ones. The key is to ensure that any referral that your family doctor may make to an RCA is done to one that is more likely to be beneficial to your case as opposed to being hardline and defence oriented.

 

The stated position of ICBC is that this process is initiated by the initial referring physician in consultation with the patient. The patient’s care and the RCA process are managed by the patient’s referring physician. ICBC is said to have no involvement in directing patients or physicians to initiate an RCA referral, or in directing treatments.

 

However, in practice, you can be rest assured the ICBC adjusters will be recommending to self-represented claimants a defence oriented specialist so as to further secure a “minor injury” classification. Also, many adjusters will be approaching the physician to help influence the outcome of the RCA process, influence treatment models, and influence the classification of the injury. To expect the ICBC adjuster to allow the RCA process to run its course without input is unrealistic as it would need a fundamental change in the current approach at ICBC.

 

Under section 11 of the Minor Injury Regulations, the RCA accepting a referral must assess the patient within 15 business days after the date of the referral and provide a full report to the treating physician within 10 days after the RCA assessment. In other words, it is a 25-day turnaround from referral to report writing. Unless the system works smoothly, which is unlikely, these tight deadlines are unlikely to be adhered to in practice.

 

The RCA’s reporting requirement is extensive as the written reports are expected to cover:
  1. Injuries;
  2. Any diagnostic investigation;
  3. Prognosis, and
  4. Recommended treatments

 

The reports are generally organized into the following headings:
  1. Pertinent history;
  2. Subjective findings;
  3. Objective findings;
  4. Diagnosis & prognosis;
  5. Medical recommendations;
  6. Treatment recommendations; and
  7. Outcome measures.

 

In other words, the reporting requirements for the low fee that an RCA can charge to ICBC is similar to IME reports that doctors usually charge thousands of dollars for. It is a leap of faith to expect physicians to generate IME style reports for a low fee.

 

If, after the initial RCA assessment and report, the referring physician is still not able to make a clear diagnosis, the patient is still not recovering as expected, or there are other factors complicating the patient’s recovery, the referring physician may refer the patient to the same or to a different RCA at any time up to nine months following the date of the accident which caused the injuries. Follow up sessions are therefore likely where:

 

  1. Imaging is required and a report addendum is prepared and provided to the referring physician; or
  2. Incomplete medical information is obtained during the initial RCA assessment and a subsequent visit to complete the assessment is required

 

In the result, under the RCA process, an injured claimant is exposed to one or maybe two full assessments in the first 9 months, which is a more intrusive process than previous to the No-fault scheme. That is, on accidents before April 1, 2019, ICBC’s ability to send you for an assessment was far more restricted.

 

The rational for the extensive early assessments of an injured person is to prevent a claimant from falling through the cracks and having an injury that escapes the “minor injury” cap. ICBC wants an early diagnosis as that will help ensure most injuries are capped as “minor injuries”.

 

The good news is ICBC covers the RCA’s initial assessment and follow up assessment fee.

 

In summary, the RCA program is clearly in place to allow ICBC access to medical evidence likely for the view of categorizing a claim as a “minor injury” so compensation can be capped. The program will, however, assist in a better early diagnosis and treatment of injuries with the expected outcome of improving the over recovery timeframe for many claimants. The question is whether or not the RCA program will be operational as there needs to be a lot of “buy-in” by the physicians in this Province.
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