The committee met at 8:32 a.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): Good morning, everyone. My name is Stephanie Higginson. I am the MLA for Ladysmith-Oceanside and the Chair of the Special Committee to Review Provisions of the Insurance (Vehicle) Act.

I’d like to start by acknowledging that we’re meeting today on the legislative precinct here in Victoria, which is located on the territory of the lək̓ʷəŋən People, now known as the Songhees and Esquimalt Nations.

This committee is tasked with reviewing parts 10 and 11 of the Insurance (Vehicle) Act, and the committee is also considering Bill M237, Insurance (Vehicle) Amendment Act, 2026. As part of the public consultation, our committee accepted written submissions over the summer, and this week we will be receiving presentations from some of those who made submissions.

I’m going to ask the members of the committee to introduce themselves. I’ll let folks know that we do have a number of people who are attending remotely. I’m going to start introductions with our Deputy Chair. We’ll do the folks in the room first, and then we’ll move to online folks.

Brennan Day (Deputy Chair): Hi, my name is Brennan Day. I’m the MLA for Courtenay-Comox. Great to see everybody here in the room.

We’ve got a couple of my constituents. Adam, one of my…. Just from down the street, I’ve known him for quite a while, and Kaila Holtz. Congrats. Thank you for being with us. I really look forward to hearing your submissions.

Steve Kooner: Hi, I’m Steve Kooner, the MLA for Richmond-Queensborough, and, yes, I’m looking forward to hearing the submissions. Thank you for being here today.

Jennifer Blatherwick: Good morning, I’m Jennifer Blatherwick. I’m the MLA for Coquitlam-Maillardville. Thank you for coming today.

Jeremy Valeriote: Good morning, I’m Jeremy Valeriote, MLA for West Vancouver–Sea to Sky. I apologize for not being there in person. That had been my intent, but a lack of respect for fixed-election-date law keeps me close to home. I will be listening intently and taking notes.

George Chow: Hi. Good morning, everyone. I’m George Chow. I’m the MLA for Vancouver-Fraserview. Yes, I was planning to be with you in person, but my father got into the hospital yesterday. Sorry about that.

I also want to acknowledge that I’m speaking to you from the territory of the Coast Salish People.

[8:35 a.m.]

Stephanie Higginson (Chair): It appears we’re having some technical difficulty with MLA Routledge.

We have a number of presentations today. The order of things is that there are ten minutes for presentations and then 20 minutes for questions from the committee.

We are starting today with the first presentations from the Doctors of B.C. We have Adam Thompson, Robert Hulyk and Kaila Holtz here.

I am going to pass it over to you folks.

Presentations on Parts 10 and 11
of the Insurance (Vehicle) Act

Doctors of B.C.

Adam Thompson: Thank you for having us this morning. As said, I’m Adam Thompson. I’m president of Doctors of B.C., and I’m a family physician practising in Courtenay in the beautiful Comox Valley.

On behalf of Doctors of B.C., we’re very grateful for the opportunity to meet and present to you our key recommendations for ICBC’s enhanced-care model. Joining me today is Rob Hulyk, our vice-president of advocacy and government relations, who has supported the ICBC liaison committee since 2012 — so has a long experience. Dr. Kaila Holtz is a specialist physician working in the beautiful Comox Valley who has represented Doctors of B.C. on our joint liaison working group with ICBC since 2023.

As you may know, Doctors of B.C. is a voluntary association representing more than 18,000 physician members across the province. Our work includes supporting B.C. doctors as leaders in delivering improved patient care, negotiating the physician main agreement with the provincial government and, often, collaborating with the Ministry of Health, health authorities and other partners to improve health care in British Columbia.

The work we have been doing with ICBC is a great example of this collaborative approach. As I mentioned earlier, this relationship is supported by an established liaison working group which comprises Doctors of B.C. physician representatives and senior leaders from ICBC. This group meets regularly to discuss patient care under ICBC’s enhanced-care model.

Overall, our belief is that the enhanced-care model is working well for most patients. What we’d like to do today is share what’s working well and where there are opportunities for further improvements. Our physician members have played a critical role in providing input to develop mutually beneficial solutions to improve that patient care.

I’m now going to turn it over to Rob to share more about our work in this area.

Robert Hulyk: Thank you, Adam. I’d like to begin by providing some context for our partnership with ICBC. In 2018 Doctors of B.C. was invited by government and ICBC to participate in the process to inform enhanced care and has provided critical recommendations to ICBC in its transition to a care-based model.

Between 2018 and 2021, we co-created a suite of report templates to facilitate the exchange of medical information between family physicians and ICBC to support patients’ early recovery under enhanced care. The provincial government supported this by incorporating fees for these reports. This has significantly improved the way family physicians inform, organize and provide care for patients affected by motor vehicle accidents and represents an important improvement over the previous system for most injuries.

With the introduction of enhanced care in 2021, Doctors of B.C. identified a significant gap in the adjudication of claims. Medical information from specialists, who were often the physicians treating complex or catastrophic injuries, was not shared with ICBC, with the exception of comprehensive medical assessments and independent medical examinations.

This meant that at the time, specialists treating these patients lacked a mechanism to share medical information with ICBC through the Medical Services Plan. To address this gap, a pilot for a specialist services report was proposed and developed in collaboration between Doctors of B.C. and ICBC, which Dr. Holtz will speak to in more depth momentarily.

In 2024 we commissioned a third party to conduct a review of the ICBC enhanced-care model from the physician’s perspective. We recruited 32 physicians to provide feedback through in-depth interviews and a brief survey, identifying areas where enhanced care was working well and areas of challenge. Physicians highlighted several strengths, including timely access to care for minor injuries, extended coverage for allied health services, less time spent on litigation paperwork, new regulated reports and fees for family physicians.

[8:40 a.m.]

As Dr. Thompson said, overall the system was working well for most patients. However, challenges included gaps in communication with allied providers, such as physio and occupational therapy; inadequate compensation for providing medical updates and escalating concerns to ICBC; and the significant administrative burden of navigating static PDF report templates.

Specialists also identified significant gaps in services for patients with complex or catastrophic injuries. These cases, which may require long-term specialized care or result in prolonged time away from work, account for 25 to 30 percent of reported injuries. Aside from the pilot specialist services report, there are currently no specific services within the enhanced-care model that enable specialists to support and manage direct patient care for these complex injuries under the Medical Services Plan.

Specialists have also asked for clarity on when and how often they should share medical information with ICBC. We are working with ICBC on that. Specialists can share information with ICBC through comprehensive medical assessments and independent medical examinations. However, because these are insurance benefit assessments, both fall outside the Medical Services Plan.

Dr. Holtz will now take you through our recommendations.

Kaila Holtz: Thanks, Rob.

Hello, everyone. Thanks for the opportunity to speak with you today.

First, let me introduce myself. I’m a physiatrist. You might not have heard of a physiatrist before, but physiatrists, or physical medicine and rehab specialists, are medical doctors with expertise in the secondary complications of stroke, spinal cord injury, amputation, brain injury, burns, polytrauma and myofascial pain, to name a few.

I’ve been in practice since 2019, and I’ve worked in both inpatient and outpatient settings. I see patients with ICBC-related injuries through MSP referrals for comprehensive medical assessments, and I perform independent medical examinations as a medical expert qualified by the Supreme Court.

I’ve certainly enjoyed collaborating with ICBC as a specialist member on the ICBC liaison committee. We have four key recommendations from the perspective of physicians like me that I’d like to share with you today.

Our first recommendation is to amend the Enhanced Accident Benefits Regulation to include reporting options for specialists and to ensure fair compensation for our expertise. This would involve collaboratively developing tiered reporting and payment options for specialists based on the type and/or amount of information that would benefit ICBC. Formalizing specialist reporting would enable timely and appropriate sharing of medical information with ICBC and would allow us to provide status updates for patients with more complex injuries.

Family physician reports are enshrined in regulation and include templates and fees that vary by the type and extent of medical information shared with ICBC. In contrast, the specialist services report remains in a pilot phase, and its uptake has been relatively low, with only 892 specialist reports submitted in 2025 compared with 18,980 family physician extended reports. This is partly because of the associated fees being below market value, including those for family physicians and WorkSafeBC. Despite the low uptake, we’ve been told the information that has been provided through this vehicle has been valuable to ICBC.

Our second recommendation is to consider redefining the purpose and scope of the comprehensive medical assessment, or CMA, in the current Enhanced Accident Benefits Regulation. We suggest a review of the efficacy and efficiency of the CMA by multiple stakeholders and to consider whether the information acquired by this assessment tool can be fulfilled using other options, such as an extended specialist report or an independent medical examination.

Our third recommendation is to amend the Enhanced Accident Benefits Regulation to include physician communication services that support timely verbal and written communication among family physicians, specialists and ICBC. Because ICBC relies on information provided by physicians to make decisions about benefits, particularly beyond the 12-week pre-approval period, we feel it’s vital to authorize physicians to raise concerns proactively about patients with risk factors for prolonged recovery and to encourage them to communicate those concerns to ICBC.

[8:45 a.m.]

Finally, our fourth recommendation is to review and reconsider the definition of a “catastrophic injury” under the permanent injury regulation. There are some nuances for patients with severe injuries, such as a spinal cord injury or a traumatic brain injury, that require further review beyond Bill M237.

We recommend a review of the benefits and compensation available to patients with catastrophic injuries to ensure the real-world costs of care are accounted for. Meaningfully addressing friction points in the approval process for medically necessary home or nursing care, travel benefits and specialized equipment would improve patient outcomes.

Thank you for your time and the invitation to present.

I’ll now pass it back to you.

Adam Thompson: Thank you again, Dr. Holtz, for sharing your expertise today.

We strongly believe that meaningful reforms to specialist services, communication pathways, the comprehensive medical assessment process and the definition of “catastrophic injuries” are essential to improving enhanced-care outcomes.

We would like you to consider continuing our collaborative work with ICBC to examine the details of the reports and the communication mechanisms with input from our physician members.

The reforms we outlined in our recommendations would greatly benefit ICBC, physicians in B.C. and the patients that they serve. If implemented, we believe these recommendations would ensure that physicians can provide high-quality care to patients who need it and that ICBC receives the necessary medical information to make informed decisions about patient recovery, thereby ensuring fair process for adjudicating claims.

Thank you again for your time today. We’re happy to take any questions.

Stephanie Higginson (Chair): Thank you for your thorough presentation. I really appreciate it.

Dr. Holtz, I am very familiar with physiatrists. I had an experience myself with one. After 18 months with a head injury, it was actually landing with a physiatrist where I was finally put on a path of recovery.

Thank you for the work you do. It’s really important.

Jennifer Blatherwick: Thank you so much for the presentation. I feel like it really encompassed the main highlights of the material that you’ve given us.

Could you just expand for me a little bit more about No. 2, where you’re defining the purpose and scope of the CMA? You mentioned other forms of reporting that you feel would be more effective. Could you draw me some contrast between the two, to help me understand how those would work better?

Kaila Holtz: Sure. The CMA, or comprehensive medical assessment, is enshrined in regulation. I feel it’s an insurance tool where patients are referred by recovery specialists to undergo a medical evaluation.

Typically, independent medical evaluations do not have allied health testing associated with them. What’s unique about the CMA is there’s also a physiotherapist there. It takes the client anywhere from an hour to 90 minutes to go through this assessment. Then we produce a report — the physiotherapist and the physician — for ICBC.

That differs from an independent medical examination, where there’s no physiotherapy input. Independent medical examination has been used, under part 10, later in the claim. While we had hoped that CMAs would be at three to six months, I’m seeing clients for IMEs at two to three years. It’s generally, then, to help the recovery specialists, as I understand, to determine: have they met maximal medical recovery?

Both the CMA and the IME information go back to ICBC. I understand from talking with recovery specialists that some of that information is shared with the clients so they can make decisions about their care, since they direct it.

Now, in contrast, the specialist services report form is a tool for physicians to communicate with ICBC after they see patients in an MSP visit. We can voluntarily submit information. ICBC can also request that information and ask us to complete the form. Generally, it’s what we’ve discussed with the patient as the treatment plan. I understand it’s to help inform claim benefits, but it’s not a formal ask that patients attend an appointment for that purpose.

Jennifer Blatherwick: If I can maybe explain it back to you a little bit to make sure that I am fully grasping it, the difference is between the underlying function of the form — what you are evaluating the client for — and how ICBC is then using that information and sharing it with the client?

[8:50 a.m.]

Kaila Holtz: Yeah, it seems like there’s some redundancy between a specialized services report form and a CMA and an IME. So our ask, really, is to review.… The way I’ve proposed it to ICBC is: “What information do you need, and where would it be most effective to ask for that?”

For some clients, that information is coming back through the specialist services report. Some are being asked to attend a CMA. Others might not have either and then, later in the claim, see a physiatrist like me for an IME. There’s some overlap in the information, and we feel that a review of that overlap would probably make it more efficient and effective for both ICBC and the patient.

Jennifer Blatherwick: So a more effective use of your time, better consistency in reporting to ICBC but also better outcomes for the client because then they’re getting the same information back to them. You’re collecting the same information and being able to have a baseline standard of like…. Okay. Great.

Kaila Holtz: Yes. I’ll just add that you can imagine that introducing an additional CMA to the process requires creating a whole set of forms and a whole referral process within ICBC and a whole kind of terms of reference. Our ask is: can we evaluate whether that information can actually be captured after an MSP specialist consult and not have to staff and create this whole other program?

Robert Hulyk: If I could tag on, we have this figured out on the family physician side, but based on the progression of how some injuries go under the treatment of specialists, we’ve only got one slice of the information figured out. The CME, the CMA and the IME happen in certain circumstances in long-tail or for patients who aren’t recovering sooner.

We think there is an opportunity — and we need to work on this — for information to be provided by specialists sooner and more often to better inform not only benefits but other types of supports. That’s where we think there’s an opportunity to improve care.

George Chow: A question to Dr. Holtz. Regarding the reports between family physicians and specialists, there’s quite a difference, right? For the specialist, it’s less than 1,000, whereas from a family physician, it’s 19,000. That’s quite a difference.

Well, I guess one of the factors would be that the number of family physicians is a lot more than specialists, but you also mentioned the fee. Can you kind of give an indication in dollar terms? What are the differences?

Kaila Holtz: I’ll have Rob correct me if I’m wrong, but my understanding is that the extended family physician report is renumerated at a rate of $390, whereas the specialized services report form is renumerated at $275. WorkSafe forms and appointments are renumerated at a higher rate than both of those.

George Chow: Okay. But the difference in the number of reports…. Could it be accounted for by the fact that you have many more family physicians versus specialists? What category of specialists are we talking about here?

People do go see their family doctor, and certainly, people rely on their family doctors to produce reports and take care of them and that kind of stuff, whereas specialists…. I think the procedure to actually see a specialist is more time-consuming, and you’ve got to jump through a couple of steps.

Robert Hulyk: If I can jump in, the lower number of responses by specialists is because this has been a pilot, because the compensation is not where it should be and also that we have to create some greater awareness within the specialists. It’s not because there is a vastly larger number of family physicians as opposed to specialists. It’s actually quite close.

You asked about the type of specialists that would see ICBC patients. Well, you’ve got, obviously, one of them sitting here in physiatry, but you can see orthopedics, psychiatry, radiology. There are all sorts of specialists that will assist in the treatment of folks injured in vehicles.

[8:55 a.m.]

I think what we’re saying is that, like I said, we figured this out with family physicians by having enhanced reports and follow-up reports. This was a pilot to engage to see if ICBC benefited from having additional information from specialists. Where we think we have to go is to probably create two or three types of reports coming out of this: a basic update, a follow-up report and then a different report for much more complex injuries.

And I think what Dr. Holtz is speaking to is, also, what can we do for those patients that aren’t getting better, who are those long-tailed patients that need additional supports, and how can we best inform ICBC in terms of the benefits and supports that they provide? So there’s more work to do, and we think that once both the nature of the reports and the compensation is fixed, you’ll see those numbers drive up considerably.

One last point. The information that we have provided from those 800 reports ICBC has found tremendously valuable, and they can speak to that when they come.

Steve Kooner: My question has to do with the communications and the issues that you have found with communications, and you feel that they need to be improved. So my question is: from your study, your research and your work to consider this current system that we’re discussing today, has lack of communication from medical experts…? Do you feel that has affected recovery of patients under this model of ICBC?

Robert Hulyk: Perhaps I’ll start. First of all, in terms of the gaps in information that we saw, it was most often from places like physio or OT back to family physicians. That was largely a result of patients being able to self-refer themselves to physiotherapy at the outset of injury, and these are places where we’ve said that the family physician, for example, needs to be better included in information.

Some of the other gaps, like we’ve identified from specialists…. Obviously, there are gaps there in terms of some of the information that they would have liked to have been sharing with ICBC or vice versa. So can we say that patient care has been affected? In some cases. And we think that there are some cases where there are improvements that can be made.

But, overall, we would have to say on behalf of the profession that care is better under the current system than under the previous system in terms of coordination. But that’s not to say that there aren’t improvements that need to be made, and we are advocating for those improvements with ICBC, because they should be made.

Steve Kooner: Going back to the communications aspect, how much of an improvement do you think has come about as a result of adopting this new system in terms of communications versus recovery of patients? You said communications have definitely improved under this system. How much do you think those communications have actually improved under this system?

Robert Hulyk: Why don’t you start?

Kaila Holtz: Well, we’ve heard from family physicians on the ICBC liaison committee that for patients with minor injuries early in their course, things are much improved. This pre-approval process — people can get the care they need, and there isn’t this back and forth of documenting injuries for the purpose of documenting injuries.

ICBC’s actually been a really great partner to work with, with respect to us providing feedback on gaps in communication. An example of that is at G.F. Strong, the rehab centre in Vancouver, where ICBC has a point person that the occupational therapist who oversees patients can coordinate with. So I think there have been some ad hoc adjustments as friction points have come up for both patients with minor injuries as well as more severe injuries.

Adam Thompson: As a family physician myself, I have noticed a significant change in the volume of work that I do for ICBC. I historically would see a number of patients coming into my office because their lawyer had asked them to get something documented or they were coming in to get a physiotherapy referral. I’m not seeing those patients anymore.

[9:00 a.m.]

And, of course, the care for ICBC patients does not operate in a silo. It operates in a bigger ecosystem of care delivery, and that has enabled me to improve access for all of my patients as a result, as well as the patients getting the appropriate care that they need straight off the bat.

Stephanie Higginson (Chair): I’ll move to MLA Valeriote and then MLA Day.

Jeremy Valeriote: I’m just going to skip down to your last recommendation and catastrophic injuries. I’m just trying to get a sense — as you noted, we’re considering Bill M237 — regarding number of amputations. You mentioned spinal cord injuries and traumatic brain injury.

I apologize for asking you to speak in generalities, but can you give us a relative sense of the catastrophic nature of, say, a single amputation versus some of the other pieces you’ve recommended that be reviewed? Are you able to provide any more definition on what you think maybe should be included based on a general sense of the injuries?

Kaila Holtz: Well, I think the definition of “catastrophic injury” probably needs to be expanded to include some of the patient cases where…. For example, spinal cord injuries are classified using a degree of impairment scale, the ASIA. Complete spinal cord injuries, where an individual has no feeling below the level of the lesion or no motor power, are obviously catastrophic.

But patients where they may have some sensory and motor function below the level of the lesion…. They might be moving their legs and arms, but they might not have any meaningful coordination or proprioceptive function. From my colleagues who practise spinal cord injury medicine, I’m told that the definition just doesn’t include those types of cases on the edges.

Similarly, traumatic brain injury patients may be walking, talking, taking care of their ADLs, but patients after a severe traumatic brain injury have significant impairments in executive function. They would struggle to find work. They would struggle to pay their bills and do groceries. The legislation doesn’t account for those types of patients.

Our recommendation would be that there would be a special committee that could review the “catastrophic” definitions and account for those cases on the edges, including amputees as well.

Robert Hulyk: Just to tag on, I think what we’re looking for is some flexibility in these situations that can reflect the real-life circumstances of these patients who’ve been injured to this level. The current definitions will bring in a system where — I don’t want to use the word “check box” — if you don’t meet the check box, certain benefits or things don’t happen.

What we’re recommending, in consultation with physicians like Dr. Holtz and her colleagues, is that some of that flexibility and clinical determination be brought into the process. Our initial conversations with ICBC are that they’re open to those types of conversations. They’re aware of these gaps and some of the impacts that they have.

Brennan Day (Deputy Chair): It’s encouraging to see that people are getting the treatment earlier, because obviously, that limits problems later on down the road, and that there’s at least a concerted effort to reduce paperwork, which I know is one of the primary complaints I hear from physicians in terms of WorkSafe and many other areas.

I guess my question is: when ICBC denies or limits a treatment that the treating physician believes is medically necessary, what avenue does that physician actually have today under the current system to challenge or discuss that decision? And do you think that the medical community is well represented within ICBC on the boards that do those reviews?

I think one of my concerns and probably the feeling of many of the people that I’ve spoken to and that have put forward submissions is that ICBC is making decisions to save money, not to improve treatment. Obviously, that has to be balanced. But I think it’s important that the medical community feels that they have adequate representation there when there is some sort of block to treatment.

Just looking to get your feedback on that and, potentially, what could be improved there. I think that would improve at least the appearance of transparency when they’re making these decisions.

Robert Hulyk: Thank you for the question. A lot of it will depend on the type of injury and the circumstance in terms of when you’re talking about care being refused and so forth.

[9:05 a.m.]

There are opportunities for physicians to raise directly with the case manager, so in the case of a minor injury. In the case of a specialist and some of the more catastrophic, it’s probably a little more complex. And I think we’ve identified some of those barriers. Some of the definitions need improvement; some of the terms and the benefits need looking at.

In terms of our representation, there are also opportunities for improvement with ICBC. Doctors of B.C. has a liaison committee with ICBC. They’ve been very supportive of our recommendations. They have physicians that advise them on their committees, but they don’t have what we would call a chief medical officer. That’s one of the recommendations that we’ve made. We think they could benefit from some of the other approaches that WorkSafe uses in terms of how they have physicians on staff to inform things.

But a lot of it comes down to…. This is an organization that is new to this area when compared to other organizations, and they are learning. They’re making mistakes, but they’re learning. What we need to do is to be able to add that flexibility so that when a physician is advocating or prescribing a type of treatment, we have to listen to the people who have 12 years of medical training in these areas to respond to those areas. So there is work to be done.

Brennan Day (Deputy Chair): Thank you for that response. I think it’s encouraging to see that at least there is a bit of back and forth there and that you feel reasonably represented.

I guess I’ll move down to the catastrophic injury portion because I do believe that’s one of the big unknowns where there’s obviously some concern. We’ve got a lot of submissions from people that struggled with that system because when you have a catastrophic injury, it is hard to be a self-advocate.

Where do you see the biggest improvements being made in terms of things like brain injuries and what we would consider hidden injuries that come out of this? I know even under the old litigation system that was extremely hard to quantify with just a set number, and the treatment can go on indefinitely in some cases.

I know I’ve seen your recommendations in regards to limits and things of that nature for the ongoing treatments. Where do you see that going to make sure that those people don’t slip into the cracks, effectively, being in sort of an indeterminate grey area?

Kaila Holtz: I think what I’m hearing and seeing is that with those invisible injuries or injuries where there there’s an unclear trajectory, there can be delays in approvals because we’re hoping for recovery and the client hasn’t met maximal medical recovery. So I think there is some work to be done in severe injuries where patients are hospitalized to better understand, usually from the physiatrist, what we’re expecting for recovery and then act on our opinion of what the patient’s prognosis is.

I’ve also heard that a big sticking point is home care and nursing services and who the first payer is and who the second payer is. You can imagine that if you had a very significant change in function and you were having to go home and have nursing or home support or a specialized piece of equipment and it wasn’t clear in terms of who was paying, that would cause patients a lot of distress. So I think in that early part of a severe injury, that’s where we need to have a more consistent approach for hospitalized patients.

G.F. Strong seems to have figured it out, but there are several other hospitals and major centres where these patients would be admitted to rehab that need the same attention.

Brennan Day (Deputy Chair): This is a quick one. Does Doctors of B.C. believe that there’s enough flexibility within the current system that if there is a change in an individual — it immediately looks fairly minor, and they get treatment quickly with less paperwork — that if that changes over a period of months or a year, there’s enough flexibility to get that person into a better-funded stream, or do they just sort of get left out?

Kaila Holtz: Yeah, you’ve highlighted a massive challenge with this legislation. It’s that we’re reliant on the MSP system where specialists’ wait-lists are getting longer. The client might know, the family physician might even know, but the recovery specialist is going to be waiting for a specialized services report form or a CMA or an IME, and that can take some time. So you’ve identified a critical gap. How do we get patients seen by specialists like myself sooner?

[9:10 a.m.]

I think there are some solutions certainly on the ICBC side, but there also need to be some solutions on the MSP side for wait-list management.

Robert Hulyk: I would just tag on to that. If you consider our recommendations to implement them, we’ll be on the road to where you’re talking about.

Stephanie Higginson (Chair): Okay. As the person who has to keep this all on time, I’m going to end our questions now, and I’m going to thank you for your presentation. I want to thank the Doctors of B.C. for being collaborative partners. It’s apparent from your submission report and from your presentation that you’ve been great partners with ICBC in the implementation of the enhanced-care model, and I’m encouraged and hopeful that that continues.

With that, I will thank you for your time today and for the care that you provide to people across the province. Thank you for coming.

We’ll have a quick seat change to our next presenter, which is the Occupational Therapy Association of B.C. I’ll ask my colleagues to remain seated while we do that. It’s just going to be quick.

Okay. Our next presenters are the Occupational Therapy Association of B.C. We have Tanya Fawkes and Tricia Earl.

I will turn it over to you for your presentation. Then we have 20 minutes for questions after. Thank you.

Occupational Therapy Association of B.C.

Tanya Fawkes: Great. Thank you.

Good morning to everybody. Thank you for giving us the opportunity to speak with you about how enhanced care is going. As you said, my name is Tanya Fawkes. I am an occupational therapist and one of the founding directors of Occupational Therapy B.C., the professional association representing occupational therapy in British Columbia. We also go by OTBC.

I am particularly pleased to be here with all of you, as I was involved in the early days of consultation related to enhanced care in my past role as the regional director for our B.C. chapter of our national association. So this feels quite full circle for me.

Sitting beside me is Tricia Earl. She, too, is an occupational therapist and a leader in our professional community, and she’s also one of the founding directors of OTBC. There are five of us that have founded this organization and represent the voice of occupational therapy in B.C., and we’ve all been involved in leadership positions both provincially and nationally. We’re sitting here today with you as the voice for occupational therapy in British Columbia.

We are aware that you have all had a chance to review our written submission, and so we plan to use this time here to share our thoughts on the main issues that can benefit from continued improvement.

Before we dig in, we’re well aware that many people, likely including a few of you, don’t fully understand what OT is. Occupational therapy is the only profession that works to help people recover and return to their full spectrum of functioning in their work, home and daily lives. We address the physical, emotional, cognitive and environmental aspects of rehab and recovery to help people get back to all the activities that they want to, need to or enjoy doing.

As you can see in our submission, we do think that the process and procedures have become smoother with enhanced care in many ways, and ICBC is continuing to participate in meaningful consultations with the professional groups to ensure ongoing improvements that are relevant and applicable for both the clients and professionals working in the system.

We do have concerns and suggestions for the care pathways that ICBC customers — a.k.a. the humans injured in motor vehicle accidents — need.

OT has had a long-standing, valued relationship with rehabilitation for ICBC customers with the most complex functional impairments. Despite our direct value to support these people with returning to their daily lives, a core goal of enhanced care, they do not have easy access to us. We are the only regulated health professional without pre-approval, and ICBC has stepped back from a long-standing practice of connecting customers to OTs when they need them. We believe this is in contradiction to section 120, which requires ICBC to ensure every customer is advised and receives all the benefits they are entitled to.

As someone who was involved in that early consultation, this was the clause that made health care providers at the table feel more okay with the removal of the formal advocates from the system. ICBC would be sure to provide all the services and health care needed.

The layperson doesn’t always understand the benefits offered by occupational therapists to help them return to their daily lives. The debate about the definition of “directing care” is ongoing.

A family physician referring someone to a physiatrist or a physiotherapist is identifying a need for an assessment. They do not direct the clinical professional judgment about the assessment and how it is conducted or what clinical findings are reached and what the recommendations are.

[9:15 a.m.]

An insurance company can send an insured person to a collision shop to assess the vehicle damage. The insurer does not tell the mechanic how to diagnose the problem or how to fix it.

Having ICBC recovery specialists recommend a client for occupational therapy assessment is not directing care. Having referral indicators for an OT assessment from ICBC recovery specialists is following enhanced care.

Tricia Earl: Thank you for the opportunity to speak with you today. As you examine British Columbia’s motor vehicle insurance system, I would like to ask you to consider one question. Does your current system reliably identify what an injured person actually needs to function safely at home, at work or in their community?

Enhanced care has created important early-access pathways. During the first 12 weeks following a crash, an injured person can directly access physio, chiro, massage, kinesiology without prior approval from ICBC.

Occupational therapy can also be funded, but it sits outside the automatic early-access pathway. ICBC currently advises customers to speak with their recovery specialist when their health care provider or themselves feel like they need an OT. I want to illustrate why this distinction matters through three people.

First, imagine this is your mother. Your mother is struck by a vehicle while walking to pick up your father’s prescription. She fractures her right ankle and her left wrist. She lives with your father in a typical B.C. home with multiple stairs just to get through the door.

The hospital treats her injuries and determines she is medically stable for discharge. But being medically ready to leave the hospital is not necessarily the same as being functionally ready to go home. How does she get in the house? How does she go up the stairs? How does she use a piece of mobility equipment or a walker with a fractured wrist? How does she get on and off the toilet? How does she prepare meals?

The hospital team recognizes these issues but cannot connect with ICBC in time to arrange for the necessary community supports before discharge. Now you take a day off work, and you find the borrowed equipment, and you try and figure it out yourself.

That isn’t primarily a treatment problem. This is a transition-of-care problem. The question for the system designers is: why should access to the assessment depend on someone successfully obtaining authorization through a very narrow hospital discharge window?

Now let’s consider a very different person. A 43-year-old nurse is rear-ended while driving home from a camping trip. She has neck and back injuries and a concussion. She doesn’t require hospitalization and appropriately accesses pre-approved physio, massage and chiro treatment.

She is having difficulty tolerating the physical and cognitive aspects of her nursing job. Her problem is no longer pain. Sitting and standing for prolonged periods of time aggravate her symptoms. The light, noise and pace of the workplace increase the concussion symptoms. She is trying to stay at work, but the interaction between her symptoms and the demands of her occupation becomes the barrier.

This is where the design of the system matters. The system has successfully provided treatment, but who identifies when the problem has shifted from treating the injury to restoring function?

She should not have to know which professional assesses the interaction between a person, an environment and the demands of the work. The system should recognize this as an indicator. This person is struggling to return to work and stay at work despite accessing treatment. That could also consider an occupational therapy assessment. This isn’t directing care. It’s designing a recovery system that recognizes when someone’s functional recovery has stalled.

Finally, consider a self-employed father driving home from Whistler with his son. He swerves to avoid an oncoming vehicle, rolls multiple times and lands upside down. He, too, is mildly injured but trapped in a vehicle, listening to his injured son scream while they wait two hours for emergency services to extract them.

His physical injuries may improve, but what happens several weeks later? He cannot sleep. What happens when he avoids driving altogether; when he cannot tolerate his son being in a vehicle; when, as a self-employed person, those symptoms begin affecting the ability to operate his business and support his family?

He may not know those are issues that should be raised with ICBC, and he certainly may not know that occupational therapy can address how psychological and cognitive symptoms are affecting his daily routines, parenting, driving, community participation and work.

Again, the problem here isn’t necessarily the absence of benefits. The problem is whether the system recognizes the need.

[9:20 a.m.]

These are three very different people, but they expose the same system-design issue. Our system should not depend on an injured person knowing which health professional they need before they can access it.

So perhaps the question isn’t simply: is occupational therapy covered? The most important question here is: how does the system identify the people who need it?

There are practical ways to address this. Hospital discharge that involves significant mobility or self-care barriers could be an OT referral indicator. Difficulties staying at work or returning to work after several weeks could be an OT referral indicator. Persistent difficulties with cognition affecting parenting, driving, daily routines could be an OT referral indicator. And where the hospital has already identified these functional needs, there could be a clear pathway to community OT rather than requiring the individuals to begin the process after discharge.

This does not mean that every person in a motor vehicle crash should receive occupational therapy. They shouldn’t. It means that the system should be designed to recognize the functional problems when they appear and connect those individuals with the appropriate professional. That is the opportunity here before us — not simply to add another service, but to design a motor vehicle system that identifies early need, connects care more effectively and measures recovery by whether British Columbians are actually able to return to their lives.

Occupational Therapy B.C. is looking forward to continued work with ICBC’s claims program and strategies team on enhancing British Columbia’s experience that can help the ICBC customers link to occupational therapy services and return to their daily living.

Stephanie Higginson (Chair): Thank you for your presentation. I’m looking to my colleagues for questions. I’ll start with MLA Blatherwick.

Jennifer Blatherwick: Thank you so much. Incredibly informative. I think your point is so valid that most people do not understand the function or the capacity to change their circumstances that an OT can bring.

What I’m hearing is that it’s not just the patients, perhaps, who don’t have that knowledge to just go ask for an OT or to know when they would need one. It’s that the system itself sometimes doesn’t understand where that can come in — that there’s a little bit of, maybe, siloing of care.

This also sounds like an education piece as well as a system piece. You’ve been working with ICBC, and that’s fantastic news. How has the…? During the time that you’ve been working with them, have you seen a significant shift in education and understanding within the system?

Tanya Fawkes: I’ll start. It’s an interesting question. Historically I do wonder about if it is an education problem, because clinically we worked with ICBC for decades — 1970s, I think — in a rehabilitation capacity. Certainly, in-house, ICBC has an understanding of the value and importance of occupational therapy in the recovery of people who’ve been in motor vehicle accidents. And since then, certainly in the early consultation days, there was lots of opportunity to try to develop processes and procedures of OT referral.

In fact, when the transition happened, occupational therapy was removed as an automatic kind of approval or availability, and it was removed as one that people could…. It used to be that the ICBC adjusters, in the old days, had a roster of OTs that they worked with, and they knew what specialties those OTs covered. They would refer their brain-injured client to the neuro OT or the spinal cord to the spinal cord OT.

That did exist in ICBC pre enhanced care, and it’s changed since enhanced care where those processes don’t happen anymore. That’s one gap that we think is a confusing one.

That said, working with them since the time of enhanced care, they do participate well in consultation, and we are constantly at the table and working with them to help educate within the new way that they’re doing the policies and procedures.

Tricia Earl: I would agree, as one of the liaison committee members with ICBC. I will say that the work that we’ve been doing with the claims program and strategies teams has been excellent.

One of the things around access, in terms of looking at the indicators for OT referrals, has not resurfaced itself, and I feel like that might need to be the next project.

[9:25 a.m.]

What I mean by that is developing strategies. I’ve heard from the Doctors of B.C. where they’re getting reports that are streamlined. I know that one of the reports has: “Has the client returned to work, yes or no?” If that is a no, and that’s maybe like 45 days post-crash, is that not just an indicator to engage an occupational therapist? Because we know what the detriments are when somebody does not return to work and the level of disability and the burden on our system that can create.

So looking at what already is existing in the system — with the physio reports, our physician reports — but also an indicator with ICBC. They pay wage loss for people who aren’t at work. That is an indicator itself. Should somebody still accessing wage loss be an indicator to have that support?

But I’m looking at practical ways that exist in our system that could then trigger that referral to reduce the long-term disability of our people involved in crashes in British Columbia.

Jennifer Blatherwick: Thank you. When I was speaking of education, I wasn’t actually thinking of ICBC. I was thinking of the broader medical system, like specialists and doctors knowing: “When do I recommend to my patient that it’s time?” Or even people who are the client, of understanding the function and the utility of having an OT.

I think that your point was so valid that everyone knows: “Oh gosh, my back hurts. Time to go to a massage therapist.” I would not necessarily, if recovering from an injury, immediately think: “Gosh, there’s a function here for a professional who has a depth of experience that could advise me on how to adapt my living or working conditions to facilitate a better recovery.” I really am very appreciative that you came today, because I feel like this is a little piece of that education right here.

I’m wondering. You said that you were integrated into the ICBC system before. Has there been any shift within the medical system itself? For instance, when there is discharge. Over time, have there been times where it was better or different? Are there areas in the province where there’s a better system of referring people to an OT at discharge?

Tricia Earl: I would have to say…. As an occupational therapist who takes on clients who are being discharged from G.F. Strong, that was mentioned at Doctors of B.C., as well as my local Nanaimo General Hospital, I would have to say early identification, so not the day that: “They’re discharging today at noon, please go in and help this client.” I think that access issue is difficult, and that’s what I mean by these indicators need to be almost already embedded into the system.

But that would be my example there, is that yes, have I seen any improvements? I do believe that there have been improvements with ICBC putting together a hospital discharge team, and the processes and procedures are much clearer for occupational therapists, thereby the customers that receive that. But we still struggle with the early identification and bringing that community clinician to transition over.

Tanya Fawkes: We did hear from our…. To your point about the provincial differences. We, obviously, consulted with our leaders from different health authorities. It’s a consistent issue across the board, that there’s difficulty sometimes with the timing and the process by which…. It’s a 24-hour system for the hospital discharge program at ICBC, but the hospital runs on: “You’re going home at two o’clock this afternoon.” That is the crunch, that there’s not quick enough turnaround to be able to access that all the time. Sometimes; not all the time.

Brennan Day (Deputy Chair): Yeah, very timely. I had a constituent that had a major car accident in Nanaimo. Not yet ambulatory, got discharged with no ride home, no assessment at the house, in a panic. It took concerted pressure at the ministry level to get people on it quickly, which, obviously, shouldn’t happen.

I guess my question is: what is the missing link that you see when it comes to those types of discharges? How do we see that pre-approval happen earlier? In this particular case, it would’ve been obvious to everybody — she was in hospital for a considerable period of time — that she was going to need those supports.

What do you think is stopping that OT engagement far earlier on in the process in terms of ICBC pre-approving that assessment, which should be going on in a parallel line with her stay from the hospital? We have an overcrowded hospital system. Those beds are valuable. Getting people home and into care is critical for the entire system to function. Where do we go from here?

[9:30 a.m.]

Tricia Earl: Great question. I think it’s the identification. When somebody comes in, especially if they have a catastrophic or let’s just say complex injury, they’re coming through an ambulance or they’re coming through the emergency room system. That’s actually where the identification of care needs to happen.

It needs to be a trigger between ICBC and the emergency room team to actually have that in place, because that happens on the weekends. People get in accidents on Fridays and Saturdays and Sundays. Sometimes it takes a delay for us to respond to those pieces. My thought is that we need to work on that communication between the hospital and ICBC.

Our occupational therapists are likely to be involved in hospital for that person’s care for them to have some direct access to ICBC to ensure that that information is being transitioned and a referral is going out so that that person isn’t left with trying to find their own taxi in a wheelchair, didn’t have to access handyDART before, didn’t have to call early for a wheelchair taxi in Nanaimo. They have care in place, and the equipment is actually there when they arrive so they’re not sitting in a wheelchair that was provided by the hospital.

These are the things that…. I think you have hit the nail on the head. It’s got to be early communication of the client’s needs right from the time that they step foot in the hospital.

Brennan Day (Deputy Chair): My last question is very similar to the one before because I think…. I’m coming at this committee with putting patients first. I think, just based on the bureaucracy, that that isn’t necessarily how it’s looked at.

Does your organization, Occupational Therapy association of B.C., feel adequately represented within ICBC when it comes to advocating for these things? Are you in the room when these discussions are being made? It was good to see that Doctors of B.C. feel like that relationship is improving. I would just like to get your perspective on whether you guys feel adequately represented there to push for these changes.

Tanya Fawkes: I think that is an interesting question. I think that yes, we have been invited and welcomed into the rooms to have the conversations from the get-go, like before it happened. I think sometimes….

I’m with you. I lean towards what’s happening to the people that are getting injured in motor vehicle accidents, and I think that initially that drive was there. I think over time, there has been a shift, as you discussed with the doctors. There’s a balancing act between saving money and providing care, and that is always kind of going back and forth.

I think at times it has felt like it has not been heard all the way through. These indicators for care have been discussed. With the idea, obviously, from an OT brain…. We’re thinking of ICBC’s issues too. So we’re trying to navigate and mediate between those two pressures.

I think that yes, we have been welcomed in the room. I think it’s improving in the last year and a half. I would say it’s improving as far as being heard with what needs to be done.

Tricia Earl: Absolutely. But what I would add to that is that the question about how to access right from the get-go…. I have not been involved in conversations directly with ICBC but would absolutely welcome the conversation to say how we get an OT referral in when we know that person’s going to have mobility issues. They may have environmental issues, so on and so forth.

I haven’t had that direct conversation. I will say that the hospital discharge team has engaged occupational therapy in conversations about how to access care faster. An example of that would be that they give us pre-approval for, now, a larger number of hours because every situation is different, versus a very prescribed…. It has almost doubled the number of pre-approved hours, which allows us to be more fluid and flexible to the situation that we’re dealing with.

I would say that on the back end, when the referral has been made, there has been some significant consultation and, I think, great improvements in that area. I think we could probably have more consultation on the front end.

Stephanie Higginson (Chair): I don’t see other hands. I have a question. It’s sort of in the tension. I think you identified it, as well, in your submission, which is….

Our job is to review the legislation and make recommendations on that and try to wade through the number of submissions, from my perspective, about what is actually a legislative change versus what is actually a claims process change. The same sort of interface that’s happening as I’m listening to you talk a little bit about the hospital discharge team….

[9:35 a.m.]

I also experienced it with a constituent who had an accident, which was not motor-vehicle-related but an accident. An elderly patient was sent to the hospital, discharged but no OT at the time. I’m wondering if this is sort of a systems issue. I have similar stories to yours, but they don’t involve a motor vehicle. They have somebody being discharged quickly for the reasons that MLA Day talked a little bit about.

I’m trying to determine, and I’m looking to you to talk to me a little bit about where the ICBC interface is in this particular discharge. Is it that you think that because ICBC has the mandate around enhanced care, if it’s an accident, there should be a flag for an OT upfront? Does that lead to a different level of care for people who arrive in the emergency room from an accident but not a motor vehicle accident, if that trigger is not there, just because it’s an ICBC interface? Does that make sense?

Tanya Fawkes: Totally. It’s a good question. We’re going to avoid going all on the soapbox. You’re right. If you just tripped and fell right in front of us, you might be covered by WorkSafe. If you tripped and fell when you left your house this morning, you would go to emerg, get your broken ankle dealt with. You could be like the pedestrian-struck lady that we brought up, and you’d be on your own, because you don’t.…

In our health care system, the community-based OT is a triage system for dealing with the hottest fires. To Mr. Day’s point, it’s the ones that cost the most money if they’re coming in and out of acute. So you’re not going to get a community OT, if you trip and fall when you’re leaving your house this morning, on discharge. But you pay insurance, and you should have access to the care that you need to be able to get you home if you were hit by a car. We live in that system with everything, right? It happens.

WorkSafe would cover you if you tripped walking across the floor right now. You would get access to that occupational therapist as you’re leaving the door, because that’s what you pay your insurance for.

Tricia Earl: I will add that I know that Doctors of B.C. spoke around the fact that that program is quite good when they’re coming from G.F. Strong for catastrophically injured claimants. I will say that I’m involved at G.F. Strong as the community therapist, sometimes months before they discharge, so that we know what they’re facing when they get home.

I think my point was to say that just like the Doctors of B.C., this needs to be, I guess, duplicated in other regional hospitals so that these people who are insured, that we’ve paid for insurance, have that access earlier on.

Stephanie Higginson (Chair): Thank you. That really helped.

Other questions from my colleagues? No?

Okay. We really appreciate your time. Thank you for your comprehensive submission and actually taking the time to come here to present to us. It’s really beneficial.

Our next presentation is from the Physiotherapy Association of B.C. We have Andrea Burton and Neil Nijjar.

I will turn it over to you for your presentation.

Physiotherapy Association of B.C.

Andrea Burton: Thank you so much for the opportunity to speak to you today. I look forward to sharing the ideas and thoughts of some of B.C.’s physiotherapists with you. And I welcome Neil, who’s not only on our board of directors but is also a physiotherapy clinic owner, and he works with ICBC patients and ICBC staff on a daily basis. So I think he’ll be very helpful when it comes to questions in particular.

[9:40 a.m.]

The Physiotherapy Association of B.C. represents physiotherapists — obviously, important partners in helping British Columbians recover following motor vehicle collisions. We support — actually, most of our members would say they support — the objectives behind enhanced care: timely rehabilitation, fewer barriers to care, improved outcomes for injured British Columbians and a system that remains sustainable over the long term.

I know it’s not in your purview to talk about this today, but I would say ICBC is doing better than WorkSafe on most of those things right now. So score for ICBC.

We’re five years into enhanced care, and we really welcome the opportunity for a meaningful review of what’s working and what could work better.

Our recommendations are actually not about removing appropriate oversight or abandoning the sustainability objectives of enhanced care. They’re really about making sure the system supports good rehabilitation rather than inadvertently getting in its way.

Our first concern. I’m sure this came through loud and clear in our submission, but we don’t love the way this review has been framed. Asking physiotherapists, or members of the public for that matter, to comment on parts of the Insurance (Vehicle) Act is really challenging. Legislation, as you know, contains very broad legal language, and it doesn’t necessarily reflect what patients and providers experience every day or what they know.

Our members have some really great stories about what is working well under enhanced care, and they have some great constructive suggestions about what needs improvement. We would love to know that the committee is going to hear both loud and clear.

Our first recommendation, I think, is pretty simple. I know that you’re doing this, and just in the nature of what I’ve read of the submissions, you are talking directly with some of the health care providers and patients. I know your mandate is to look at the wording of the legislation, but this is so much more than that. So I really welcome any opportunity to have a broader conversation.

The legislation is the framework, but what ICBC is doing within that and what the processes that are put in place are — that’s where the rubber hits the road for most of our members.

The act establishes an entitlement to necessary health care and rehabilitation benefits. That’s great, but the patient experience can be really shaped by the regulations, the policies and the administrative processes that sit underneath the legislation.

Patients, as you know, receive an initial block of pre-approved physiotherapy. After that point, any further ongoing treatment is sought through extensions. Although extensions are available, patients can experience uncertainty or interruptions while decisions are being made about whether they do get continuing extensions.

For someone recovering from an injury, that gap in treatment can be significant. It can interrupt their rehabilitation, it can prolong their disability, and it can affect recovery. The question we encourage the committee to consider is really: are the processes used to administer enhanced care helping injured British Columbians to access the necessary rehabilitation they need when they need it? I think we would say “sometimes,” but there are probably ways that the processes could be improved to make that a little bit more beneficial and supportive of the patient’s needs.

Another issue that our members raised is the emphasis on demonstrating functional improvement. The act speaks to whether care is necessary, but it doesn’t define “recovery” as simply reaching a certain level of function or a functional plateau. In practice, treatment can end when someone reaches functional stability, even though that person continues to experience significant symptoms, impairments or limitations.

There’s a connect there. A person can be functioning. They can be back at work. That doesn’t necessarily mean they’ve recovered. We actually think the system should consider the durability of recovery. The goal should not simply be short-term functional improvement. That is a goal, but it shouldn’t be the only goal. It should really be helping people achieve the greatest sustainable level of function, independence, participation and self-management possible following their injury.

A system that stops care too early can achieve a short-term reduction in treatment utilization, but that can contribute to recurrence, incomplete recovery or a later need for additional care if that treatment is stopped too soon. We would like to see some greater clarity and transparency around the goals of rehabilitation and the standards used to determine ongoing eligibility for treatment.

I will just put a little side note in here. This is an ICBC thing, but we need to know that there’s consistency, as well, amongst the recovery specialists so that when one person gets an extension and the next person doesn’t, it makes sense. They’re not the exact same situation, and it’s just based on the person who’s making the determination.

The other issue that we think really looks at deserving attention — I know this has been brought up already this morning — is who’s actually responsible for coordinating a patient’s overall recovery? If you look at enhanced care, it can be physiotherapists, physicians, kinesiologists, clinical counsellors, occupational therapists — a whole bunch of providers. They often work in completely separate settings.

[9:45 a.m.]

There are some mechanisms that are intended to support collaboration, but there isn’t one person responsible for bringing that plan together. Fairly often the patient becomes the coordinator of their own health care team. They are expected to carry information between providers, explain recommendations, communicate changes in their condition, navigate ICBC’s approval processes. All of this is happening while they’re recovering from an injury. That’s not an ideal model of coordinated rehabilitation.

We would like the committee to examine how enhanced care could better support coordinated interdisciplinary rehabilitation without limiting patient choice or directing care. If there was better coordination, it could reduce duplication, improve communication between providers and, definitely most importantly, take some of the burden off of injured British Columbians who are just trying to navigate what is actually an incredibly complicated health care system.

That includes communication around treatment decisions. This is a practical problem for physiotherapists. When an extension is denied, reduced, suspended or cancelled, communication happens usually between the patient and ICBC. Oftentimes the treating physiotherapist has no idea what decision has been made. You can imagine the situation it creates. A patient shows up. They expect treatment. The physiotherapist realizes the coverage has changed, sometimes through the patient. They probably have received very little information about why, but they are then expected to explain a decision they did not make, about which they have very limited information.

There needs to become a better mechanism for communicating treatment decisions, to authorize providers with appropriate privacy protections. It would improve continuity of care and reduce confusion for everyone.

This is probably one of the top things that we discuss with our colleagues — doctors, occupational therapists and others — when we talk about how frustrating it is. If you’re a physician, you have no idea how many additional providers your patient might be seeing. If you’re a physiotherapist, you have no idea what the diagnosis is the doctor has said. There’s no access to treatment plans across the system, so everybody is a little bit in the dark, and you’re relying on a patient to give the information.

As someone who is not a physiotherapist but has certainly spent time with a physiotherapist, I can tell you the physiotherapist says that I hurt my shoulder, but all of the language around that…. My doctor would say: “Ah, this is what we need to look at.” I’m sure the physiotherapist told me, but I don’t remember it because I’m not a physio. Somehow we have to get that communication easier between providers.

The problem when we don’t have that is that there’s a substantial administrative burden associated, particularly, with treatment extensions. Physiotherapists…. I totally get that you need to demonstrate that treatment is necessary and that there’s an importance of responsible stewardship of system resources, but providers are not always clear on what information decision-makers require.

Clinicians may document pain reduction, functional limitations, the ability to be at work, the ability to perform daily activities, but they still have questions about whether that documentation meets the criteria for an extension. This can lead to repeated requests for clarification, inconsistent experience and additional administrative work.

I’m just going to put this little piece in there to say that physiotherapists are not paid by ICBC to do treatment plans. It’s currently a conversation with ICBC. It can be quite a few additional hours of time each week that physiotherapists are basically working for free to write treatment plans. I don’t like that, as you can imagine.

We actually encourage ICBC to identify administrative processes where the outcome is routinely predictable, including some coordination of benefits requirements, and eliminate the unnecessary verification steps that delay care without meaningfully contributing to decision-making. Clearer criteria, greater transparency and simpler processes would help patients and would certainly help providers, including physiotherapists. I actually think it would probably really help ICBC. Providers need to understand what information is required, and patients need to understand how decisions about their treatment are being made.

We also would encourage consideration of how information moves between professionals, as I said. Care can be provided across multiple settings, record systems, reporting processes, so the information is fragmented. Sometimes you have duplicated assessments, inefficient rehabilitation planning. Any solution has to protect patient privacy. We certainly understand that, but we do think there’s an opportunity to improve appropriate information-sharing between providers.

[9:50 a.m.]

We would love even just to see treatment plans, whether they’re written by a physiotherapist, an occupational, a massage therapist. We’d love to see those treatment plans made available to the entire health care team so they can understand what each of the different providers has done.

We’d also like to raise the current definition of “catastrophic injury.” We certainly recognize there’s a member’s bill before the Legislature proposing changes related to the definition and eligibility for catastrophic injury benefits. This is great, that this issue is receiving attention, but we don’t think that the proposed amendment goes far enough. There may continue to be people living with profound, permanent and life-altering injuries whose circumstances do not fit within the definition of “catastrophic injury,” despite the significant impact those injuries have on their function.

We would like the committee to look beyond the specific amendment that is before it, whether or not the member’s bill passes. I think it’s pretty limited, so what we would like to suggest is that the committee actually ask ICBC to undertake a broader review of the definition of “catastrophic injury” and the criteria used to determine that. That review would consider whether the definition captures the range of injuries that can result in substantial, lifelong rehabilitation.

From a physiotherapy perspective, the important question is not simply whether an individual meets a particular impairment threshold; it’s whether the framework recognizes the real-world, long-term consequences of serious injury on function, independence, participation and quality of life. This is an opportunity to examine that question.

If we left you with four things, it would be to really think about whether there’s an additional component of this consultation that evaluates enhanced care as patients and providers actually experience it — and maybe not limit it entirely to particular sections of legislation. I don’t know about you, but I don’t think most people really understand how to read it. It’s really about what’s working, what isn’t and what could improve.

Improve the transparency, communication and coordination so that patients and providers really understand how decisions are made, what evidence is required and what is happening when a treatment decision changes. Patients should not have to become the primary coordinators of their own rehabilitation, and by no means should we expect patients to be able to provide information to their doctors and others about what a provider has said.

Third would be to focus on the durable recovery and access to necessary rehabilitation. It’s not whether someone demonstrates incremental functional improvement. It should support sustainable recovery, independence, participation, quality of life. Again, we would suggest that this is a good opportunity, whether the member’s bill passes or not, to really examine whether the current definition of “catastrophic injury” is appropriate.

Physiotherapists, by and large, want enhanced care to work. We have a lot of positive things to say about it. You might be surprised at how little there would be complaining about what’s going on with ICBC. People are pretty happy with it. We don’t want to come with a list of problems into any consultation. There are things that we view positively. We think there are some practical opportunities to make it better.

Good rehabilitation and system sustainability should not be and are not opposing objectives. A system that provides the right care at the right time with good coordination and fewer unnecessary administrative barriers would support patients while also making better use of health care and insurance resources.

This front-line experience that we have…. I absolutely want to acknowledge and appreciate the value that we have had in working directly with ICBC on how they interpret the legislation and how they put it into practice. I consider them doing a great job right now, and I really value our relationship with them. So I think it’s tweaking and really looking at how we can answer the questions of the things that could probably be improved as we move along.

That’s it for me, but Neil and I are happy to answer questions.

Stephanie Higginson (Chair): Okay, thank you. The presentation was just a little bit over, so our question period may be a little bit shorter. I know we’ve got a recess after this, so maybe we can cut into that a little bit.

I will turn to my colleagues for questions.

Brennan Day (Deputy Chair): I think physiotherapy is one of those often missed opportunities for people that are recovering. I know my mother-in-law is struggling right now with a permanent back injury from a bike crash a number of years ago, and currently she’s bed-ridden. Physiotherapy is the only thing that’s getting her out of bed, so I understand the importance of that. Also, the delays currently in the system for even getting basic imaging are putting a huge pressure on working people that need to get back to work to do their job.

I guess my question is…. Under enhanced care, patients get a prescribed number of pre-authorized physiotherapy treatments quite early in their claim, which I think is an improvement. But from your members’ experiences, what happens when a patient hasn’t recovered within that initial treatment window?

[9:55 a.m.]

What challenges do you have in extending those treatment availabilities, knowing that the rest of the system for specialist care and referrals often takes a considerable amount of time in the meantime?

Andrea Burton: I’m going to let Neil answer the second part of that because he deals with this daily.

I will say that the initial block of treatments are great, but one of the concerns that we hear regularly from physiotherapists, especially working in the space with patients who have concussions, is that the time limitations in those treatments don’t necessarily work for some people.

The day after you have your accident, you’re probably not calling a physiotherapist. Because you have a concussion, it can be weeks and weeks before you actually feel physically able to have that treatment. By then, you’ve blocked through quite a few, in the timing around the ICBC.

I’m going to let Neil speak a little bit to it, because he does deal with this on a very regular basis.

Neil Nijjar: Perfect. Thank you, Andrea.

When it comes to any extension blocks outside of the 12 weeks, my real-life experience is that the first one or the second one, which may then be an additional six to eight weeks, are generally pretty easy and positive to get from ICBC. But to your mention of the delays in our health care system with advanced imaging or referrals to specialists, those can take months and months.

You’re totally right that there are these kinds of…. I don’t want to call them pressures, but it’s harder and harder to get extra treatment the further you go down the line. There may be a patient who’s just waiting for a specialist appointment, and we’re just holding the fort steady until that specialist appointment comes.

I just had this last week, where I had a patient who was waiting for a physiatry referral. It took over six months. We finally got the referral with a plan of action, but now we’re following gaps in treatment and challenges with communication with the recovery specialists, and: “Why do we need more treatment now when you’ve already had six months of treatments?”

The real-life examples of the challenges of our health care system to get these things done in a timely manner and now balancing that with asks from insurance companies…. There are definitely gaps there and opportunities there for the insurance companies to help fill those gaps.

Hopefully that answers your question there.

Brennan Day (Deputy Chair): Yeah, thank you.

I guess my follow-up would be then…. With the patient-first intention of this legislation, one of the objectives is earlier treatment and better recovery.

Can you list some cases where the administrative rules of the reimbursement structure effectively discourage physiotherapists from treating those more complex patients, in terms of imaging delays or other barriers to getting that treatment first?

We know it’s important that this system gets people back to work and back to their lives as quickly as possible. If that’s the case, what would you change?

Neil Nijjar: When it comes to the barriers, going back to Andrea’s point of return to function versus return to baseline, I think one overarching principle that I hear a lot is when patients are being encouraged to accept a new normal. That tends to be the big barrier — where they’ve seen this, in their opinion, functional plateau. Then based on that plateau: “Oh, this is going to be the new normal. How can we work and manage around it?”

As much as it’s great to get that early access and initiate treatment early, more to Andrea’s point, not everyone is using that on day 2 or uses that allotment within that initial time period. They may not get to you; they may not have been able to see their primary care network health care practitioner for four or five weeks because of the shortage there. Then it may take a week or two to get in, so you’ve already eaten up half of your block before you even are able to start.

As much as “Hey, we have early access” is a great concept, in reality there are just lots of delays and gaps. Now as I need to ask for more treatment, there’s this: “Well, why didn’t this person use all the available treatments?” Well, how am I supposed to use all the available treatments when there were all these other circumstances that are cutting into that?

For me, it’s not so much that the early access period isn’t helpful. It truly is for a vast majority of people. It’s great that they’re able to get into our doors as soon as possible, but it’s just that that blanket doesn’t work for every case in every circumstance. Again, once we get into a period or a place where traditional recovery periods aren’t really being followed and now it’s taking longer than we think, those delays and burdens just build on top of each other.

[10:00 a.m.]

Stephanie Higginson (Chair): MLA Blatherwick.

Jennifer Blatherwick: Actually, my question was answered.

Steve Kooner: My question is to the gaps in terms of treatment and particularly the reference that was made. As time progresses, as patients have gone through a series of treatments already, it gets more difficult to get further treatment. That’s what was being referenced by Mr. Nijjar earlier. My question is to that piece of testimony today.

Perhaps Mr. Nijjar can let us know whether, in his experience and his clinical experience, as a result of the gap in getting further treatment…. Has that ever made certain patients relapse or certain patients kind of go back in terms of their initial results, in terms of feeling better? Has that resulted in patients worsening in terms of their condition, in terms of having to deal with a treatment gap or in terms of dealing with a treatment funding gap? Perhaps Mr. Nijjar can provide some insight into that.

Neil Nijjar: I would say absolutely we’ll see individuals regress from their functional state with a more prolonged gap.

Sometimes the gap is just a couple of days, right? I send in paperwork on a Monday, and it doesn’t get approved until Wednesday or Thursday. A small gap like that really isn’t going to create a regression.

But we’ve also had it where the recovery specialist is asking for an updated doctor’s note or increased information. Now we’re talking about two, three, four, five weeks. And as much as we try to give our patients the tools to be able to self-manage in that kind of gap period, there is a definite regression of their abilities. Sometimes that regression is a physical limitation, and sometimes it’s the mental burden of not being able to get treatment or having to kind of jump through all these hoops for additional treatment.

So I would absolutely say that as we do see some of these more prolonged gaps, you’re definitely seeing regression, people having to take additional time off work because they’re not able to sustain their function.

Steve Kooner: As a follow-up question: in terms of your clinical practice, how often are you seeing these cases of regression, like in terms of percentage of the files that you’re working on or the patients that you’re treating?

Neil Nijjar: That’s a bit of a challenging question. Anecdotally, I would say for individuals that do have a prolonged gap of more than a couple of weeks, the majority of them are regressing in some form or fashion. The amount of files that probably have those larger gaps, I would probably say are in the, oh gosh, 20 percent, plus or minus, type of idea.

Just for some context, in the office I’m at, we have over 20 practitioners across four different disciplines. So it’s kind of hard to say an exact number without me diving into it. But I would guess it’s probably around 20 percent of the files that will have some form of a gap, and the majority of the people in that gap will have some form of a regression of function or pain.

Stephanie Higginson (Chair): Okay, I have a couple of questions. I’m wondering. We’ve heard a lot about the various committees that ICBC has in terms of claims processing and improvement. I just want to…. And I’m sorry if you said this. We’ve had a lot of submissions. Are you part of all of those committees? Are you guys participating with ICBC in those processes?

Andrea Burton: We are, and really grateful to be. We’re part of the regular health care providers advisory group. We meet, I think, quarterly, which is also an important collaboration across professions because although we meet with ICBC quarterly, we also have the ability to talk to each other within the same context and group of people, even outside those meetings. So they’re very helpful.

We’re also on the injury recovery advisory panel, so that would be an opportunity for us to sit down and talk about what some of the things in the next year are — we just had this meeting — that we’d like ICBC to focus on.

[10:05 a.m.]

And then also we meet every two weeks with our — what are they called? — relationship specialists at ICBC, and then we can talk about specific things that have come up or that our members have raised that are issues.

So I feel…. I mean, I don’t know where the committee is…. We had a bit of a dust-up with ICBC a year ago over the new service agreement, which…. We did not support some of the things that were in it, but back and forth and eventually I think we’ve come to a very good place. So I feel quite connected with them. They also reach out and meet with us maybe once or twice a year, just privately between John and Perry. Yeah, I feel like we’re very connected with ICBC at this point.

Stephanie Higginson (Chair): You may have just answered this with the end of the sentence, and I have another question after this, but I’ll put myself on the list to my colleagues.

So this is a follow-up to that. All these committees that you mentioned, and this is sort of…. You’ve just added two more to the list that we’ve heard from folks today. Do you feel, and I think you may have just addressed this, that they’re effective in the work in improving ICBC’s processes to ensure enhanced care is happening for patients, or are you feeling like the committees are there, but nothing really happens to make the improvements that are necessary?

Andrea Burton: No, they’re working well. So I talked a little bit about our frustration with treatment plans and the fact that they are lengthy and often unhelpful for the physiotherapist, who is doing them for free, and the recovery specialist. Currently ICBC is actually working with us and has been consulting with us and our members on how to streamline those treatment plans and make them better for everyone but also not quite so time-consuming.

We had gone after some concerns around people who want to do locums. The ICBC requirement has been that you have to have a business licence in each city you want to locum in. Some of the municipal governments are months and months behind in providing business licences, so by the time the physiotherapist got the licence, they were no longer needed as a locum. ICBC has removed that.

So those committees really have been listening and moving forward with, as much as they can, making the changes. So absolutely feel like they’re very useful, and in fact, I have said to WorkSafe many times: “Could you not look at doing something similar?”

It’s a pretty good world with ICBC right now, and I really feel like they are listening and hearing what we have to say. So absolutely have no complaints about that. But there are a lot of committees. I’ll give you that.

Stephanie Higginson (Chair): Okay, I don’t see hands. I’m going to ask my second question, if that’s okay with my colleagues.

I don’t mean to put you on the spot, but I’ve heard this now — this might be the third time today — and through a number of our submissions from groups of health care providers, about this notion of coordinated care, and I just want to seek some clarity on this.

Is it true — am I imagining this? — that as a health care provider, you can’t actually see access to the patient’s or client’s ICBC files to see who else is providing care to the patient and understand it, and it’s just either up to the patient to tell you what other care they’re receiving, or it’s up to an ICBC person to tell you, but you can’t actually see it yourself?

Andrea Burton: That’s accurate. We recently had a physiotherapist upset that the patient had not received an extension when the physio requested it. And it wasn’t until we were able to go directly to our relationship specialist who was like: “Well, this person has had several hundred visits this last year between providers….” I think it was 400 and something, which is a lot. And if the physiotherapist had known that, it would have flagged to them that there’s something else going on, but they have no way of knowing that.

And I’ll often liken it and say to people that it’s one thing if you’re a patient in a hospital, your chart is beside the bed, and every provider that comes in the room writes something. But we don’t have that in private system, and that’s a lot of confidentiality and privacy. But I do think it’s something that is going to be required for ICBC to try to tackle — how to get around some of that so that providers have some information around what’s been done.

Physiotherapists are about to be given authorization, from what I understand from the deputy minister, to do diagnostic imaging, to make those referrals for imaging. So it’s going to be important that if a physiotherapist orders X-ray, orders CT, orders whatever, that the doctor can see that. But it’s also just as important that the physiotherapist knows if the doctor’s ordered it.

[10:10 a.m.]

So we need to do something better about some kind of communication system where people can see what others have asked for or diagnosed. Otherwise you’re operating in a vacuum, or as I said, you’re expecting the patient to be able to relay the information. I know I can’t relay the details of the rotator cuff injury I have. All I can say is that my arm hurts. I think most patients are in that boat.

Neil Nijjar: I was going to just quickly note that the only exception is if the providers are in the same office. For example, in my office, we have physiotherapists and massage therapists, so we can communicate because we’re in the same office. But if it’s not in the same office, there’s no way of communicating or knowing.

Stephanie Higginson (Chair): Okay, thanks for that clarification.

Jennifer Blatherwick: I really appreciate you providing the additional details.

We’ve talked quite a bit about someone who would be the point of coordination for the care and that it is not always appropriate or helpful for the client to be that coordinator of care. Now, there is the recovery specialist position within ICBC. Do you see the coordinator-of-care position being separate from that or connected to that? Give me some thoughts around what would be an effective model for making this work.

Andrea Burton: Well, that’s a hard question.

Jennifer Blatherwick: Sorry.

Andrea Burton: I don’t know. I mean, Neil may be able to add to this.

I don’t know what the absolute answer is but I can tell you that, for patients, it’s so complex for them to figure out how to navigate this.

Recovery specialists are humans, and they all bring different perspectives. I don’t want to criticize, in a way, to say that there are not times when physios probably say things to the recovery specialists that they really shouldn’t. And it goes both ways. So trying to figure out that relationship….

I know we talked with ICBC at length about how we make that better. The recovery specialists have access to information and can see information, but they can’t release that information. So a recovery specialist sitting there may think “this person has basically taken a full-time job of going to see physiotherapists every day, but there’s only so much I can release to the physiotherapist about that.”

I don’t know. I don’t know if Neil can add to that. I don’t know what a person is who looks like that.

One of the things that we feel is not taken advantage of…. ICBC does allow for care meetings between providers, but it’s very rare that those are requested, and you would have some professions say that they’re never included. So if a person is seeing a physiotherapist and an occupational therapist, a care meeting between those two may be obvious, but they may also be seeing an acupuncture TCM, and as far as our acupuncturist colleagues go, they’ve never been called to a care meeting.

So there’s still a gap in that collaboration and that conversation that’s happening. How you coordinate that…. I don’t know if it’s a whole other position, but there’s not that friendly face for the patient who, you know, at a time when they’re injured, is trying to navigate something that’s so complicated.

But Neil, do you have any thoughts on that?

Neil Nijjar: Yeah. I don’t think it actually needs to be a physical person rather than a space or a portal where we as health care providers can access to see all that information.

If we are looking for a model where we would kind of have a physical individual whose role this is…. Generally speaking, OTs fit that role to be able to be that kind of point person to help collaborate care, direct care — those type of things. But again, I’m not sure if it needs to be more so an actual physical individual rather than it needs to be a way for us to be able to access that information.

To Andrea’s point, yes, we have care plan meetings. I have a patient. I requested a care plan meeting last week Monday, so I’m at a full week without hearing back from the adjuster if they will accept my care plan meeting — let alone now trying to find a way to schedule it. Obviously, that tool that’s there for this purpose is not being utilized very well.

Back to your question of: who does this person need to be? Again, if we’re looking for a profession that’s probably best suited, it’s probably going to be somebody like a social worker or occupational therapist. But again, it doesn’t need to be a person. It can just be a process that allows us to be able to get that information and glean that information for the patients.

Stephanie Higginson (Chair): Okay, thank you. We’re at time.

Thank you very much for your presentation, for your submission and for answering questions with us. We appreciate the time that you’ve taken to try to help us improve this system to better represent the patients and the clients.

And with that, I think we’re going to take a short recess and return in about ten minutes.

The committee recessed from 10:14 a.m. to 10:28 a.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): Okay. I will call the meeting back to order.

We have a presentation, another virtual presentation, from Melissa Carr of the British Columbia Association of Traditional Chinese Medicine and Acupuncture Practitioners. If everybody is ready, then we will turn it over. Are all my colleagues ready?

Okay. Ms. Carr, over to you. Ten minutes for presentation and then 20 minutes for questions. We’re going to ask that you try to keep it to ten minutes, or I may have to interrupt you if you go too long.

Association of Traditional Chinese
Medicine and Acupuncture Practitioners

Melissa Carr: Great. Thank you very much for giving me the opportunity to speak today.

I’m speaking on behalf of the British Columbia Association of Traditional Chinese Medicine and Acupuncture Practitioners — ATCMA for short. We represent regulated TCM professionals across British Columbia.

Our members regularly treat British Columbians who’ve been injured in motor vehicle accidents. We work with patients in urban, rural and underserved communities and often as part of multidisciplinary rehabilitation teams.

ATCMA is the professional association working regularly and ongoing with ICBC to support the effective delivery of TCM and acupuncture care to people injured in motor vehicle accidents, including ensuring appropriate billing processes and fair compensation for the care provided.

[10:30 a.m.]

Overall ATCMA supports the fundamental direction of enhanced care. We support its focus on treatment, rehabilitation and recovery rather than litigation, and we’ve seen patients impacted from the benefits of earlier access to care.

We believe the system can work even better with some relatively straightforward changes. Our recommendations aren’t about changing the fundamental purpose of enhanced care. They’re just about making sure that the system is working better for patients and for the regulated health care professionals that are providing their care.

Just in brief, the things that we think are working well are that enhanced care has allowed many patients to access treatment without having to first establish fault, which gives them earlier access to treatment for things that are really important — like whiplash; soft tissue injuries; traumatic brain injuries; headaches; pain; mobility and functional issues, which means they can recover to their activities quicker; sleeping difficulties; stress and anxiety following a collision.

Acupuncture and TCM provide non-pharmaceutical treatment options. Patients often seek acupuncture because they want alternatives to, or reduced reliance on, prescription medications. TCM practitioners are distributed throughout the province, including in communities where rehabilitation resources may be limited.

Because we’re already part of the rehabilitation workforce in B.C., the question is: how can we make better use of that existing, regulated workforce?

We have three recommendations for the committee today.

The first is just regarding treatment plans. After a patient has an injury, they have 12 pre-approved acupuncture treatments within the first four months. After that, they are required to submit a treatment plan. These plans include the patient’s progress, their ongoing functional limitations, their treatment outcomes and the practitioner’s rationale for continued care. This report often takes us between 30 and 60 minutes to complete, and it is uncompensated, so we’re essentially volunteering our time to create this treatment plan.

It’s not uncommon for people to come in when they are many weeks into their injury. Acupuncture isn’t always the first treatment that they seek. When other sources are not getting them where they need to be, it means that we’re sometimes having to submit treatment plans after only seeing them a couple of times. As I mentioned, it takes a lot of time for us to do that. This can discourage practitioners from taking on ICBC patients, and it can also take time away from our patient care.

What we’re asking for is compensation for the treatment plans and also being allowed to submit for compensated…. There is another avenue that is compensated, and those are progress reports. TCM and acupuncture are not currently included in the progress reports.

The second recommendation that we would like is to give patients more flexibility to access their acupuncture treatments. As I mentioned, not every patient seeks acupuncture immediately after a motor vehicle accident. Patients often begin with other rehab services, particularly when their physicians are recommending things like physiotherapy first.

They may turn to acupuncture later because their symptoms haven’t fully resolved. The four-month time frame means that sometimes we’re seeing people quite late in that period. Sometimes a practitioner may have treated the patient only once or twice before the deadline for requesting the additional treatment plan. We don’t have enough clinical information to properly assess that and to give what the response to treatment is, what the treatment trends are, what the functional improvements are. It’s too early in the game.

This can unintentionally disadvantage patients who access acupuncture later in their recovery. They shouldn’t have less opportunity to demonstrate whether acupuncture is helping. We’d like to extend or provide greater flexibility around the time frame for which pre-approved acupuncture treatments can be accessed and allow for more flexibility to follow the patient’s recovery journey.

The third recommendation we have is to recognize the full regulated scope of traditional Chinese medicine. Acupuncture is one of the modalities that we offer, but it is not the only modality that we offer.

[10:35 a.m.]

Currently ICBC only covers the regulated scope for acupuncture-regulated health professionals, not the doctor of traditional Chinese medicine–regulated professionals and the traditional Chinese medicine practitioner–regulated professionals. We would like the full service, our full scope of practice of traditional Chinese medicine, to be included, which may include traditional Chinese medicine consultations.

A large part of this is because this isn’t the case with other professions who are covered for their full scope. A physiotherapist is able to practise to their full scope. The same applies for a chiropractor and an RMT. With those of us who are doctors of TCM or TCM-regulated practitioners, we are not covered for a full scope, only covered for acupuncture scope.

These are the three recommendations that we have. Again, those are to compensate for the required clinical reporting, compensate us for treatment plans, or allow us access to the progress reports. Increase our flexibility and treatment timelines so that we’re not limited as distinctly as we currently are without providing further treatment plan requests, and expand our coverage to the regulated TCM scope of practice beyond just acupuncture.

Thank you for the opportunity to present. I’m happy to answer any questions.

Stephanie Higginson (Chair): Thank you for your presentation.

I will look to my colleagues for questions.

Brennan Day (Deputy Chair): It sounds to me very similar to the physiotherapists, that there’s an issue in the delay to treatment. I would say that, probably, very likely, people wouldn’t do acupuncture before they maybe tried physio or vice versa.

In your mind, how do we see that window being extended through recommendations or legislative changes here in regards to the enhanced care package? What would give you the flexibility in what sort of period?

I understand the need for putting a reasonable limit on the time you can access care, right? You can’t go on forever, but what, in the mind of your organization, would be a reasonable time frame for that?

Melissa Carr: I think even six months would be an improvement. A lot of times when people are in an initial accident, they’re really just trying to sort out their….

It takes a long time, first of all. They often feel the need to go see their GP, and there’s a lot of delay in care for that. I think that a six-month timeline might be more reasonable. I do understand that we don’t want to extend it beyond.

I think that the bigger piece would be if there’s an avenue to just get the treatment plan. We don’t mind submitting documentation to show the need for this particular case needing more care. It’s just that the treatment plans…. I understand that ICBC is working on making it easier for us, but it’s uncompensated time. It’s time. Even if it takes us only 30 minutes and not the 60 minutes, it’s time that we have to take away from our work otherwise.

I think the biggest piece is probably the treatment plans — compensation.

Brennan Day (Deputy Chair): I guess as a follow-up, then, what, right now…? There are two that we can look at sort of side by side in terms of how they operate. WorkSafe is the other one.

What is your experience like with WorkSafe, and what can you apply from the way they handle it in terms of best practices that we could potentially apply to the ICBC model?

Melissa Carr: I would say that WorkSafe is more challenging for acupuncturists to work with than ICBC. They’re very limiting on how we can do care, of treatment. We really have to focus on one thing, which makes it very challenging when you’ve got a patient coming in with complicated issues.

I also think that the turnaround time and the reports and that are more challenging for WorkSafeBC than they are for ICBC. I think it’s probably the reverse. ICBC is easier for us to do the treatments and billing than it is for WorkSafeBC.

[10:40 a.m.]

George Chow: Thank you for the presentation. In terms of, as the previous speaker was asking the question…. Pardon my ignorance. Who actually determines that an injured person, particularly from car accidents, either go to physiotherapists or go to the acupuncture treatment? Is there someone who is actually directing this?

Melissa Carr: Good question. It’s usually patient self-directed. The great thing about enhanced care is the patient has access to 12 sessions immediately following an MVA. They have access to 12 acupuncture sessions during the first four months after their accident, so they have the opportunity to decide to go to acupuncture right at the beginning.

Often if they are already seeking acupuncture care and they’ve had conversations with their practitioner, they may seek care early. But for those who haven’t had an acupuncture session or don’t have an acupuncture professional that they’ve been seeing, they’re often thinking first to go to their physician, and they’re often thinking first to go to physiotherapy. The physicians usually guide towards physiotherapy — and understanding that they can do needling, but the needling is different than acupuncture needling.

It is up to my association to provide more public attention to the care. We have appreciated that ICBC has included us in the care that they do fund for. But the truth is that it is very hard for us to get the message out to the general public.

I think that if it were covered, our whole scope, that would be helpful, too, because everybody always thinks about acupuncture, and that’s the way the insurance billing is currently structured.

George Chow: So how does the treatment plan come into helping a patient in terms of, so you actually…? Like, the TCM doctors or acupuncturists will actually come up with a treatment plan? Do we send to ICBC, for example?

Melissa Carr: Yeah. Good question. We immediately can provide the care of those 12 sessions over the first four months. If we exceed the need for 12 sessions, if we need more than 12 sessions of treatment or if we exceed the timeline of four months, we have to contact ICBC’s recovery specialists with a treatment plan.

They have treatment plans that we complete. Those will include things like what progress we’ve seen, what the treatments we’ve done have resulted in, in terms of functional improvement — so a patient’s ability, for example, to work two hours at the computer screen as opposed to just one hour or to be able to carry their child that they couldn’t pick up after their accident.

Then we put in there what our goals are, how many more treatments we think we’re going to need and how many more weeks or months we think that’s going to take. And then we submit that, and ICBC lets us know. Their recovery specialists decide whether or not they approve it as is, deny it entirely or provide some sort of in between.

George Chow: So this is why you’re asking ICBC to increase that time from the four months to six months as a start, actually for coverage for acupuncture therapy?

Melissa Carr: The more time we have, the patient has, at the beginning to be able to access the care…. Because for simple injuries, it’s quite easy.

[10:45 a.m.]

For more complicated injuries, they often are not improved after three months. They might come and see us, and we’ve only been able to get in a few sessions. It’s not enough for us to be able to say where they are in terms of their progress and what we can expect in terms of goals, how many more sessions we think it’s going to take, how long.

The more time we have to be able to get at least a few sessions in before we have to submit the treatment plan, the easier it is for us to do that accurately.

Stephanie Higginson (Chair): I have a question, then, if no one else has one.

I think I’m going to start asking this question of all of the associations presenting because I find this quite a fascinating gap. It’s about the access to the ICBC patient or client file and being able to see all the practitioners that the patient may be accessing. I find it fascinating that the only person who has access to that file is an ICBC specialist who may or may not be trained at all in any medical profession.

I’m way outside my scope on all the legalities of privacy here, but would having access to the patient’s ICBC care file support your ability to provide your patients with better care when ICBC is part of the interface?

Melissa Carr: Great question. I do think that having access to that would be helpful, and I think it would…. I personally worked in a multidisciplinary clinic prior to my…. I’m currently working solo. I find that communication is…. I mean, communication is important — we know that — and having knowledge of who is doing what. Definitely it’s one thing to be able to offer practitioners to be able to email me if they have any questions or you send off reports to them.

But it’s really a lot easier if there would be one point-of-care access within the ICBC portal, as well as knowing how many sessions you’re in on your approved treatment series, because we have to track that individually. The practitioners are required to keep record of that. If it were through the ICBC portal, it would make it a lot easier for all of those pieces. It would be a lot easier to share reports, to be able to access things, like if imaging were there.

It requires, right now, for us to go through the patient a lot of the time. Especially if the patient is struggling with their health — they’ve had a traumatic brain injury, they’re feeling anxious or depressed, or they’re simply not managing their life very well because of the injury — it adds an added burden to the patient. Yes, I do think it would be helpful.

Stephanie Higginson (Chair): Thank you. There’s definitely an equity piece there when a patient has to manage it, particularly even if they had a pre-existing condition that may have been exacerbated or not by the accident. For them to have to manage it is…. It’s a lot for some folks. Some folks have better capacity to do that than others — recognizing that equity gap in this.

Other questions from my colleagues? No. Okay.

Thank you very much, Ms. Carr, for your presentation, for your submission and for spending some time answering some questions for us. I think the more presentations we have, particularly from the associations, we’re starting to see some themes developing here. I look forward to further communication with you.

Okay. Our next presentation is from the B.C. Association of Kinesiologists. We have Sarah Clarke presenting virtually to us.

You’ve got ten minutes for your presentation. Then we’ve got 20 minutes for questions. If your presentation goes over, at some point I may have to give you the hook. Just watch the time, and hopefully we’ll get through it in ten minutes.

Over to you.

B.C. Association of Kinesiologists

Sarah Clarke: Thanks so much. I appreciate the invitation to participate in this process, and I hope that I can provide some useful insights and information for the committee to complete their work.

[10:50 a.m.]

I wanted to start by highlighting from our submission that information from our members and things that we’ve seen in our discussions ongoing with ICBC since enhanced care has come into place is a great improvement in the access to early care for injured people post-MVA, which is a really excellent function of this enhanced-care system. I don’t want that to get lost in any of the other things that I have to say today, so I really wanted to lead off with that.

I take an approach, generally in my work, of continuous improvement. A lot of the information I’m bringing today is intended to help support that style of improvement to what’s happening with enhanced care today.

I wanted to identify that the patient choice that is emphasized in enhanced care is a great aspect of this system.

The way that the system is functioning currently does leave the injured person with some burden to understand the system, to understand the insurance coverage, to understand the decision-making parameters and to understand injury recovery, which is quite a detailed process. If you haven’t gone through it, there are a lot of blank spaces, I think, when you enter into it.

There also is a burden on the injured person to lead the information-sharing and lead their recovery in some ways. They don’t have an appropriate level of information, often, as laypeople coming into a health care space, to be able to do this effectively. Certainly, they’re trying to work or return to participation in life and just deal with their injury, which should be a primary focus for them.

I did want to identify a couple of things that we’ve seen in feedback from our members that point to some of those pieces with how our members as practitioners in the system are experiencing things as well.

One thing that we’d love to see is a strengthening of the continuity of the patient-selected care. A challenge here is often requirements for repeated justification when continuation of treatment is sought by a provider. There’s often variability in the approval decisions without a good understanding for the folks outside of the system for the reasons behind the decision. Oftentimes it can happen because there’s information that has not landed with the decision-maker and the folks that have the information on the outside don’t always understand what information is needed in a decision.

Then there are often administrative delays. This can happen. ICBC is a large organization. There’s movement of people around for various reasons. Those administrative delays can cause delays in recovery, return to function and return to work, oftentimes for patients who really need the ongoing care.

Oftentimes patients are put into the centre of that, needing to coordinate appointments with medical doctors to get more information from a report from the medical doctor or to understand how to answer questions to their contact at ICBC that would help provide insights into their health care status or their injury recovery status, which they may or may not have a full working understanding of themselves.

Another piece I’d like to highlight is coordination and leadership of recovery, again pointing back to that burden on the patient to lead the information-sharing. They’re often in a place where they’re having to lead their own recovery. For people who don’t have a knowledge inside the health care system, this is a big challenge. Certainly, we’ve seen from feedback from our members that it causes an increased amount of stress or anxiety in some of their patients and sometimes even a desire to just give up and let go of a possibility of recovering because it feels like a burden that’s too big.

What we see from the provider lens is that there’s fragmentation across multiple providers. If there are multiple people offering support into this care or recovery treatment, they’re not necessarily all aware of the same details at the same time related to the patient’s recovery trajectory or issues that might come up in a different sphere — for example, mental health crossing over into physical rehab considerations or multiple physical rehab providers and things that they’re seeing.

[10:55 a.m.]

They don’t always have that information readily available and often rely on the patient to provide that information to them, to offer it sort of independently, as well, which can be hard from a patient standpoint — the injured person’s perspective.

There can be inconsistent progression without clearly defined recovery goals. If each practitioner has a slightly different frame on the entire recovery and the goals of that recovery, the team working together is not necessarily functioning very well as a team and might be pulling in slightly different directions.

Reliance on the information coordination…. There’s no clear accountability other than what sits with the patient, at this point, and as I’ve said already, that’s a big burden for somebody who doesn’t have the knowledge of a working health care professional — to be able to hold that on their own.

I also want to say that from our provider perspective, another aspect of the system where ICBC is not directing the care…. That’s a really important piece that I think our members would love to see continue. We’re not wanting ICBC to have that lead burden. They don’t have the personnel on staff to be providing a health care perspective, reasonably so, but should be informed with the information they need to make appropriate funding decisions.

Another piece I’d like to talk about is communication and information-sharing, and that ties a little bit into this leadership and the idea of having clear, consolidated goals across a team. If information is fragmented, it’s hard to collect from other practitioners, whether you work inside the same clinic as them but both have busy schedules or you’re working in different locations entirely. You’re reliant on the injured person to provide you with a full update of information when they may not have an understanding of what is meaningful to your practice or to your decision-making around their care or recommendations for their care.

Finally, I just wanted to look at the administrative burden that exists on the system right now, partly because of process inefficiency. I think that this lands on three different parties.

The first one is the injured person, who’s having to do a lot of this coordination on top of trying to focus energy on recovering from their injury, returning to function in their day, whether they’re fully at work, partially at work or not at work. It’s a huge added burden to that recovery process for many.

It also lands on the staff at ICBC, who are having to do a huge volume of communicating back and forth with providers. That doesn’t always land efficiently or effectively in the place where they need it to for them to move on and make their decision.

The third one is on the practitioners that are working to support the recovery of this injured person. There’s a huge volume of communication that happens outside of treatment time, outside of clinical schedules, outside of working time for these folks. Again, it doesn’t always happen efficiently.

I think oftentimes these audiences or these communicators don’t understand each other or the perspective that that person is holding or the things that are important to them. So it’s hard to have communications across those kinds of pathways, and I think there’s a really great opportunity to improve how that happens and how information is shared.

Just in conclusion of our submission, we really appreciate that enhanced care has made access to care at the early stages more impactful for more injured persons. We want to see the system strengthened to make sure that patients who need attention outside of that early access window are able to get that attention without delays and have continued support for their patient choice in who those providers are without having that added burden of coordination and understanding of the system.

I’m ready to hand it over to questions. Look at that. Earlier than ten minutes.

Stephanie Higginson (Chair): Nice work. Well timed. Thank you for your presentation and your submission.

I will look to my colleagues for questions.

Jennifer Blatherwick: We’ve certainly heard a lot today about concerns around coordination of information, streamlining of information, streamlining of process, and we’ve heard from other organizations that they have been communicating with ICBC as part of their consultation committees. Are the kinesiologists doing that as well?

Sarah Clarke: Yes. We have a seat at the health care provider advisory group meetings with ICBC, so we have regular contact with that broad group of provider associations.

[11:00 a.m.]

I also have biweekly meetings with a designated liaison for the kinesiology world with ICBC, so I’m able to bring individual concerns and some general concerns to both of those pathways.

Jennifer Blatherwick: That’s really great.

If I can ask a follow-up?

I think another piece we’ve heard a lot about is consultation, having thorough access to the information to make informed treatment decisions, treatment plans. I think one of the things that we are searching for is some really good recommendations about what a good alternative model would look like.

We’ve heard from some professionals that they would just like access to some kind of portal where they can look at all the assessments, the scans, the diagnostics, the treatment plans from other providers. Then we’ve also heard that there is a search for some actual coordination.

Could you reflect a little bit more on how you think a better system could work, from your perspective?

Sarah Clarke: Yeah, thank you. That’s a really great question. I’m glad that you’re hearing lots of thematic things already. I hope that’s going to make your job easier, to focus on the solutions. I would say our members often are searching for something like a portal where they would have access to information from other providers without having to try to coordinate communication with the providers.

I would reflect, from a system perspective, that that could be a very complicated undertaking. Speaking back to some of the burdens right now that exist on the different major players in the system, I would not like to see that portal create a burden for the providers, where they’re suddenly having a huge volume of information, on how to sift through it to find the pieces that are important to them without it taking more time, even, than they’re spending right now.

One of the things that we laid out in our proposal was around this leadership or coordination of care. I think having an accountability plan around who’s leading things, who’s helping to make sure that the information exists and that the different parties that need different information are accessing it or are aware of it, are able to access it or seek it, would be a really important piece to pair, maybe, with the portal, if that’s in consideration.

Ultimately, the policy decisions are going to be up to you guys about how to move forward with that on a legislative perspective. But access to information, as well as having some clear accountability and leadership within the rehab, I think, would help and would help the patients navigate it.

I think there’s so much more access, even for patients, to their own medical information in B.C. It’s growing right now, which is exciting. I think some of that can come with an assumption that if I can see everything, then everybody I see from a health care perspective knows everything about me. It’s very different, the information being available to an individual person and being able to own knowledge of it, even in their care to that person. That’s the reflection I would offer in that case.

Brennan Day (Deputy Chair): We’ve heard this repeated a few times, and I think it’s probably one of the topics we’re going to be talking about at great length following up on the committee. It’s that there’s no real key point person in terms of coordinating that care.

I understand the privacy protections in health care, and it’s not just health care. MCFD and CLBC pose a lot of barriers to just getting things done, where everybody knows what needs to happen, but there are barriers there. That’s not something, unfortunately, that we’re going to be able to deal with in this committee — and a far bigger conversation, certainly, in health care.

In your view, then, who should hold the responsibility of quarterbacking these cases at ICBC? The problem I have just with the insurance industry in general is that they have a cost savings prerogative, right? They’re trying to get people off care as quickly as possible and move them along. With enhanced care, the intention is not to have that happen, but we know that people are slipping between the cracks.

In your view, how do we make that position more neutral than it is currently, so it’s putting the patient first?

Sarah Clarke: A really great question. I appreciate the complexity of these things, and the purview of this committee is not to address everything. I would say that, again, outlined in our presentation and our submission was this positive affirmation of ICBC’s position, where they are not directing care.

[11:05 a.m.]

I think this piece of quarterbacking, or coordinating the rehab, if it’s happening within ICBC, could dive into that realm a little bit, if that part is not kept in perspective. There are other ways that insurance handles these kinds of things in other realms outside of motor vehicle insurance that I think the committee could probably investigate, having some kind of a third party to do some of this. Somebody who understood the insurance side of things and the health care side of things that could help translate across those worlds may also add value to this piece.

I do also want to say that my view of enhanced care, and what I’ve seen in my own patient care when enhanced care first came into place and then from members in the kinesiology world since then, is that I think there is a strong intent for people to come off of claim. Although claims don’t close anymore, not to need care anymore because they’ve actually recovered, and they’ve recovered durably. What I mean by that is in a way where they’re not getting easily flared up again or a return of symptoms, but they’re actually able to return to life, and that is at a steady state.

I would support that effort of enhanced care from a cost-savings perspective, that it’s not run-on or ongoing claims forever. But really, the purpose of it to address things from an injured person’s functional perspective and to support their return to function.

I think you’re on to something with a third party being of benefit in that space. To point out who, in terms of a group of people…. I don’t know that that’s for me to say. I just have information that I can bring from our members about what would be valuable.

I would highlight that somebody who understands the insurance perspective and the health care perspective that could help to bring those worlds together and translate would probably add some efficiency, also, to the communication piece.

Brennan Day (Deputy Chair): Just a quick follow-up. Right now who, in your view, then, is making that final determination that the person has reached durable recovery? What flexibility exists, in the current system that your members are working under right now, if that person does have a flare-up two or three years down the road? We know that can happen as you age, etc.

I’ll use the example of my mother-in-law who was in a bicycle accident many years ago, in a bike race. She now has chronic back injuries. Had it been in a car, that would have probably covered on this. In your view, where does that determination of durable recovery end? We have a snowball problem with these claims that if they go on forever, that just bogs the system down.

We have to make a reasonable determination, but who’s making that determination right now?

Sarah Clarke: It’s a great question, and I appreciate the insight into that space. It’s certainly a complex thing that comes up with injuries. There are often times, even with a durability of recovery, that there could be flare-ups, or the area that was injured will be more sensitive or weaker than it would have been if it had never been injured.

What does that look like ten years down the road, 15 years down the road, for individual people? It’s hard to say. Health care providers certainly don’t have a crystal ball and can’t predict those kinds of things in the future.

I think if the system is truly functioning the way that I understand it to be intended, there would be access to reinitiated care for folks under enhanced care.

At this point, our members are not one of the groups that can easily reinitiate care at a distance from the claim or, certainly, once care has been finished. We can put in a request, but oftentimes there’s more medical information that’s sought when a request comes from a kinesiologist, at least. I think right now that the determination if can care restart, if there’s a request for it, sits with the decision-makers on the claims at ICBC.

That’s a piece where what I was talking about with the inefficiencies, with the way communication is happening, the health care providers don’t fully understand what insights the decision-makers need to be fully informed. When they’re making a decision, there’s a lot of back-and-forth that happens — requests for more information, a volume of information dumped with some burden of time on the health care provider. But that’s not the exact information that was needed. So it happens again and goes back and forth some more.

[11:10 a.m.]

I think getting to some clarity about what the pieces of information are that a decision-maker might need to understand in order to make a good decision on these things certainly would help the health care providers to be able to provide any insights they have efficiently.

We don’t want to spend any more time on that kind of stuff than we need to. We’d rather be providing treatments to people who need our support directly.

Jeremy Valeriote: Thank you. I appreciate the reinforcement of some of the things we’ve been hearing in terms of the coordination of treatment.

One thing we haven’t talked about yet, I don’t think, in your submission is coordination of benefits. I’d just like to understand it a bit better. For people who have extended benefits through their employment or their own private insurance, how does that typically work? How long is the delay between…?

It sounds like you need verification that a private insurer won’t cover anything before ICBC can really get started. How long of a delay does that impose? And should we be…? Is there a way to solve that if it’s lengthy?

Sarah Clarke: Yeah. Great question. Unfortunately, it depends. It’s probably case by case, oftentimes, with those things. I think this is one of the pieces that ends up landing as a burden on the injured person. As a health care provider, I wouldn’t be able to directly communicate with their other insurance company on their behalf, so it’s reliant on them being able to get in touch with the right person to be able to ask the right question framed in the right way to have a clear answer come back.

For folks who are dealing with injuries and the burden of reduced function in life, there’s usually a long list of things that they need to get to, and sometimes this isn’t at the top of the list, even though it could impact their access to different approvals or resources from the ICBC insurance.

I think that’s a really challenging one. I do think that people recovering from injuries…. They’re often having to use the benefits that exist within their workplace — so vacation time, if they need time off of work to begin with. If the injury happens early in the year, they may end up having a harder time staying at work towards the end of the year if they have no access to time off to allow for normal recovery that everybody needs when they’re working full time.

There are lots of challenges, I would say, in that world. The delays can be short if there’s a good response from the other insurer. They can be long. There are administrative burdens, I would say, all over the various insurance layers in this world. Really hard for the folks who are doing this for work, whether it’s the health care providers who might be doing it outside of their clinical time or the folks at ICBC to be able to move that along and make a difference if it’s really a piece that the injured person or the patient needs to lead out.

That’s a piece of understanding the system — understanding all of the different aspects, what the coverage at ICBC is, how it interacts with other coverage and even how typical that is that there’s a first payer and a second payer. It’s not unusual. It just takes certain action to be able to navigate it. It’s challenging for people when they don’t understand those elements.

Jeremy Valeriote: Quick follow-up, Chair?

Stephanie Higginson (Chair): Yeah, go ahead.

Jeremy Valeriote: It sounds like some of these second payers, some of these insurance companies will just automatically disqualify if it’s motor vehicle–related, and some won’t. Would there be some benefit to just the blanket assumption under enhanced care that it should proceed regardless and maybe sort it out on the back end?

Sarah Clarke: From a person on the outside of the insurance world, I would say that would be wonderful if that would be a possible solution. On the inside of the insurance world, I don’t know how those logistics work.

But I would say that if there’s consistency across certain aspects of it that would allow for that without a lot of administrative burden on that back end, trying to figure it out later…. I feel like that is something that could make sense. Certainly. Yeah, if there was an understanding of where to go forward and where to pause on certain things.

Stephanie Higginson (Chair): Okay, I have a quick question.

[11:15 a.m.]

Tell me if you don’t feel like you can answer this one. I get it. It’s not specific. But I do feel like the kinesiologists have a unique perspective on this. And it has to do with the….

You talked about flare-ups. But flare-ups of previous injury and where this sits in, for instance, MLA Day’s case…. Maybe there was a previous injury. The motor vehicle accident caused a flare-up in that injury, but it didn’t cause the injury.

And I think, from some of the submissions we’ve seen, there seems to be a bit of a grey area here. I’m wondering if you are able to comment on that at all, and if you are, if you have any suggestions on that.

Sarah Clarke: Yeah, great question. I can probably add stripes of grey to that, unfortunately.

As I said, you know, health care providers…. We can’t predict the future. I mean, there’s oftentimes…. There can be findings of tissue abnormalities or damage on different scans or things, and it’s not necessarily causing dysfunction or causing pain that causes a dysfunction in a person.

This is a really big challenge, I think, of the insurance world — to try and determine the cause of something. Somebody who’s had a previous injury and is functioning fine in life, if they have a further injury or further damaging event to their body that changes their function….

From a health care perspective, I think when we’re trying to help with the recovery, that’s the piece that we would look at. Certainly, we would want to know what the history of injury is because it gives us some information. But, you know, a change in function is what we’re looking at, and we’re hoping to affect the change in function in the other direction and get people back to things that they were doing.

I don’t know if that offers anything. But that would be even outside of insurance things. If we’re just dealing with somebody who’s, you know, a weekend warrior and likes to mountain bike or snowboard or things like that…. Your body’s going to go through things in life and sometimes needs support to get back to feeling better doing those things.

Stephanie Higginson (Chair): Okay, I appreciate it. Thank you.

Okay, I am not seeing any further questions. I will thank you very much for your submission and for your presentation and for answering our questions so comprehensively. Thank you for your time.

Sarah Clarke: Great, thank you so much.

Stephanie Higginson (Chair): We’re a little bit ahead of schedule. Our next presenter is not due till 11:25, so we’ll take a short recess. I do request that everybody is back in your seats by 11:25 so we don’t fall behind.

The committee recessed from 11:17 a.m. to 11:29 a.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): Okay, we are back. Thank you, everyone, for that short recess.

We are going to move to the presentation from the Insurance Brokers Association of B.C. With us to make the presentation is Julie Skelton.

Nice to see you, Julie. You have ten minutes for your presentation and then 20 minutes for questions.

Insurance Brokers Association of B.C.

Julie Skelton: Good morning, Chair Higginson, Deputy Chair Day and members of the committee. Thank you for the opportunity to appear before you today as part of your review of the Insurance (Vehicle) Act.

My name is Julie Skelton. I’m the executive director and COO of the Insurance Brokers Association of B.C. I have also been a broker in this province for 37 years and the leader of IBABC for the past two.

[11:30 a.m.]

IBABC represents more than 100 member broker association organizations with over 900 locations — 12,500 licensed insurance brokers that serve more than four million British Columbians. Our brokers work directly with British Columbians every day. They help people understand and purchase their ICBCcoverage and optional coverage, and they are often also a source of support when clients are navigating a claim, particularly when those claims become complex. We appreciate the opportunity to bring that perspective to this review.

I want to begin with our main message today. IBABC supported the introduction of enhanced care, and we continue to support the model as an improvement over the prior model that existed for decades in B.C. We believe enhanced care has delivered real benefits for the people of the province. One of the most important changes was moving away from a system where a significant amount of premium dollars would ultimately go to legal costs and moving toward a model where those dollars are focused on providing benefits and care to people who have been injured.

The principle behind enhanced care is that when someone is injured in an accident, the priority should be getting that person to treatment — to support that they need to recover without delay and for the entire time that they need the care. It also means that access to that care is not dependent on determining who was responsible for the accident before someone can begin receiving that care. That is a significant benefit of this system over the prior model, and we do not want to lose sight of it during the review.

Our message is not that enhanced care needs to be replaced. Our message is that, after five years of experience with the system, we now have an opportunity to identify where it can work better.

Brokers occupy a unique position in this conversation because they hear directly from the drivers. When the system works well, they hear that. But they also hear from people when they are confused about what comes next, what benefits they qualify for, and where they’re supposed to go for help.

One of the areas that we believe can be improved is simply making the claims process easier to understand. For someone who has just been seriously injured in an accident, or their family’s acting as their advocate, navigating the insurance system can be overwhelming.

There should be a clear path explaining what happens from the initial injury and assessment through those first 12 weeks of care and then into whatever treatment or support is required next. People should know who’s making decisions about their care, what benefits are available to them and where they can turn if they disagree with a decision. The transition after the first 12 weeks is an area where we believe added clarity would be particularly helpful.

There are also several specific benefits that we believe warrant review. Income replacement is one. The current limits and the cost of purchasing additional coverage should be examined, and the interaction between EI, employer benefits and wage-loss benefits can be difficult for consumers to understand.

Funeral costs. Limits should also be reviewed to ensure they reflect actual costs faced by families today.

Death benefits. There should also be greater clarity around those death benefits, particularly the distinction between a wage earner and a caregiver. Someone providing unpaid care for children and a household contributes significant value to their family, and the system should appropriately recognize that.

Twenty-four-hour care for catastrophic injury. For people with catastrophic injuries, we believe the cost of providing 24-hour care should be reviewed against the actual cost of in-home support today.

These are practical changes that can strengthen the system while maintaining the fundamental principles behind enhanced care.

I’d like to spend a bit more time on the catastrophic injury portion, because this is one of the areas that we believe deserves particular attention. Our concern is that the existing definition can be too narrow. If someone experiences a severe, permanent and life-changing injury, the distinction between whether that person technically meets a particular threshold can have enormous consequences for the care and support available to them.

It is why IBABC supports Bill M237. As currently drafted, the bill would change the catastrophic injury threshold relating to amputations from two limbs to one. It would also extend the period in which people with qualifying catastrophic injuries sustained on or after May 1, 2021, can make a claim.

[11:35 a.m.]

There is opportunity to continue to enhance the definition of “catastrophic injury” going forward, and we see that as a reasonable improvement to enhance care. Someone who has experienced a permanent, life-altering injury should be able to easily access the level of support intended for catastrophically injured parties.

There’s another part of this that’s just as important as the benefit itself. People really need to understand what is available. Most British Columbians will, hopefully, never have to navigate a catastrophic-injury claim. As a result, they are unlikely to understand the system until they or someone in their family suddenly needs it.

Information about lifelong care, accessibility modifications, in-home support and other benefits should therefore be clear and accessible. A family dealing with a catastrophic injury should be focused on recovery and adapting to a very difficult situation. They should not also have to struggle to understand what assistance is available to them.

Ultimately, IBABC believes the foundation of enhanced care is sound. British Columbians benefit from an auto insurance system that focuses on care and recovery, provides broad access to benefits and directs premium dollars toward supporting injured people rather than unnecessary legal costs. At the same time, supporting enhanced care does not mean saying the system is perfect. This five-year review is an opportunity to make improvements based on what British Columbians and brokers have experienced since the system was introduced.

Our recommendations are straightforward. Strengthen the current enhanced care model. Support the changes proposed in Bill M237 to address the gap in the catastrophic injury definition and extend the availability period as proposed. Make the claims process clearer and easier for injured people and their families to navigate. Review benefits where current limits may no longer reflect the actual costs people face, and continue listening to brokers who hear directly from British Columbians using the system.

IBABC has worked with brokers in the delivery of Autoplan for more than 50 years, and we look forward to continuing to work with ICBC, government and this committee to ensure British Columbians have access to fair, effective and sustainable auto insurance.

Thank you for the opportunity to appear today. I’d be happy to answer any questions.

Stephanie Higginson (Chair): Great. Thank you for your presentation. I think your association is quite uniquely placed to provide us with recommendations. I also appreciated how clear and concise your recommendations were.

With that, I will turn it over to my colleagues for questions.

Brennan Day (Deputy Chair): It’s interesting to see that you’ve said the transition after the initial 12 weeks care is one of the most confusing parts of the system. We’ve heard that multiple times today.

What are your clients actually struggling to understand? When they disagree, what’s the next step, and what’s your role in that next step? Obviously, you’re sort of on the front line of that frustration, most likely.

Julie Skelton: I would start with, as a broker, working with clients, giving professional advice on the product. Where we feel there’s an opportunity is the missing understanding and issuance of information from ICBC on the claims process.

In regular personal insurance on a homeowner, you know exactly what’s going to happen when there’s a fire. You know exactly the next steps.

In an injury case where the broker hears from a customer that they don’t understand or where to go or what they’re getting, there’s really not a transparent process in place for a broker to guide. What the broker will do is take that concern, find the case person who’s handling the file at ICBC, and translate the message from the consumer.

In a consumer’s eyes, they bring their premium dollars, hard-earned, into their broker’s office to support the transaction, and they trust the advice they get. They come in and say: “This is confusing, and I don’t know what’s next.”

So we are advocating for transparency with the government and with ICBC on a regular basis, and I think there’s an opportunity to make that much more clear.

Brennan Day (Deputy Chair): Given that we have a single insurer, mandatory insurer, with ICBC for loss, what sort of uptick are you seeing on private insurance for additional coverage now that ICBC has sort of demonstrated that there are fairly significant limitations in some of their coverages?

Julie Skelton: I’ll answer that the optional coverage has always had a competitive, open, private marketplace. In fact, there has been one market in the industry 20-plus years. There’s one that has been in and has left. There are also supplementary products available — replacement costs, those types of benefits that you can purchase outside of the ICBC product.

[11:40 a.m.]

I think the main piece here is that those products do not involve the care benefit, right? They are literally on the physical damage side, on the optional coverage. So you don’t see any differential there.

Brennan Day (Deputy Chair): Okay. Just so I understand it, it is not possible to buy additional medical coverage in British Columbia, under the current regulation, in the event of a catastrophic claim?

Julie Skelton: If you’re looking at the ICBC product offerings and the benefits available to you, there is ability to increase, for example, your income top-up. As I noted, that income top-up is a very expensive product to increase, and I would say one of the most confusing to consumers out there. It is not part of basic insurance as a buy-up. A broker would have to pull it apart as a separate policy to pay for an increase in benefits you perceive that you might need.

The most confusing part of that is that most consumers don’t really understand their own benefits from their employer. When they sit with a broker and the broker says, “Do you understand you have a cap of X?” the client says, “I think I’m okay. I might be okay.” They’re not sure how their benefits would participate with any ICBC care benefits.

So that is a confusing product, and when someone does understand, that product is purchased at quite a high rate, depending on what you need, per thousand.

Jennifer Blatherwick: One of the things we’ve heard is that “catastrophic injury” has quite a, shall we call it, historical definition that doesn’t always meet people’s experience of how their symptoms are affecting them in their everyday life.

One of the recommendations we’ve heard is to do a comprehensive review of the catastrophic injury rules to make them more closely aligned with people’s functional experience of their life after. Is this something that you would recommend as well?

Julie Skelton: Yes, we would wholeheartedly recommend that, and the reason I think that there’s an opportunity for the committee to do it is that you’ve had five years of losses to study. When you look at insurance actuarial studies, that’s what you do. You go back and you look at the losses.

That would also allow the committee to review the impact on the quality of life. I think when you hear people say, “It’s frustrating. You can’t sue somebody….” If you hit black ice or hit a moose, there is no suit, and there never was in the past. It’s about: what is the quality-of-life change that you will have as a result of your injuries?

We feel like that permanent impairment assessment that is in the current program needs a serious review, because there is no litigiousness involved in pain and suffering coming to someone. But people do have a huge change in some impacts to their lives, and we hear that from consumers all the time. They may not have had a loss of limb, but they’ve had a crushed leg, and they can’t work in the job they were in before.

As much as the change has benefited in many, many ways, we think that that’s an opportunity. Probably one of the most volumes of claims concerns we hear is: “They don’t understand what my life is like now.”

Jennifer Blatherwick: Yeah, thank you. I really appreciate you following up on that.

Can I do a second follow-up question?

In the most difficult cases, the funeral costs and death benefits…. I’m understanding those are not commensurate with current costs.

Julie Skelton: We have heard from members of our board, members of our constituency and their clients that they don’t feel that they are adequate. The Lapu-Lapu event — one of the brokers that is a member of our association was a victim, and I believe the committee will be hearing from him at some point. He brought up, very much, that the cost of funerals was not commensurate with current costs.

I do believe there’s indexing involved in the whole process, that it’s done annually, but I think this is an opportunity to do a fulsome review of whether the base is even correct at this point in time so that when you do index, you actually are hitting the right numbers that should be expected. I think that is probably the section that…. It’s about the dollar amounts that are being assigned. Permanent impairment as well.

Steve Kooner: First of all, thank you for being here. You were talking about income top-up earlier. There’s a limit to that, correct?

Julie Skelton: There’s a limit in the current coverage available when you buy coverage with ICBC. You do have an option to increase that dollar amount by buying an income top-up policy. It’s like we would call an excess.

[11:45 a.m.]

Steve Kooner: Then what are you hearing from your members in terms of what consumers are saying or customers are saying to your members about that limit on that? Are there any complaints about that? What are you hearing?

Julie Skelton: Well, I would say that one of the things we’ve questioned ICBC on…. To be clear, we work with ICBC on a regular basis. We have committee meetings, we’re with them on council meetings, we have a memorandum-of-understanding council, and we have an accord. We are what we call the keepers of the accord. We advocate on a daily, monthly, weekly basis with ICBC. What we did ask them was: what is the uptake on the sale of the increased cover optional policy? And it’s minimal.

What brokers would say is that the consumer really just doesn’t understand. There has not been a case yet, to my knowledge, that someone has exceeded that limit, but it’s coming. I’m certain it will come if the average is…. I believe the number is $122,000 — 90 percent of net income is what you’re eligible to purchase.

Again, what people’s income derives from is also an interesting part of this exercise. I think that it does require a fulsome review. We’re told that it came from the average income in British Columbia. You know, it’s a different number in Saskatchewan, Manitoba and now Alberta as they go through their care-first model review. It’s the average income in B.C. that is being focused on.

Again, I do not believe that consumers really understand their income top-up benefit or what their personal benefits cover, if they have any. It’s not a guarantee that everybody has, you know, a limited short-term disability or long-term disability or any of those benefits. That integration between how they all work together, I think, is confusing for consumers.

Steve Kooner: Say the threshold was reached in terms of that income replacement. What would happen to the person? If something negative can happen to them not receiving their income, do you guys offer some sort of product that can make that person whole?

I understand the income level that you get with the basic insurance is about $100,000 — right? — where you just talked about those numbers of $122,000. To get covered with that, you’d have to buy the additional, and the additional is another $100,000, my understanding.

Julie Skelton: You can buy in increments of…. I believe it’s $5,000 or $10,000.

Steve Kooner: But the maximum is $200,000. Do your brokers advise their customers about what happens after $200,000? And is there any sort of recourse after $200,000? Say if your customer earns well beyond that, do you offer some sort of products to kind of supplement that? Are there any products to kind of supplement that, and are there any potential issues you’re seeing?

Julie Skelton: If you separate long-term disability, short-term disability coverage, that is available from representatives who sell that type of insurance regardless of an auto claim. There is that that you can get through your benefit provider. There are stand-alone products that you can buy. Our brokers don’t sell that at the desk. What a broker can sell at the desk is the income top-up, up to the maximum that’s available with ICBC. The advice is: there’s coverage here, and there’s availability here. If you need in excess of that, you need to reach out to a benefits provider.

The problem with all of it is most people don’t really quite understand what their limits are at the time you’re sitting to do their Autoplan transaction. Often we will advise…. The brokers will suggest, “You should go take a look at this,” and it’s just often that consumers don’t come back.

What our ask was was to increase that minimum threshold to even $150,000 or $200,000, and that would generally have most consumers picked up by that number. Then someone in that higher bracket would be working with their benefits provider. Normally somebody in that income threshold is part of an organization that will have benefits providing short-term and long-term disability. Again, that’s separate from any permanent impairment settlement, catastrophic injury settlement that is part of the injury that occurred during your vehicle accident.

[11:50 a.m.]

Thank you for the question.

Stephanie Higginson (Chair): I have two questions. One of them sort of builds on this, and I think this is sort of this tension that we have and confusion around which insurance provides what coverage for what issue.

There’s sort of a feeling from folks that the ICBC insurance should cover everything that may happen to you as a result of an accident, when, in fact, the income top-up, for instance, is something that might be provided through an extended benefit, through your employment or purchasing it separately yourself.

You talked a little bit about this. People tend to not really know what they’re getting and if they need to get something else until they need it. It is sort of where I framed this reactive versus proactive nature of the world today.

I wonder, since your association has such a unique perspective on dealing with the results of this gap, if there’s been any thought put into what is a good educative program to help people, whether it’s right there at the desk, making sure…. I think about myself, buying my own insurance. Now that you can renew it, if you’re just doing the same thing, online, it’s “let’s do it.”

How do we take the time to make sure that people understand what they’re purchasing and understand what they’re getting before they are in need of it? Has there been thought to that?

Julie Skelton: Well, I would say that that’s exactly what brokers try to do every day with consumers as far as getting an understanding of what the benefits are that you’re purchasing through auto. It really comes down to the committee’s opportunity to create transparency for consumers. In working with ICBC, I’ve advocated and actually met with their new CEO and president and suggested that that education has to come from their claims side.

In the ICBC world, there are three pillars. There is the insurance pillar, the claims pillar and driver services pillar. We’ve explained to the corporation that brokers and consumers don’t separate insurance from claims. They work together. That’s the purpose of buying the insurance — to protect themselves should they have a claim.

If your ability to educate a consumer about a claim happens before, it is a better experience for the consumer when they have a claim. To be fair, and I’m almost four decades in this industry, no one ever thinks anything bad will happen to them. That’s a nice way to live. It’s just not reality. Bad things do happen.

We have advocated for more education on the claims process, more transparency on the claims process and more ability to educate consumers at the time that they purchase it or even send them away with more information for them to do some self-learning. It’s a concern with online being available to consumers, buying a complex policy without any advice. It’s why we are connected to that, as a broker advised online. But a consumer still has a choice to not take a phone call where a broker senses there’s something missing and wants to discuss it with the consumer.

I think the advocacy part that we would always suggest is transparency on the process. How you’re assessed, what your steps are — just like the 12-week move to the next layer — what modifications can be made to your home and to your vehicle, what home care you get. All of those pieces are not clearly laid out, and it now, at the five-year mark, should be the time that it is available. There is an understanding and a learning that ICBC has gone through when they transitioned, and I believe there’s an opportunity for us to work together with the corporation to do that for consumers.

Stephanie Higginson (Chair): A follow-up, but actually a separate question. Bill M237. I noted your support for it. I just wanted some clarity to make sure — I think I know the answer — that it’s not support just for that one particular recommendation.

It’s support for a broader review of what defines a catastrophic injury beyond just that particular injury that’s recommended there.

Julie Skelton: It’s a good first start. I believe that that bill was created from, perhaps, a constituent’s experience coming to an MLA and them wanting to get something changed on their behalf.

I think all of us have an opportunity to look at that definition and, in the legislation, how it could be more broad and also take into effect the long-term change to a life or quality of life in an event of an individual who’s injured. That’s really where the litigious need to have somebody pay for the damages that happened to me comes from.

But if you can create a system that is well designed to compensate for that permanent impairment and loss of income and permanent disability or permanent catastrophic injury, then the litigiousness and the cost and that $1 billion that was in there before, or a third of the premiums that B.C. residents pay, actually goes to the injured parties.

I don’t think anybody would have any concerns with that being the way the model is built.

Stephanie Higginson (Chair): Any further questions from my colleagues? No?

Okay, it looks like you are all wrapped up. Thank you very much for your submission and your presentation. We appreciate your time.

Julie Skelton: Appreciate you having me. Thank you very much.

Stephanie Higginson (Chair): Okay. This puts the committee in recess for lunch.

The committee recessed from 11:55 a.m. to 1:00 p.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): If everybody’s ready, we’ll call the committee back to order.

Our next presentation is from the Trial Lawyers Association of B.C.

Thanks for coming.

We have Nicholas Peterson and John-Andrew Pankiw-Petty.

You have ten minutes for presentation, 20 minutes for questions after. If you go beyond the ten minutes and I don’t notice that you’re starting to wrap up, I’ll remind you of your time, okay?

Excellent. Thanks very much. Over to you.

Trial Lawyers Association of B.C.

Nicholas Peterson: Good afternoon. My name is Nick Peterson, and I currently serve as the first vice-president of the Trial Lawyers Association of B.C. As noted in the introduction, I’m joined by my TLABC colleague John-Andrew Pankiw-Petty. At the outset, TLABC’s goal as an organization is to protect and promote the rights of British Columbians.

Simply put, no-fault is bad public policy that harms injured British Columbians.

The submission of TLABC, as this committee will note, provides real-world examples from real people who have had experience after their injury directly navigating the system, as well as experience with dealing with ICBC and the provision of benefits. It’s easy to look at statistics — financial projections, for example — but the best evidence comes from the experiences of real people who have had to navigate the system.

Now, at its origin, the no-fault system is built on a fundamental conflict of interest. ICBC controls the delivery of accident benefits but, of course, profits when they pay out less. This is the fox guarding the hen house.

Now, in 2023, to their credit, ICBC surveyed occupational therapists who deal directly with this new regime. This was of course done on purpose, and that’s because OTs at the time were a very notable stakeholder that supported this no-fault model and, as well, worked closely with ICBC. The survey results as of 2023 painted a different picture at that time.

Years into enhanced care, that 2023 ICBC survey of OTs revealed that 77 percent of practising occupational therapists surveyed expressed dissatisfaction with the experience in dealing with ICBC in relation to this new enhanced-care model. And 74 percent of practising occupational therapists confirmed that on more than one occasion the opinions of ICBC staff had been inserted into the occupational therapist’s care plan.

This survey further revealed that ICBC staff have denied treatment plans recommended by the patient’s doctor or other paramedical treatment providers. This committee will hear, of course, from Occupational Therapy B.C., and in 2026, through their submission, those same types of concerns exist.

Before no-fault was implemented, if a fair settlement could not be reached directly with ICBC, you as the injured party, of course, had the opportunity to prove your case before an independent judge. If, and only if, you proved your case, you received compensation that reflected your actual losses. Those rights are now gone. Today ICBC makes all of the decisions.

If you dispute ICBC’s decision now, instead of access to the courts, you are directed to the Civil Resolution Tribunal. This committee will know that the CRT is a government-appointed body with far weaker procedural safeguards. In fact, the governing legislation behind the CRT expressly notes that that tribunal is not bound by the rules of evidence, so there are procedural safeguards that are seriously lacking. Generally, an injured party will not have the right to an in-person hearing. It’s an exception, not the rule. And this, quite simply, takes the person out of personal injury.

Of note, ICBC has had significant success at that tribunal. This committee will hear, of course, from the Canadian Bar Association in their submission. Of note is that, in a review since the CRT took over adjudication of motor vehicle claims under the previous minor injury set of laws, ICBC has had an overall success rate at the CRT in the range of 73 percent, and that’s to be contrasted with ICBC’s success rate of 13 percent when one looks at 2018 and cases before the B.C. Supreme Court dealing with motor vehicle claims.

[1:05 p.m.]

All said, the samples assessed, albeit small, suggest that ICBC enjoys an unusual level of success at that provincial tribunal.

Now, under this new no-fault model, which is now past its five-year anniversary, rates are on the rise. Insurance rates are increasing but rights have gone down and remain down. While basic rates have remained frozen, optional rates have increased, leading to an overall global increase in average insurance premiums for B.C. drivers.

Under the no-fault model and enhanced-care model, pain and suffering compensation has been entirely eliminated. It’s been replaced with a standardized impairment schedule. Wage-loss benefits are capped, and they’re only applicable to an individual that is deemed totally disabled, so it’s an all-or-nothing approach on that basis. And future care is no longer a lump sum that the injured victim can control.

Most fundamentally, this system ignores who you are. I’ll say a quote at this point, and that is that an insurance company shouldn’t tell you what services you can and can’t get. That’s a quote that’s not attributable to Trial Lawyers Association of British Columbia nor myself, but rather that’s Premier Eby from just three days ago when he was addressing a panel for the Union of B.C. Municipalities.

No fault, again, has taken the person out of personal injury. The government, of course, justified no-fault on the basis of cost savings, but the system depends and requires continuous administration. The administrative cost of running a large government insurance benefit system with ongoing case management, treatment approvals and a dispute adjudication will grow as the injured population ages.

What we know is that by its own numbers and by its own financial statements, there are periods where ICBC has clearly shown it can be both profitable as well as protecting injured British Columbians and their access to the courts for an individualized assessment of their actual losses.

Insurance should be about consumer protection. Regardless, financial sustainability is one part of it, but it alone should not determine whether or not legislation has achieved its objectives.

Further, no-fault benefits bad drivers. Bad drivers are simply not held accountable under this model. Deterrence for bad drivers is a critical factor to increase public safety. Removing civil liability removes the most powerful deterrent to dangerous driving. When a negligent driver faces no personal consequences, road behaviour does not improve. In fact, casualty rates are higher in jurisdictions with no-fault models than when compared to jurisdictions where the right to access the courts and the right to seek fair compensation exists.

This committee provides a real opportunity to effect real change for British Columbians, real change for real people. The Insurance (Vehicle) Act should be amended to restore the right to sue for fair compensation. Ensuring injury victims have the right to access the courts and obtain fair compensation ensures bad drivers are held accountable.

I’d like to conclude my submission today with a quote from Blaine Redlac. Mr. Redlac was a victim of the Lapu-Lapu tragedy in April 2025. At this festival, Mr. Redlac was struck by the offending vehicle, propelled a number of feet and was severely injured. His partner, Jendhel, was killed in this tragedy.

This is what Mr. Redlac says on his experience with no-fault and dealing with ICBC:

“I was abandoned by ICBC after leaving the hospital. That day took my spouse, Jendhel, my dear friend Glitza, her parents, and left my cousin AJ with a severe brain injury. ICBC left me without meaningful support. I was bedridden, heavily medicated and surrounded by a household in shock. No one told me what help was available or how to access it.

“I had assumed I’d be supported through a system designed for victims. Instead, I found myself dealing with ICBC without representation, confused and overwhelmed, trying to process catastrophic loss while navigating a system I did not understand. Jendhel and I were on the verge of building a future together. We had plans to buy our first home.

“The ICBC death benefit provided does not begin to reflect the lifetime she would have contributed to our shared life. When funeral costs exceeded ICBC’s maximum benefit, my family paid out of pocket. Because of no-fault and ‘enhanced care,’ there is no meaningful accountability, and my family and I will be left carrying the burden of this tragic event for the rest of our lives.”

[1:10 p.m.]

To this committee I respectfully say that it’s time to consider the people, it’s time to consider the innocent victim, and it’s time to consider the vulnerable. I’ve often heard it said that a nation or government can be fairly judged by how it treats its weakest and most vulnerable. That’s the lens with which we should be looking at this no-fault policy and how it’s assessed.

On behalf of the Trial Lawyers Association of British Columbia, I thank this committee for their time.

Stephanie Higginson (Chair): Thank you for your presentation.

I will move to my colleagues for questions now.

Brennan Day (Deputy Chair): The arguments that I’ve heard on both sides seem reasonable. One of the major arguments for enhanced care and something that actually has been reflected through many of the stakeholders we’ve already heard this morning is that the speed to which people access care improves greatly under this system. I’m not willing to argue that, especially in significant cases.

I guess my question, then, to the trial lawyers is: how can we find a middle ground that allows people to properly be represented? We’ve heard from people, and I’m sure we’ll hear from more, as you testified, from that tragic, tragic case. Where’s the middle ground here? Because if somebody is left without care for a year while they await trial, or years…. We’ve seen cases like that on the extreme end. Where do we find the middle?

John-Andrew Pankiw-Petty: Thank you for the question. It’s about accountability and having the ability to seek representation and have someone represent your interests, someone there in your corner to help you when ICBC delays, when they deny, when they dither on these decisions.

You’re quite right. There are a lot of people that have had good experiences through enhanced care, but the problem is that under the current system, people don’t have meaningful access to legal representation. The argument has been made that this has reduced insurance costs. Well, a cheap insurance policy isn’t necessarily a good policy if when you need it the most it’s not there to protect you. Lawyers have a cost. All professional representatives have a cost. The question is what injured people lost when their advocate was removed.

Don’t take our word for it. Think about all of the submissions from all of the people that are here, the people that are sitting behind us today, who have gone through and are still living through no-fault and enhanced care. Listen to them. They tell the story, through all of these submissions, including the submissions of the various stakeholder groups, that ICBC continuously denies coverage and delays coverage.

People have problems going through this administrative bureaucracy. Frankly, when you look at the legislation, you need a legal degree, a medical degree and probably a philosophy degree to understand this legislation, and these folks are doing it predominantly on their own. That’s important, because the context is that those folks are injured and they’re at their most vulnerable. They’re trying to understand what benefits they’re entitled to, and they’re trying to challenge decisions that are made by the same insurer responsible for paying those benefits. They’re expected to navigate that system while recovery itself can be a full-time job.

The question is about accountability. It’s about putting meaningful measures in place to increase accountability. One of those measures that existed under the old system was the ability to go in front of an independent adjudicator — a judge who doesn’t work for government, a judge who’s independent, who weighs the evidence and makes reasoned decisions based on what’s fair.

It’s also about ensuring that individuals get access to fair and meaningful compensation. Under a fault system, you didn’t need to be wealthy to hire a lawyer. Anybody would have access to representation. That lawyer was paid a percentage, typically, of what was recovered at the end of the day.

The person who hired the lawyer, the injured victim of a car crash, had an advocate who understood the system, could obtain the evidence, deal with the insurer, challenge improper decisions along the way, not just at a trial, and put that dispute before an independent judge, if that was called for.

What we’re asking for is for this committee to take a serious look at the legislation. No-fault didn’t eliminate disputes. It left British Columbians to largely handle those disputes on their own. What we’re saying is this committee should take a hard look at the legislation and re-enact legislation that allows individuals to have meaningful discussions and meaningful accountability and hold this insurance company to account.

Nicholas Peterson: I might add on that point, and thank you for the question, that the ability to sue provided an individualized process, but the court was, always has been and remains the great equalizer.

[1:15 p.m.]

The fact that somebody could challenge an issue — not a micro-dispute but the end goal being fair compensation on an individualized basis that reflected one’s actual losses — served as an incentive. If you threatened recourse from a treatment denial before, often there was a more prompt response. Eliminating the entire access to the courts and eliminating the entire system of fair compensation doesn’t improve speed, generally speaking. There might be exceptions, and that’s always going to be the case. There are exceptions on both sides of the ledger always.

The reality is that people had the right to seek compensation both on the benefits claim that they had before no-fault existed — there was always a benefits claim — as well as a tort claim, where people could give effect to their civil rights and actually pursue compensation that matched their losses rather than being reduced to a standardized chart that doesn’t reflect them as an individual but groups them in, at best, with a threshold that oftentimes requires such things as permanent, life-altering injuries.

Are there people that are struggling that might fall short of a total 100 percent disability? Of course. Are there people that might suffer losses, who can’t work the same way but might not meet the threshold of a life-altering injury? It’s life-altering to them if it affects the way they can earn a living for their family.

The threat and the reality of having the ability to access a court with an independent adjudicator served as an incentive, and it was, at the end of the day, the great equalizer. That should be preserved.

Stephanie Higginson (Chair): Questions from other members?

Okay, I have a question. I’m going to try to wrap my head around how I frame it. I was hoping somebody else would ask a question so I could get it framed in my head.

You used the example, or the quote at the end, of the Lapu-Lapu experience the person had, which was quite a terrible, exceptional event of a mass casualty, which is not a common event. Sometimes when we have some of those uncommon events, there are some gaps that are identified, and I think that Lapu-Lapu did identify that.

You’re focusing a lot on the ability to sue — and I’m not a lawyer, so I might say the wrong terms, and please feel free to correct me — as an equalizer, as an opportunity to provide something that is no longer available to people. I’m wondering what happens when people sue.

Because you used this example in your presentation, in this situation, there would be so many people, and the person on the other side that’s being sued…. You know, your assets are only so much. Lots of people would be suing. Even in a different situation where it’s maybe one person and your liability insurance is tapped out now….

In the example of Lapu-Lapu or in other examples maybe — it doesn’t have to be this — what happens when you sue and the person’s assets or the insurance that they had does not meet the judgment that was given?

Nicholas Peterson: Thank you for the question, and it’s a fair one.

No system is ever perfect. There’s always an ability of individuals to insure up to a certain amount, mandatory in the old system being $200,000, and then you could escalate your coverage for third-party losses that you might cause to $1 million, $2 million and so forth.

In this jurisdiction, there’s the ability to separately insure, for a modest amount, an additional coverage in the event there is a shortfall, and that would be the underinsured motorist protection policy. That’s one pot, if I can call it that, that would kick in.

As well, you’ve touched on assets that are available to individuals. We don’t know that at the outset. Nobody plans on these things. But, yes, policies can be shared if there’s a tort-faisor. It’s our submission that, clearly, that potential conflict on, say, a mass loss or a mass casualty scale should not be a basis for eradicating the rights of all British Columbians.

[1:20 p.m.]

These situations can arise, and it’s unfortunate. We’ve all been a part of it, as practising lawyers in this area, where the available proceeds are there and they’re divvied up pro rata amongst the claimants. But that in itself should never be a basis for saying, “Well, the benefits must be better under enhanced care.” They aren’t, because not everybody injured under one policy might meet the thresholds of, say, catastrophic, life-altering injuries.

The system before, by and large, functioned at a much greater level to provide individualized care to the extent there is an exceptional tragedy that is something…. There could be legislative amendments there that actually operate to ensure the innocent victim is not left in the cold, but that itself should not be a basis for saying that prior model didn’t provide proper coverage and enhanced care does.

John-Andrew Pankiw-Petty: The problems with this system aren’t confined to the mass casualty events. If you look at the submissions of the Ombudsperson, the number of complaints about ICBC, particularly with respect to accident-related issues, went from 30 percent before the introduction of enhanced care to 51 percent afterwards. The Ombudsperson reflects the problems with, on the whole, delays; problems with reasons for decisions not being given; problems with income replacement, communication. Again, these are not one-off problems.

What I’m saying is the system isn’t going to be fixed by getting an adjuster to pick up the phone. There need to be meaningful measures and accountability in place to hold the insurer to account.

One of the advantages of the old system was that you had both a negligence-based system, where you could sue a responsible driver, while at the same time having access to care benefits that were, effectively, no-fault benefits as well. In both situations, you could still hold the insurer to account, still have representation and still say: “I want to go in front of an independent judge because ICBC is not treating me fairly.”

Steve Kooner: Thank you for being here today, first of all.

We heard from other organizations before you guys spoke. A common theme that I heard from the different organizations, the issue that they were noticing, was there was a lapse in communication at times, and there were delays as well. The aspect that you brought up was representation. You were referring to the legislation as difficult to understand. I think another organization also brought up being able to understand what enhanced care really involves and what tools you have access to?

Maybe you can shed some light in terms of the old system. Would representation have helped in the communication aspect of finding out what you have access to under the legislation and what that legislation means? Was there any facilitation between treatment providers, the injured party and the insurance corporation?

There seems to be a theme here. Throughout the whole day, we’ve heard about lapses in communication and delays and lack of comprehension. Perhaps you can touch upon that issue and provide us a little bit of a comparison.

John-Andrew Pankiw-Petty: I think that the starting position is: look at some of the submissions that have come in before this committee. You’ve got insurance brokers, I think a doctor whose partner was injured. You’ve got paralegals, some sophisticated, intelligent folks who are struggling with the current system, with enhanced care and no-fault, effectively saying: “This is a full-time job when I should be spending all my time trying to recover.” There are the submissions from the chiropractors who say that they spend 40 percent more time dealing with the administrative issues of enhanced care and no-fault.

Under the old model, the equalizer was having a law firm and lawyers and their team of folks helping regular British Columbians out, navigating the shoals of bureaucracy that is an insurance company. Not only do lawyers and their teams help when ICBC says no, but they also help along the way to get ICBC to say yes. That’s everything from our saying: “Well, if you’re injured, go see your medical provider. Put your priority on getting better first, and we’ll help with getting the records that ICBC needs in order to approve treatment….”

[1:25 p.m.]

The denials come, the delays come, and it’s those representatives who act on those clients’ behalf that are there to protect those folks so they can focus on the most important thing, which is getting better.

Nicholas Peterson: I might add that of course it’s a laudable goal, and we should always encourage the ease with which someone can navigate this complex system. It’s got to become more simple, but at the end of the day, it’s only as good as the actual inputs into that system.

If it becomes easier for somebody to navigate, that is to be encouraged. However, if at the end of the day, the end result is now a system that people better understand but in no way reflects their actual losses, it’s not an individualized, personalized approach.

They’re not meeting a total disability, and therefore they’re not obtaining any wage loss. They’re not meeting a restrictive definition of “catastrophic loss,” and therefore they’re not getting a lump sum payout. They’re fighting about things like 12 physio sessions. While we want to make it easier for them to communicate and navigate that system, which is, as we know, largely alone now, there still remains the elephant in the room. The system itself is not personalized to them.

It might be short-term benefits, but they don’t begin to reflect their actual losses. The umbrella which we ought to start from is that they have access to a system of compensation, that if they cannot agree with ICBC, they have recourse to the courts to obtain fair compensation that reflects their loss. There’s much work to be done under that umbrella, but that should be the starting point.

One of those features under that umbrella ought to be navigating a system that’s made more simple for the everyday person. However, if at the end of the day, they understand it better, but they still don’t have the ability to obtain personalized, individualized rights, then how is this legislation achieving its objectives of protecting British Columbians?

Brennan Day (Deputy Chair): I guess probably the last question…. We’ve seen the mixed results. That’s probably being very charitable to the people that have really struggled under this system.

Under this current system, how can we better separate cases where the old system provided far better accountability and extreme cases and major disability cases from the sprains and minor injuries that drag out? They need treatment right away. It’s not long term.

We were sort of nibbling around the edges of that before enhanced care came in. But how do we make that separation so we can protect both the ratepayer and their protections under the law? I, quite frankly, find that troubling under this system as somebody that drives on the road and sees, every day, fairly major accidents where people’s lives will be changed.

Nicholas Peterson: Essentially we went from a full tort system to a minor injury scheme for two years. Then, without much fanfare, it suddenly was changed to section 115 of the Insurance (Vehicle) Act that statutorily prohibits the rights entirely.

I don’t know if we scratched the surface to your question. We nibbled around the edges. Did we involve the proper stakeholders on a fair system that captures British Columbians that have the ability to seek personalized, individualized compensation? Instead, the pendulum has swung to the extreme end, where there’s a bar for everybody.

There are big questions here. It’s not an easy issue. It’s an unenviable position that a committee may have, but it shouldn’t be that we throw the baby out with the bathwater. If that’s one theme we could leave this committee with, it’s that a lot of people short of “catastrophic” still have very real losses.

A mother or a father that can’t go to work full-time will not qualify for wage loss benefits that are even capped at best. But they’re still missing 50 percent of their work week with no coverage. They should always have access to pursue fair compensation from the individual who caused those losses.

John-Andrew Pankiw-Petty: If you’re asking us for what you should do as a committee, what you should recommend…? Frankly, three things. Restore civil accountability and individualized, fair compensation; preserve immediate rehabilitation benefits for British Columbians; and restore meaningful, independent adjudication and access to representation for all British Columbians.

[1:30 p.m.]

Stephanie Higginson (Chair): I’m seeing no more questions from my colleagues, and it couldn’t have been better timing. Look at that.

Thank you for your submission. Thank you for your presentation, and we always have the ability to seek further questions in the future.

Our next presenters are virtual. This is the B.C. branch of the Canadian Bar Association. We have Kerry Simmons and Sarah Klinger. You have ten minutes for your presentation, and then we have 20 minutes for questions.

Canadian Bar Association, B.C. Branch

Kerry Simmons: Thank you for this opportunity to speak today. My name is Kerry Simmons. I’m the chief executive officer of CBABC. With me is Sarah Klinger, our first vice-president. Our association represents over 8,000 lawyers across British Columbia. Our members are committed to strengthening the rule of law, improving the justice system and ensuring fair access to justice.

Our submissions are prepared with our members, who provide the front-line knowledge and expertise working within our legal and justice systems. Sarah and I will be sharing their submissions to you today.

Sarah Klinger: Thank you, Kerry. We appreciate the work of this committee in reviewing parts 10 and 11 of the Insurance (Vehicle) Act and in considering whether the current enhanced-care model is meeting the needs of British Columbians. As this committee knows, the 2020 reforms fundamentally changed the relationship between injured people, ICBC and the justice system. This review presents an important opportunity to assess whether those changes are delivering on their stated objectives.

Today we’d like to focus on three recommendations from CBABC submissions and, more importantly, explain why we believe that these changes are necessary.

The first recommendation is to restore the fair and prudent principle of holistic loss recovery for victims of negligence. At its core, this is about fairness. The current system relies on predetermined benefits rather than individualized assessment of a person’s actual losses. That means compensation is no longer tied to the unique circumstances of the injured person. Instead, people are fitted into categories. The consequence is that many injuries and losses are not fully recognized.

Consider a student who has not yet entered the workforce. Consider a parent who has temporarily stepped away from employment to provide care to family members. Consider someone retraining for a new profession or building a business. Under the current model, those individuals may not receive the compensation that reflects the earning potential that they’ve lost because that potential does not fit neatly within the existing framework.

Similarly, income replacement caps mean that some higher earners experience losses that are never fully compensated. The principle that should guide the system is simple. When a person is injured through negligence, compensation should reflect the actual impact of that injury on their life.

That does not mean returning to every aspect of the previous system. It means recognizing that fairness requires an individualized assessment of loss. Real people experience real consequences in different ways, and the law should acknowledge those differences. A compensation system should not be designed around administrative convenience. It should be designed around people.

Kerry Simmons: The second recommendation we have is to shift to a model that allows for meaningful challenges, to ensure decisions with the benefit of legal representation. This has to do with accountability, and one of the most significant concerns we hear is that ICBC occupies multiple roles within the current system. They determine what benefits will be paid, what treatment will be approved. They assess the claim. They’re paying the claim. They have those multiple roles.

The important piece is to allow for some measure of independent review, because without it, you have a fundamental imbalance. An injured person who disagrees with ICBC’s determination is often in the position of navigating a complex system while recovering from their physical, psychological and financial consequences of the accident.

[1:35 p.m.]

At precisely the moment when people are at their most vulnerable, they are expected to advocate for themselves against a sophisticated institutional actor. This challenge is compounded by the limited role available for legal representation.

Under the previous system, many lawyers represented injured individuals. People could access legal advice and advocacy regardless of their financial means because payment of legal fees was done under contingency fee agreements. It was dependent on the outcome.

Today that model is largely unavailable because the economics just don’t work. The result is that access to legal representation increasingly depends on personal resources of individuals. That means those with means can access legal representation and those without are left to fend for themselves. That raises significant access-to-justice concerns.

The question isn’t whether every claim requires the assistance of a lawyer. It’s that people should have the option of obtaining meaningful independent advice and representation when they are trying to challenge a decision by a sophisticated actor that will affect their recovery and their livelihood and their future.

Equally important is the review. The review mechanisms need to be independent from government so that there is consistency and transparency and public confidence in decision-making. We really need these changes to be made.

Sarah Klinger: The third recommendation is to ensure that injured people receive medically recommended treatment more quickly.

Now, the enhanced-care model was intended to place care at the centre of the system. If that promise is to be fulfilled, medical treatment — medically necessary treatment — must be available when people need it.

The reality that we continue to hear about, unfortunately, is delay. People report uncertainty around whether recommended treatments will be approved. Health care providers identify necessary care, but injured individuals sometimes wait for decisions from ICBC before they can proceed.

Those delays are not merely administrative inconveniences. When treatment is delayed, recovery can be delayed. When recovery is delayed, people may be unable to return to work, support their families or resume their normal lives. Delay has very practical consequences. It also has human consequences. The uncertainty itself creates stress at a time when individuals are already coping with injury, financial pressure and disruption to their lives.

Now, if an individual disagrees with an ICBC decision, they may then face additional delays while pursuing a challenge through the Civil Resolution Tribunal. That compounds the problem.

A system that is intended to prioritize care should prioritize timely access to treatment. Decisions about medically recommended care should be clear, prompt, practical and predictable. People should not have to wait months to learn whether they can proceed with treatment that could assist with their recovery.

In conclusion, members of the committee, CBABC’s recommendations are grounded in three principles: fairness, accountability and access to care. The enhanced-care model was introduced with the promise that care would come first, but the experience reported by many injured British Columbians suggests that gaps remain.

Compensation should reflect actual loss. People should have access to meaningful independent review and legal representation when challenging decisions that affect them. Any medically recommended treatment should be available without unnecessary delay.

Ultimately, this review is not simply about insurance policy. It’s about whether injured people are treated fairly at one of the most difficult moments of their lives. The law should provide support, it should provide clarity, and it should provide accountability.

So we respectfully submit that the reforms recommended by the CBABC and many others would move the system closer to these goals. Thank you for your time.

Stephanie Higginson (Chair): Thank you.

Over to my colleagues for questions.

Brennan Day (Deputy Chair): I guess I’ll pose the question to you as I posed it to trial lawyers. I absolutely understand the position of both organizations.

[1:40 p.m.]

I do feel great concern over the ability not to have somebody in your corner, especially when you have a catastrophic injury with potentially no other assistance to help you navigate that process. I’ve spent the last two years navigating those processes on behalf of a lot of my constituents, and it is certainly not easy.

I guess the question is: where can we, through this committee’s recommendations, find that sweet spot where people can seek representation when they need it, but we’re not biasing the system towards unnecessary litigation?

I think that’s what the magic question is here. Where does your organization see that balance?

Kerry Simmons: Part of it would be to have independent oversight of that system, where you’ve got an independent mechanism managing any challenges by people who are saying, “I don’t like what’s happened,” so that there are better time frames involved with making representations, having a hearing about it and going forward. That would be a central part of what we would want to see going forward.

Brennan Day (Deputy Chair): So how do you envision that system?

The dispute resolution system now is obviously not working very well for people that are catastrophically injured, and the representation is challenging. How would we set up that organization outside of ICBC as a stand-alone and allow it not to become just another Human Rights Tribunal–like organization that is hands off but still has the same challenges of, you know, where the independence stops and ends, right?

Kerry Simmons: Yeah. Well, you could have everything return to our courts, which are an established independent oversight system. And the rules of court with respect to timelines of meeting deadlines and managing what kind of information needs to go forward could be developed to make it proportionate to the significance of what it is that the claim is all about.

Obviously, when you are talking about a catastrophic injury, you want to make sure that you have all the information, the data and the medical reports so that there is an appropriate decision within the bounds of the legislation.

You can use the existing tools of the Rules Of Court, and they could be modified for these kinds of claims to make sure that judges hearing these claims have the tools to keep ICBC and the injured person moving forward with getting it all sorted out.

Brennan Day (Deputy Chair): Okay, so I guess my follow-up from that — I mean, that all seems reasonable — is that the delays that we’re seeing in the courts across the court system would add significant additional cost to the government, maybe not necessarily ICBC itself. But how would we square that?

We already see delays in criminal cases and all sorts of things in the courts, that they’re understaffed and that Crown prosecutors struggle. How would that sort of line up with that vision? How would we navigate that?

Kerry Simmons: Well, what we need is to make sure that our courts have the resources that they need in order to operate, given the population that we have in British Columbia.

Part of that is the provincial government advocating to the federal government for the number of judges that we need to have in this province, given the population increases we’ve experienced, and then to appoint judges to the Supreme Court in a timely manner so we don’t have vacancies that then are causing the delay.

If we are speaking of review at a Provincial Court level, if that was where these claims were directed in a future model, then, similarly, the provincial government needs to make sure that there are appropriate judges being appointed in a timely manner.

The provincial government does have a track record of doing that in Provincial Court. We don’t have significant vacancies in our Provincial Court, but that’s what we would need in the Supreme Court.

The reality is that we have a justice system that has been underfunded by all levels of government for many years, regardless of who is running the government at the time, and we’re playing catch-up.

[1:45 p.m.]

That is going to be a necessary consequence and step that a government needs to take to bring the resourcing of the courts up to speed regardless of what’s happening.

Steve Kooner: Thank you, first of all, for being here to present to us virtually. My question is that in regards to representation, and you’re taking injured parties or dealing with ICBC…. My understanding is you could still have representation, but the impediment is that somebody that’s injured would have to pay out of pocket, and so it doesn’t become feasible. Can you shed some light in terms of that?

Sarah Klinger: I can shed some light on that, yes. As we said, under the old system, because lawyers knew that there would be a damage claim coming forward, we would be able to take these matters on contingency, which is really important because this is a time when people are probably out of work, and if they have any spare money, they may be trying to even put it towards medical treatment themselves.

At this point, for those that want to go to the Civil Resolution Tribunal, unfortunately, counsel can no longer offer contingency fee agreements because there isn’t going to be a settlement amount. If we get things sorted out, there will be some benefits that will be payable, but it’s not going to cover legal fees. So now you’ve created a system where only those who can pay are able to have representation at the Civil Resolution Tribunal.

Stephanie Higginson (Chair): Other questions?

No? Okay, I’m just going to fire away at one then, specifically to your third recommendation: “enable injured individuals to obtain medically recommended treatment more quickly.” You talked a little bit about people waiting for a decision on care, next steps on care. I’m wondering how…. Is this sort of a…? Does ICBC need more people to be handling so each individual adjuster, or whatever their new title is, is handling less? How, specifically, is inserting a lawyer into that process going to speed up people’s access to care?

Kerry Simmons: I think there are two parts to that. As you have suggested, one option is to have more people available to assess and review and document and move the system faster. We see under-resourcing in lots of parts. The Human Rights Tribunal has got too many claims and not enough staff. It’s sounding like ICBC may not have had enough staff to deal with the volume. That could be a solution to move things forward.

Another thing might be better information and education to those making the assessments so that they can do it quicker. Something to explore.

But the other piece is that sometimes when somebody is injured, they are compromised in their ability to move something forward. That’s where having a representative can sometimes help that go more quickly, because that representative can be their voice and get to the point while they might be compromised in doing it themselves.

Stephanie Higginson (Chair): Okay, thank you. It’s a theme we’ve heard a little bit about today. Particularly after the first 12 weeks, there do seem to be sort of two hurdles or areas. We’re seeing some requests in that area.

Any other questions from my colleagues?

Jeremy Valeriote: Thank you for the presentation. My question is actually for the committee rather than the Canadian Bar Association. So if there’s any…. Maybe I should save that till the end. But we’ve got ten minutes, so I’ll just pose it really quickly.

There are a number of what I think are pretty valuable questions on page 4 of the submission. I’m just wondering from the committee and maybe from staff. Can we assume that ICBC will take those into account when they appear before us Thursday? Should we forward…? Though there’s a quite a bit of data crunching or data demands there. Does the committee have any interest in forwarding those questions to ICBC and the AG in advance of their Thursday appearance?

Stephanie Higginson (Chair): Both presenters that you’re talking about who will be presenting at the end of the week, the AG and ICBC, have had access to the submissions. If there are particular questions that we want answered on that ahead of time, then we can ask.

[1:50 p.m.]

We also have the ability to talk about these questions during our own deliberations and decide what questions we want answers to. There are lots of opportunities for us to dig into specifics around submissions during deliberations as well.

Do you have a question for the presenters, MLA Valeriote?

Jeremy Valeriote: I don’t, thank you.

Stephanie Higginson (Chair): Okay, seeing no more questions, then, thank you very much for your submission. Thank you for your presentation today, for taking the time to provide us with your perspective. As you can see, it appears that perhaps we’re going to be talking a little bit more about it during our deliberations. I really appreciate your time today. Thank you for coming.

Kerry Simmons: We appreciate that you paid attention to those questions that we’ve raised, because we think that might help you. Take care.

Sarah Klinger: Thank you for having us.

Stephanie Higginson (Chair): The next presenters are in person — Crisis Centre of B.C., Stacy Ashton.

Nice to see you. Hello, Ms. Ashton. You have ten minutes for your presentation, then we have 20 minutes for questions. If your presentation starts to go over, I will let you know that it seems like it might be time for you to wrap it up, okay?

Excellent. Please go ahead.

Crisis Centre of B.C.

 Stacy Ashton: Thank you very much. Awesome.

I’ve spent a few days going through the many submissions that were made to this committee, and I think what I’m seeing, and maybe what you’re seeing too is that, in principle, enhanced care should work. But it’s not working because the practical and cultural changes that are needed to take ICBC out of an adversarial system and into a care system haven’t been made.

The complaints that I read really boiled down to: early access is great, but if I’m not all better within four months, I enter a world of delay and deny and deflection that interferes with my rehabilitation and generates a great deal of stress and administrative burden for myself and my medical care professionals.

Income replacement is great, but it doesn’t cover all the costs that are associated with my injury. If I’m self-employed in any way, it doesn’t really account for that, and it also doesn’t reflect my future losses. I’m capped at whatever income I was making when I was injured.

ICBC is working really closely with disability organizations. That’s also great, but if it takes an intervention from a disability organization to ensure that I receive benefits, then something’s gone very wrong.

Being able to appeal decisions is awesome, but bringing evidence is all at my own cost. The tribunal is not independent, cannot help me make my case against highly experienced ICBC representatives and rarely overturns decisions anyway.

You’re hearing from ICBC that changes are being made and adjusters are being retrained to a new way of approaching claims. You’re also hearing that ICBC is running pilot projects to bring in navigators who can support selected folks through the administrative hurdles set in front of them.

You’ve heard a lot of people…. Even in my original submission, I thought: “Yeah, that would work, right?” Then I started thinking, and I want you to think too: “What does it mean that ICBC must resort to navigators and advocates to ensure that their staff grant access to legitimate benefits?”

It means that ICBC is fully aware and actually does agree that their staff are withholding legitimate benefits to injured people. It means that the problem of withholding legitimate benefits to injured people is so severe their internal management have not been able to control the problem. It means that ICBC staff are continuing to pretend that they are working against lawyers when they’re working against injured regular people. If you’re not able to fight or navigate for every piece of benefit that you’re actually entitled to, then you’re probably not going to be successful.

I also want you to understand that when an advocate or a navigator is successful in getting benefits, that person was entitled to them all along. ICBC shouldn’t have withheld them in the first place, and ICBC should be the ones who knew better than to withhold them.

[1:55 p.m.]

Their job now is not to deny care or benefits. Their job now is to make sure that people who have been injured in a car crash get their benefits, get their entitlements. That’s their only job.

Premier Eby called this. When he spoke in 2020, he said: “ICBC has had a culture for decades where they had a legal duty to defend the at-fault driver with a lawyer paid for by insurance premiums to fight the person who is entitled to benefits. One of the hardest things is going to be shifting that culture into the care-based system.” That is turning out to be very, very true.

What does this mean for you on this committee? You’re being called on to help ICBC make this transition. You’re being called on to motivate ICBC to become a care system.

If this change is to happen, withholding benefits to injured people has to be by far the worst thing you could do as a staff member at ICBC. There has to be no worse thing that you could do. Letting a claim go that turned out to be, “well, they didn’t actually need five massage therapists; they needed four sessions” can’t be the worst thing. It has to be that you illegitimately withheld claims from somebody.

I’m here from the Crisis Intervention and Suicide Prevention Centre of B.C. I’m here because a parent, Susannah Devitt, reached out to me to share the experience of her son Matthew — an experience he had trying to recover after he’d been hit by a car while cycling.

When she shares her story with you and Matthew’s story with you on Thursday, I want you to hear the profound loss that Matthew felt on losing his health, his hopes, his dreams for the future to a car accident. Then, I want you to think about how it feels to have to fight ICBC while grappling with these losses. I want you to hear the sense of betrayal that Matthew felt and the humiliation of having treatments that his medical care team thought would help him denied.

I want you to think about the despair and hopelessness of giving up on getting better and giving up on the fight and deciding you’ll just live, or not live, with the cards you’ve been dealt. The level of despair and suffering can be quite profound. For Matthew, that despair took his life.

I want you to understand that you could be in that same situation yourself today after a car accident. I want you to understand that if you allow ICBC to continue operating this way, you are allowing a system of despair to exist. It’s a system that, by its very design, is outputting anger, sadness, despair, hopelessness and helplessness because it’s not meeting the needs of people who’ve been injured.

It doesn’t have to be this way. It will, though, take some pretty concerted efforts, in the legislation and by government, to encourage and force a change that ICBC has not been able to make by itself. Thank you.

Stephanie Higginson (Chair): Thank you. I was just looking through your submission while you were…. To look at those recommendations…. Okay. Thank you for your presentation and for representing the folks that you do so well.

I will turn it over to my colleagues to see if they have questions.

Brennan Day (Deputy Chair): Just reading over your submission. You make a great point, and I’ve made it a couple times today already — that the people with the greatest support needs are also the least able to advocate for themselves.

Under this system which takes away the right to legal representation, as that advocate, what would you envision that looking like in terms of victims’ advocacy services and giving them at least a seat at the table in the event that we don’t get to a place where we’re going to be going back to a tort system? Quite frankly, unfortunately, we don’t have the numbers on this committee to make that happen, but the recommendations certainly need to move things forward for victims.

Stacy Ashton: I think what you’re seeing is ICBC is making a lot of its own work. The more they deny, the more they have people who are making complaints and needing access to courts and access to tribunals and access to independent reviews. If the threshold to deny care is far, far higher, then you’re going to see a reduction in the complaints and the need for intervention, right?

If ICBC is telling you that they need navigators to help people access their legitimate benefits, then they know that these are legitimate benefits that need to go out the door. Why are they pausing? Why is it so hard? Why does it require so much paperwork? Why is a note from my doctor not enough?

[2:00 p.m.]

If you think about what needed to happen for freedom-of-information requests, you were dealing with a bureaucracy that had, for hundreds of years, not wanted to give up any records ever. The legislation had to be very clear in order to change the culture from “withhold” to “get it out the door as soon as you humanly, possibly can.” Get those benefits out the door as soon as you humanly, possibly can.

Brennan Day (Deputy Chair): You bring up an interesting point with the freedom-of-information issues. We’ve been through that quite a bit this session, and we know that there are significant barriers being placed on freedom of information.

What’s your experience with freedom of information being required for claims through the ICBC system?

Stacy Ashton: Well, it seems very strange to me that, as a person who’s receiving medical care, I wouldn’t know what exactly was in my ICBC file at any time without cost to me. Why would I not know that? Why would I have not seen every single piece of paperwork that has gone into those files?

You’ve heard stories of people needing to contest things because they didn’t see them go into the file, and they weren’t correct. So there’s really…. I can’t see why there’s any excuse for that. I should have access to all my medical records. No one should have to charge me for them. If ICBC required less records in order to just approve my claims, then there would be less paperwork to argue about in the first place.

Brennan Day (Deputy Chair): I think that’s a fantastic point.

Stephanie Higginson (Chair): Other questions?

Okay. I just want to dig in a little bit.

Sorry, was there somebody else with one that I didn’t see?

Brennan Day (Deputy Chair): I’ll have more, but go ahead.

Stephanie Higginson (Chair): Okay.

I want to dig in a little bit to your recommendation No. 2 here — ensure access to independent advisers to help insured parties navigate ICBC’s enhanced-care framework. We’ve heard a lot about the maze, and because of the capacity that’s needed to do it, sometimes it creates inequity.

What does that structure of independent advisers look like to you? We just heard from a group of folks who have a specific idea about what that looks like and who it should be, but I wonder, from you, what that looks like from your perspective.

Stacy Ashton: Well, I think you’re dealing with a situation where either you make the maze much, much easier to navigate, or you have independent advocates with teeth who can take down some of the unnecessary walls themselves.

What you’re doing is you’re trying to change a system either by force — by having an external force like a lawyer, with the same kind of clout and ability to hold to account as a lawyer; do that — or you’re making it impossible for ICBC to deny claims much, much more often, which means that there are fewer claims that are going to end up being disputed.

I think those are the things. If you want to keep it going the way it is, you’re going to need lawyers in order to hold ICBC to account, unless you take away ICBC’s power to deny claims.

Stephanie Higginson (Chair): Thank you.

MLA Day, I think we’re back to you then.

Brennan Day (Deputy Chair): Great, thank you.

For the independent complaint body, we’ve asked the people advocating for more of a step back to the old system. You’re saying: “Well, maybe we can work within this system.” What do you see for the independent complaint body being different from the current dispute process, which we’ve heard complaints about? As we go forward through this, we’re going to hear from quite a few people that express that problem.

How can we do that so that it can intervene early and make sure that disagreements over treatment aren’t held up unnecessarily?

Stacy Ashton: Yeah. I think when you’re trying to overturn a system…. What makes up a system of despair is when you as an individual have far, far less power than the person that you’re dependent on or the entity that you’re dependent on. Your choices are very, very constrained, and your ability to access any kind of justice is very, very limited. So wrongdoing can be done to you, and there’s nothing that you can do about it. That’s the kind of thing…. Plus, you’re injured, and the consequences of not getting your care needs met are very profound.

[2:05 p.m.]

That’s the situation you have here. If you are going to have a tribunal, you’re going to need to have a tribunal that restores people’s choices and empowers them so that they are at the same footing as the ICBC representatives who are claiming that you don’t deserve the benefits you think you’re entitled to.

Right now, as far as I can see, the burden of proof is very much on the injured person and not on ICBC, which seems strange to me. Why…? If ICBC is withholding benefits, then perhaps they should prove that they have the right to do so.

Brennan Day (Deputy Chair): That’s a very good point.

Along those lines, one of the other recommendations was that ICBC is not currently measuring properly, which I would agree with. I think that that kind of leads to the transparency piece as well.

What do you think ICBC needs to be measuring and publishing publicly, in terms of metrics that would help us understand the problem better? I think, as I’ve worked through government over the last two years, one of the primary problems that I’ve seen is that we’re just not transparent with the problem. So there’s no push from the public to fix it because it’s kind of glossed over with press releases.

You either measure savings to the ratepayer on the insurance side or you measure the fiscal sustainability of ICBC on the other. But it doesn’t seem like there’s a very good public measurement of how many people have been either helped by the system or failed by the system. It’s not very transparent.

What would we do in the recommendations of this report to try and get that into the public light?

Stacy Ashton: It’s a tough one because the tactics of delay and denial make it so…. They stack the data, right? So to be able to get an honest count of how many people have given up on the process is difficult, because they typically don’t tell you. They don’t believe there’s any purpose to complaining.

I would be very curious to see how many denials are happening, how many delays are happening, and be looking at it like…. When we evaluate the crisis lines, we’re looking at how many seconds you wait before I can answer the call. We have a service level that we are hoping to meet, which is that 90 percent of the calls should be answered in less than a minute.

Those kinds of service demand levels, like that 95 percent of your benefits need to be out the door within…. The four months seem pretty solid, but continuation of benefits needs to be out the door within a week of request, and if you’ve failed on that, you’ve failed.

In those kinds of models, you set up a service level demand, and then you hold people accountable to that. The service level demand is in the interest of the individual who is getting the claims met.

Does that make sense?

Brennan Day (Deputy Chair): Very good. I think that’s a fantastic follow-up, once we get ICBC back in the room, to understand what data they already collect and get that on the record so we know as a committee what’s already being tracked and perhaps just needs to be published to ensure that there’s some accountability there.

Thank you for that.

Stacy Ashton: The term “service level demand” is a very common thing in customer-facing service. Help desks do it. We do it.

Stephanie Higginson (Chair): Any other questions?

George Chow: I just thought perhaps you could give your opinion on whether anything can be done, in terms of the governing board of ICBC, to improve some of the issues you were talking about.

Stacy Ashton: This kind of system change comes from both the top and the bottom at the same time. It will require the board itself to be looking at different measures of success. If you’re looking at savings as success instead of that there’s a large proportion of those savings that are likely to be legitimate claims that have not been paid out, then you’re going to be reading those reports very differently. It really is: you have to change the incentives and the motivations from the top down.

[2:10 p.m.]

Stephanie Higginson (Chair): Do I have other questions? No?

Thank you very much for your time.

Folks, since we’re running a bit ahead of schedule, we’ve got some folks who are in the audience who were scheduled to present after our recess, so we’re going to bring up one of them, if that’s okay with everybody here.

We’re going to bring up Julia Kwan. We’re going to have a presentation from Julia, and then we’re going to have a recess.

Hi, Julia. A little bit of a change in timing. Because you’re an individual presenter, you will have five minutes for your presentation, and then we’ll have ten minutes for questions.

Thank you very much. I’m looking forward to hearing from you, Julia.

Julia Kwan

Julia Kwan: On November 4, 2024, a Monday morning, I was waiting on the curb for the pedestrian light to change so that I could cross the street to get home.

When the sign turned, I stepped off the curb, and my whole world changed. My leg was getting crushed, then my thigh, pelvis and hip. Would it get to my heart, my brain? Am I going to die? How will my two-year-old son, Lucas, live without me? How will my husband, Andrew, raise him without me?

I was pulled out of the wheel and saw it was a dump truck. My leg was crushed. It didn’t get to my heart, but I knew I was dying. I could see and hear the fear in the voices and the chaos of the first responders and those around me.

I arrived at VGH with a blood pressure of 50 over 30, trauma team waiting for me, massive transfusion protocol, 12 doctors around me saving my life, degloving of leg and abdomen, fractured pelvis, lacerated spleen, kidney damage, eight fractured ribs, fractured wrist and foot. Six nights in ICU, nine weeks of hospitalization My ninth surgery was just three months ago. Statistically, I should not be sitting here in front of you today.

I was 33 years old when this happened. My husband and I were hoping to grow our family. I’d spent a decade building my career. I was the primary caregiver for my toddler.

When you experience trauma, certain sounds, situations or words can trigger the nervous system to respond as though the trauma is happening again. When I am triggered, I go to November 4, 2024, dying on a road, thinking my family would never see me again.

Reading that my nearly fatal accident is not considered catastrophic — triggered. Hearing “We can’t help you” from lawyers — triggered. Three months after the crash being asked by an adjuster when I thought I might go back to work — triggered. Browsing 117 pages of medical and legal terms for how much my permanent injuries are worth — triggered. Following up for five weeks about expenses not being reimbursed — triggered.

Being told that the driver of the accident pled not guilty and that I would have to be a witness so he could defend himself — triggered. Being told nine months later that he changed his mind, so no trial — triggered. Coming to terms that this accident took away my dreams of having another child, a sibling for my son — triggered.

Some of you listening here have children. If you lost the opportunity to have another child at no fault of your own, how would you feel if that wasn’t even acknowledged or considered?

It is one thing to go through one of the worst human experiences imaginable. But needing to prove that it was one of the worst human experiences imaginable just to get the care that I need, and needing to prove that the losses I’ve had at 33 years old matter, when legislation tells me it doesn’t — there are no words to describe what that feels like, and I would know. I’ve been hit by a truck.

I am not alone in this. Through Victims of No Fault, I surveyed 218 injured victims under enhanced care, and 73 percent have had to advocate for themselves. My ability to return to work is always asked; my ability to parent is never. I would love to work if I could, since I have used savings to cover what income replacement benefits don’t.

[2:15 p.m.]

I’ve also paid $4,000 in top-ups for essential care that I am receiving. Again, I am not alone in this, as 76 percent of survey respondents have dipped into their savings, and 54 percent have borrowed or incurred debt. People have lost homes. People are back to work before they are ready.

ICBC reports one measurement for customer claim satisfaction. It’s 74 percent. I checked what was reported to the Utilities Commission. It is an average of two metrics. One, first notice of loss, 84 percent; closed claims, 65 percent. Seriously injured victims like myself are completely excluded from this process.

In my two years of being in this system, this is the first time I have been invited to share feedback. I will add that this legislative process is inaccessible to most. I’m speaking today because I did not have a brain injury. I’ve worked ten years in corporate. I was born here; I have a degree. I can’t help but think of how my late grandparents would have had to advocate for themselves just to be heard.

If I’m being honest, the lack of statistics and forms for feedback makes it sound like you don’t want to hear from us. Where is the accountability for better care for as long as you need? Who is accountable to injured victims?

I would also like to add, given that a snap election may be upcoming, I have major concerns that this process will be lost in that. Injured victims are suffering. They need help now.

Stephanie Higginson (Chair): Thank you, Ms. Kwan.

Julia Kwan: Call me Julia.

Stephanie Higginson (Chair): Thank you, Julia. Thank you for sharing your story and having the courage to share it.

I will look to my colleagues for questions.

Brennan Day (Deputy Chair): I share those exact concerns. I don’t think we’ll be back in this room tomorrow, and, quite frankly, that is an absolute disgrace.

Julia Kwan: It is.

Brennan Day (Deputy Chair): With that said, the 12-week treatment period has come up several times now. For somebody with a severe injury…. I had a constituent that was in hospital for a month — same issue — then kicked out of the hospital with effectively no wraparound supports to get her home. How do you think we can best adjust that to take into consideration catastrophic claims like yourself?

Julia Kwan: Well firstly, I will say that I was not able to access those 12 weeks of care. Those 12 weeks start the day of the accident. I was in the hospital for nine weeks. That would’ve given me three weeks. I was still bedridden for another month because I couldn’t put weight on my leg.

I remember being very, very distressed coming home from the hospital because I had to figure out how to get physio to come to my house. Although my OT helped me and although ICBC tried to be supportive, from when I was discharged to home from the hospital, my first assessment took place four weeks after. That’s not acceptable for somebody with injuries like mine.

I was supposed to be going to G.F. Strong, but given the weight-bearing status on my left foot, it was decided that that wouldn’t be the right place for me. I was discharged home, but my physiatrist actually kept me on in his care. He was very concerned that I would not get the care that I need.

Brennan Day (Deputy Chair): Could you tell us about what care you’re receiving now, if you’re willing to share, and the process as you’ve moved from the immediate injury through the four-month or 12-week timeline to that longer-term recovery?

Just describe the challenges you’re having now, dealing with ICBC and accessing reasonable and timely care.

Julia Kwan: At the busiest point in time, I think I had nine different practitioners or health care providers. It was my responsibility to organize all of those appointments, make sure they were not conflicting, do the exercises of recovery and also the administration of everything.

That would be impossible for an average human being, in general. I was recovering from something very, very traumatic. Not only that but I was still trying to be very present in my toddler’s life, which is never really considered in all of this. You’ll hear from my husband, who talks a bit more about the caregiver perspective of that.

[2:20 p.m.]

I would say I’m the exception because I do have ten years of experience in corporate, working as a project manager. I am very efficient and resourceful with my time, but the threat always feels there. Like I said, three months after my accident, even being questioned about work…. That has scarred me for the rest of my recovery. I will always feel like, if a work question is asked, I’m being threatened.

George Chow: Thank you for your presentation. Certainly, I do share…. You know, one of your comments about you being born here, working in the corporate side. You’re kind of really well versed into this kind of work. Sorry. Not work, but trying to fight your way through the system.

As an MLA, I have met people in my office who don’t have your qualifications in terms of dealing with government and corporate and, of course, having language difficulty as well. I fully understand what you’re saying here, and I think that’s something that we should be looking at. Yeah, I think this navigator system that’s being talked about could be a potential as we go forward.

Julia Kwan: Just to comment on that, I do think a navigator system would be helpful, whether that’s through lawyers or another body, but I think the key thing here is that it cannot be funded by ICBC.

I actually had to get an OT changed because of the way…. I just felt like she was more on ICBC’s side than mine, and she holds so much power in my care. I actually got my whole care team changed to parents, because that is such a large task or large life that is not even accounted for.

When you actually look at all of the assessment forms, return to work is listed higher than return to functionality. I think that says a lot about what ICBC’s priorities are.

George Chow: I do agree with your point about the independence of the navigator system, yeah.

Stephanie Higginson (Chair): Other questions from folks?

Brennan Day (Deputy Chair): One of the other ones, I think, that you can uniquely talk about is the caregiver benefit, in terms of the challenges you see. I want to give you some more time to talk about that. If you could just let us know what those challenges were right at the beginning, your struggle with that system and what you see are changes to that benefit that need to be adjusted.

Julia Kwan: Well, my husband will definitely speak to what it’s like to be on the other side of caregiving for both a spouse and a young child.

What I do know is that the caregiver benefit really doesn’t apply to very many people. It’s kind of shocking. Basically, you only receive the caregiver benefit as a stay-at-home parent, but in this economy, the number of homes that have a stay-at-home parent versus two working parents, even if it’s full-time or part-time…. I don’t know the metrics. I’m sure you probably do better than I do, but I highly doubt that there are a lot of homes that would get that.

If anything it’s…. What I’ve found really interesting about this system specifically is that multiple adjusters have been, like: “Oh, can’t you get that caregiver benefit?” They’ll look into it, and they’re: “Oh no, you don’t qualify for that.” I’ve actually been in a position where I’ve had to educate my adjusters more about the legislation than most, and I’m an injured victim. That education should not land on me.

In the survey that I did, 75 percent of injured victims did not understand enhanced care until they were injured.

Stephanie Higginson (Chair): I just want to pick up on one of the things, a term you used. I just want you to sort of, if it’s okay with you, explain it a little bit. You said that when asked to go back to work…. You described it as feeling like a threat. Can you walk me through the choice of words and what it was that made you feel that way?

[2:25 p.m.]

Julia Kwan: Well, I was home for three months. The accident happened three months prior to this first conversation with ICBC. It was an hour-long call. Luckily, my husband was on the phone with me, but essentially he asked: “Oh, not that I’m rushing you or anything, but can you give us a timeline of how long you would think until you can start thinking about going back to work?”

And, you know, was it me being sensitive? Maybe. But I also got hit by a truck, so in my opinion, that was very inappropriate to be asked.

I also had another adjuster who…. He was onboarding me to his care, because adjusters change all the time. And he asked me specifically more about my accident and what my job was. He was like: “Okay, so you work at a desk job.” I’m like: “Yes.” And I told him about my wrist. I’m like: “This is actually one that’s aggravating me, and I think this will take a long time to heal, which would prevent me from doing my work.” He clarified if it was my dominant hand.

I think it’s the subtle undertones of these things that really…. It has set me back in my recovery. After that conversation, I was in bed for four days, and I’m a strong person. To have your whole security taken away from you when it wasn’t your fault, and then to have that constantly questioned….

I’ve worked since I was 16 years old. I’ve always been in charge of my finances. And now it’s like David and Goliath, trying to figure out what my financial security is.

If I just had one adjuster who came up to me and said, “Don’t worry about it; you’re going to return to work when you feel ready,” that would’ve changed my recovery completely. But because it’s always asked, it’s always top of mind for me as well.

Stephanie Higginson (Chair): Okay, thank you.

Are there other questions yet? No?

Can I just ask one more then, with the short time we have left?

Julia Kwan: Yes, absolutely.

Stephanie Higginson (Chair): How many adjusters have you had?

Julia Kwan: I think it’s been about four or five in the two years. I actually had one adjuster last year who was basically MIA for eight months, I would say. I think she was on a leave of some sort.

I have done an excellent job in escalating my concerns to their manager. But one of my concerns, especially as a change management consultant, is that if you have all of these concerns being escalated to managers, who’s then tracking that, and who’s developing the themes from that, and where is the accountability?

The fact that this had to be the forum for me to provide feedback is ridiculous. I have actually called once to the call centre to tell them that I couldn’t access the online portal, which I’ve never been able to access. I asked if there was a person I could provide feedback to. They said they didn’t know, and that’s when the conversation ended.

Brennan Day (Deputy Chair): Yeah, I just wanted to say thank you for stepping up on behalf of the thousands of people that are injured that couldn’t do what you just did.

Julia Kwan: Thank you. I do worry about that. A lot of people, in the research that I did…. A lot of people just want to be heard. This can’t be the forum for injured victims to provide their feedback. This takes guts. This takes smarts. Not to say that nobody is smart, but for an injured victim to do this…. I was literally writing this submission three weeks after a surgery — my ninth one.

Stephanie Higginson (Chair): Okay. Julia, thank you for your courage. I’m sorry for what you’ve gone through. I appreciate you taking the time, and I hear that we’re going to hear from your husband in a little bit.

Okay, folks. That puts us at time for a recess. Julia was the next presenter. Our next presenter after that wasn’t scheduled to be here till 3:05, but let’s all return here at three, because usually people show up a little bit early. So let’s return here and be ready to go for three o’clock.

The committee recessed from 2:29 p.m. to 3:01 p.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): Okay, everyone, we’ll call the committee back to order.

We are going to hear next from Kim Lockwood.

Kim, it’s nice to see you on the screen. You will have five minutes for your presentation, and then you will have ten minutes left. We’ll ask questions for ten minutes. If your presentation starts to go over, if I don’t notice that you’re starting to wrap up, I may have to interrupt you to remind you to wrap up in time. Hopefully, we can keep on time today. I look forward to hearing from you.

Kim Lockwood

Kim Lockwood: Good afternoon, and thank you for the opportunity to speak with you. My name is Kim Lockwood. I was injured in a motor vehicle accident in December of 2021. Part of my injuries is brain damage that affects my visual memory and my reading skills, so please bear with me.

Besides memory and vision issues, I’ve lost a lot of my health, my career and my independence because of the accident. What I didn’t expect was that the system designed to provide long-term security could also leave a permanently disabled person dependent on the ongoing insurance claim and benefit system for much of their life, which brings me to the question I want this committee to consider.

What is the finish line for enhanced care? When someone is recovering and expected to return to work, ongoing income replacement and active case management make sense. But what happens when the recovery has plateaued and reliable medical evidence establishes that the person will not return to work?

Long-term eligibility is not the same thing as long-term financial security. A person’s financial security can continue to depend on the ongoing statutory benefit system. Benefits will have to be calculated, adjusted, information and documents requested. Reassessments occur, and errors and disputes arise. For someone living with a permanent disability, it can mean years of continuing to deal with the administrative consequences of an accident that they’re already trying to learn to live with.

And there’s another side to this. The long-term benefits also require ICBC to maintain and administer those obligations for many years. The committee has heard evidence about ICBC’s long-term financial obligations under enhanced care and the need to estimate future benefit costs. I understand that an accounting liability is not the same thing as an individual settlement value, but the concept of estimating the future value of financial obligations is not new.

I think we should ask that if a person’s inability to return to work has been reliably established as permanent, does every case need to remain with an ongoing administrative system for years or potentially decades? At some point, the focus should no longer be on repeating establishing permanency. It should be on learning how to live with those permanent injuries or injury and building whatever future remains available.

This is why I’m asking the committee to consider a voluntary option for permanently disabled people to resolve their future income replacement entitlement — not mandatory, not a return to the old tort system and not an individually negotiated process where someone needs a lawyer to fight for the best offer.

People who want to continue with the current payment system should be able to stay there, but where reliable medical and functional evidence establishes that the person will not return to work, there should be a voluntary pathway to resolve the future income replacement entitlement. The pathway should include safeguards, independent financial and legal advice, informed consent and a transparent standardized calculation that’s based on the person’s statutory entitlement.

[3:05 p.m.]

I recognize that choosing a lump sum would transfer financial investment and longevity risk to the injured person, but that’s why there should be safeguards and it should be voluntary. For ICBC, such an option could mean resolving appropriate permanent claims rather than continuing to administer these obligations for many years. For the injured person, it could mean something more personal — certainty, independence and the ability to plan a future.

My accident permanently changed my life. My world has become very small. I cannot change what happened to me. I cannot recover the health, career or independence I lost. But I should be able to decide how to build the future I want around the life I have now.

My recommendation is simple. Create a voluntary option for permanently disabled people to resolve their future income replacement entitlement, once reliable medical and functional evidence establish they will not return to work. Give the protection of periodic payments to those who want it, but give us living with permanent disability another choice.

Permanent disability should not mean permanent administration. Give us the pathway to certainty so we can start organizing our lives around our own future.

Stephanie Higginson (Chair): Thank you, Kim. Thanks for your presentation and your submission, and I also really appreciate your focused suggestion.

I’ll turn to my colleagues for questions.

Jennifer Blatherwick: Thanks very much, Kim. I remember your written submission.

Can you just talk a little bit more about what a difference it would make in your life, like in a practical way, to go from doing managed payments to having a lump sum? Lead me through that. What would the difference be for you?

Kim Lockwood: It would mean security, not wondering every two weeks if I’m going to get paid.

I wouldn’t be having to do the same reassessments twice a year. I wouldn’t be having to talk to my independent client recovery agents every week for different documents or different demands. I think I probably spend about five hours a week right now — and it’s been five years almost — still dealing with administrative demands for ICBC.

Jennifer Blatherwick: Which is a lot.

Kim Lockwood: It’s exhausting. That’s my life. My life is ICBC. When I talk to somebody, they ask me how it’s going. There’s no future. There’s no end goal.

I worked as a project manager before, so I always was used to setting goals, and now I have no end goal with this. There’s no resolution.

Jennifer Blatherwick: For you, in particular, is the push to end that ongoing relationship more about the ongoing burden of the administrative work, or is it the financial security part, which…?

Kim Lockwood: I think it’s a little bit of both of them. And then with every…. I’ve had three specialists say I can’t go back to work, and I don’t know how many treatment providers have all said the same thing.

It’s the continued assessments and that continued: “Well, what if this one says something different?” I know I’m broken, but it’s exhausting having to re-prove it to these new people every time.

Brennan Day (Deputy Chair): Thank you for sharing, Kim.

Obviously, we want to see some changes here. I think you’re on to the right path, at least in my head. How much extra administrative cost are we spending versus what we’re actually saving on the actual delivery of the health care that people need? I think that’s something that the committee desperately needs to look into, because if we’re trying to fix a band-aid with more bureaucracy, that’s not going to work for anybody long term.

I guess my question is: for that binding long-term treatment and benefit plan, what would that plan need to include to give somebody in your situation more certainty over that, finances and the care you’re receiving?

Kim Lockwood: It doesn’t have to be…. You could leave the care with ICBC if you wanted to. It’s just the income replacement section. You can separate them if they don’t want to pay that one.

They’re already calculating how much it’s going to cost us in the future if they keep us on, so it should be a clear and concise calculation that’s the same for everybody. I think the main thing is they show you what they’ve calculated out. They have actuaries. They have people that do the calculations. I’m not going to attempt. I can’t do math anymore.

Does that answer?

Brennan Day (Deputy Chair): Yeah, absolutely.

One thing that wasn’t in your submission, to try and put this into perspective, do you know how many hours, roughly, in a week or a month you’re currently navigating through ICBC to try and get basic benefits given to you? I think that would certainly put into perspective how much time ICBC is spending on the other side in terms of costs in dealing with each individual claim.

[3:10 p.m.]

Kim Lockwood: I only communicate with ICBC by email. It’s not over phone anymore. I probably get two or three emails from them a week. Each email takes probably half an hour to an hour to respond to and then whatever they’re asking for — if they’re asking for documents, if they’re asking for me to attend an assessment.

A lot of times it’s me asking them questions, and I will have to re-ask them probably about 20 times before I get an answer. So maybe five hours a week. Yeah, 20 hours a month would probably be about right.

And then I don’t know what it is on their side. I assume it’s a lot on their side as well. I have ongoing CRT cases though, too, so that’s taking out time, and then I have an Ombudsman investigation that also takes up time. So it’s not just the ICBC aspect as well.

Brennan Day (Deputy Chair): Could you elaborate on your experience with the Ombudsman? That’s supposed to be the neutral person that’s fighting in your corner. How has your experience been with that?

Kim Lockwood: It takes a while to get hold of them. I think it took six months. The issue we’re talking about right now happened in April, so that would be the only thing. They’re great to talk to.

I don’t know what happens, though, at the end, really. They just talk to you for the front end and then just tell you if it’s going to be investigated or followed through or what. There’s the delay. They’re not an easy resource. If there’s an emergency, you’re pretty much on your own. You have to wait.

George Chow: Thank you, Kim.

You’re advocating a lump sum payment in place of the future income loss that is being implemented right now — right? — because of the difficulty and the time you have to devote to getting that. But what happens if you were able to have a better system in terms of getting your entitlement, the income going forward?

Kim Lockwood: I would still have ICBC, for the next potential 40 years, running my life. It’s people I’ve never met and I’ll probably never meet, making the decisions about my life.

George Chow: Okay. What if the system were a lot cleaner and clearer, so you could actually receive the income entitlements over, basically, whatever time period?

Kim Lockwood: It would depend on how it’s set up. Right now I just know it doesn’t work. They’re late. They’re inconsistent. They’re different amounts. It’s very frustrating, and you always have that hanging over your head that if you don’t do something, they’ll suspend it. That’s a constant threat.

If it could get rid of that and that anxiety, then maybe. But it’s hard to set goals without knowing if you’re financially secure right now.

Stephanie Higginson (Chair): I’ll just have one quick question, and it’s regarding your mention of your support for Bill M237’s proposed extension of the claim period for catastrophic injury benefits. I just want to make sure that it’s about the broader view of catastrophic injury and not the very specific case that’s mentioned in Bill M237.

Kim Lockwood: No, it’s the broader catastrophic injury. It’s that you have to reach a certain threshold for catastrophic injury, and it’s hard to define it. I don’t qualify for a catastrophic injury, even though I’ll never be able to return to work or to my old life.

Stephanie Higginson (Chair): Thank you. Seeing no more questions, Kim, thank you so much for taking the time to make your submission and also to come and present. I really appreciate it.

Okay, Andrew Kwan. You’re next, friend. Andrew, you are familiar with how this goes already, so I will turn it over to you for your presentation. Thank you for joining us today.

Andrew Kwan

Andrew Kwan: Good afternoon, members of the committee. My name is Andrew Kwan, and my wife is Julia Kwan, who you heard from earlier today. Thank you for the invitation to speak and for the work this committee is doing to review the Insurance (Vehicle) Act.

[3:15 p.m.]

While I am grateful that some supports exist, I’m here to speak about how the current legislation fails to recognize the full burden placed on families, especially those with dependents, and to ask the committee to broaden family and caregiver supports.

In November of 2024, our son Lucas was just two years old, and we were looking forward to the upcoming holiday season as a family. Then, one morning, our lives changed forever when my wife was run over by a dump truck while crossing the street in a marked crosswalk. We are extremely lucky that she survived.

As you heard, Julia spent nine weeks in VGH, including one week in ICU, and has undergone nine surgeries. She lost part of her small intestine, had a splenectomy, over a dozen fractures and extensive soft tissue injuries requiring significant skin grafting. After discharge, she spent another four weeks in a hospital bed in our home while her wounds and fractures continued to heal because she was not eligible to go to G.F. Strong.

Nearly two years later, she continues to live with ongoing health issues and an uncertain path to recovery. It affects her daily life, and, more importantly, her ability to be the mother she wants to be.

In the immediate aftermath, I was managing a full-time job, caring for an injured spouse, grappling with uncertainty about our future and effectively parenting our toddler alone. I was also trying to manage my own emotions while protecting our son from the reality of the situation. All of this was happening while coordinating an ICBC claim and providing extensive documentation to ensure that my wife received the benefits that she was entitled to.

My mother put her life on hold and essentially moved in with us so I could spend long stretches at the hospital. Our community organized a meal train to ease the burden of meal planning. My employer was understanding and gave me the time and flexibility I needed. I want to be clear about that, because it matters. I was incredibly lucky.

Many people in my situation would not have an employer who could accommodate extended leave or have a supportive community around them that was willing and able to help. For those families, the emotional, financial and professional consequences would be devastating.

The family and caregiver benefits outlined in division 11 of the Insurance (Vehicle) Act are narrowly focused on the injured individual and do not take a holistic view of the impact of serious injury on families. The legislation provides some family-related supports, but it does not fully recognize the value of family caregiving. It does not recognize the additional physical and financial burden placed on family members who must absorb extra responsibilities including household duties, child care, transportation, coordination of medical care and help interpreting the legislation.

In our case, the practical work of parenting, household management and supporting Julia’s recovery fell largely to me. There was no direct recognition of the burden I had taken on as a family caregiver and no pathway to reimbursement for the unpaid caregiving time or lost income I incurred while keeping our family functioning.

The legislation assumes either the victim is alone and eligible for care supports or that their family and friends can absorb the impact without assistance. That assumption is not aligned with reality, and most families in B.C. are not eligible for caregiver benefits. I urge the committee to amend the Insurance (Vehicle) Act to broaden eligibility for family and caregiver benefits.

Specifically, recognize indirect caregiving by allowing reimbursement or support when family members must assume responsibilities the injured person previously performed. Recognize direct caregiving provided by families when the injured individual continues to require care after discharge from the hospital, and allow benefits when an injured person’s partner is required to perform additional family caregiving tasks that create financial hardship. These changes would align the legislation with the lived reality of families who survive catastrophic injury but are left to shoulder the long tail of care and recovery.

I am grateful my wife survived and that we had supports that helped us through the worst weeks, but more help is needed. The Insurance (Vehicle) Act should protect not only injured people but also the families who help them recover.

Thank you for your time.

Stephanie Higginson (Chair): Thank you, Andrew. I also have to say I have such respect for how you two figured out the system here.

Questions from my colleagues.

Jennifer Blatherwick: Again, I also really appreciate seeing this from both sides. My husband and I have five children, and it does not work if you are not a team. If one of us goes down, the whole system goes down.

[3:20 p.m.]

The work that you both put in to get through, and the priority you’ve put on your child, is genuinely inspiring. I really, genuinely feel that across the board, we undervalue the contribution of caregiving and indirect caregiving.

You said that you had your mom come stay with you. Is that what you mean about recognizing the cost of indirect caregiving? Could you just talk a little bit more about how that was an essential piece and then how you think that that could be better recognized within the system?

Andrew Kwan: Yeah, absolutely. We couldn’t have done it without my mom. Luckily, she’s local; she’s able. You know, she’s incredible.

She was there when I couldn’t be there, especially during the first week, when I had to try to be in two places at once. I wanted to be there for Julia 24 hours a day if I could, but I also have a two-year-old son who I needed to look after and who was wondering where mom is and what was going on.

So my mom was there to be there in my place. But I recognized that, like I said, I’m lucky I have that community. I have the family support, but others may not have that. What are they left to do? How are they going to make that difficult decision between being at the hospital’s bed or being at home to look after their child or even an elderly parent who they have to look after?

Jennifer Blatherwick: That’s an excellent point. In my understanding, the system as it exists right now does not recognize familial caregiving.

Andrew Kwan: Correct. I did have a…. When I opened up the ICBC claim, in my initial conversation, the person I spoke to thought I would be eligible for caregiver benefits, but then they came back to me later and said: “No, you’re not eligible.” Again, I was lucky to have supports from work, from my community, but other people don’t have that.

Brennan Day (Deputy Chair): On the side of broadening the caregiver benefit, where do you think the current rules need the most improvement? If we’re going to be looking at recommendations to expand that benefit, where do you think they would do the most good? Is it flexibility in how you spend? What would have helped you at the time?

Andrew Kwan: That would be helpful — maybe like a central pool of funds you could use towards certain benefits, whether it’s a meal service, groceries delivery, housekeeping services or after-hours child care. Those would be some of those benefits that I would recommend, for sure.

Brennan Day (Deputy Chair): So under the current system, could you describe to me the approvals process you have to go through to get just basic services into the home?

Andrew Kwan: Yeah. I can only speak to my own experience.

As I mentioned earlier, I was not eligible for anything while my wife was in hospital. What I had to do…. To ensure that she was continuing to get income replacement, for example — maybe it’s more complicated because she’s self-employed — I had to provide tax returns going back a couple of years. I had to provide her business licence. I had to provide contracts that she had signed, and all these other things, just to make sure that she would get the funds that she was entitled to.

All that was going on while she was in ICU, while I was trying to deal with everything else and deal with my son, and it was extremely hard.

Brennan Day (Deputy Chair): I can imagine. Thank you.

Stephanie Higginson (Chair): Do you think…? Maybe I should have asked Julia this question, but I have you here. Do you think that the self-employed aspect of things made it more difficult?

Andrew Kwan: Absolutely. Julia was lucky that she had some contracts and some retainers. That was documented to last up until a certain point. We had some documentation of some…. Like, you could see a progression of where her earnings were going.

If there are people who are self-employed, that are contract to contract or that freelance, they don’t have that future security. My understanding is that under the legislation — especially with the hoops that we had to jump through, just to prove Julia’s case — they wouldn’t have that documentation, and my understanding is that they wouldn’t be eligible for some of the income replacement benefits that they could be entitled to.

Stephanie Higginson (Chair): Do I have other questions from my colleagues? No? Okay.

Thank you very much for your time and your presentation. I really appreciate both of you using your skill and your capacity to advocate for others who might not have the ability to do that. Thank you for taking the time.

[3:25 p.m.]

Okay, our next presenter is virtual.

Anne-Marie, you have five minutes for your presentation, and then we have ten minutes scheduled to ask you questions, which we may or may not take the whole time for. If your presentation of five minutes starts to go over and it doesn’t look like you’re starting to wrap up, then I may remind you of your time, okay?

Anne-Marie Lamarche: Okay. Sounds great.

Stephanie Higginson (Chair): Excellent. We look forward to hearing from you. Please go ahead.

Anne-Marie Lamarche

Anne-Marie Lamarche: Thank you for inviting me to speak to you today. My name is Anne-Marie Lamarche. I was injured in a motor vehicle accident in 2010 under the previous insurance system and again in 2023 under enhanced care.

Following my 2023 accident, I have lived with persistent post-concussion symptoms, chronic migraines, chronic fatigue, neurological dysfunction and significant limitations in my daily functioning. Given this experience, I would like to share the following observations and recommendations.

First, health care decisions need to remain with health care providers. Treating providers are best placed to make those decisions because they know the patient’s history, monitor their progress and make recommendations based on current clinical circumstances and evidence. My recommendation is that treatment decisions be based on the medical advice of the treating providers, rather than being overridden by insurer policies or one-time assessments. An injured person should not be placed between their treating providers and an insurer making a different clinical determination.

In my case, ICBC arranged a comprehensive medical assessment about a year after my accident. Following this assessment, I lost funding for some of my treatments, not because the assessment said they were contraindicated or should be stopped but rather because they had not been included in its recommendations section.

When my clinical circumstances later changed, I asked ICBC to reconsider the funding. They initially agreed to resume covering one of my treatments but then reversed the decision based on the report of the comprehensive medical assessment. An assessment done over a year earlier by someone who had never treated me was ultimately given more weight than the recommendations of the providers who had been treating me all along.

Second, injured people need independent advocates. Enhanced care places a significant burden on injured people by making them advocate for their own treatments and benefits. My recommendation is that injured people have access to effective, independent advocates and that dispute processes be simpler and more accessible.

Due to my conditions, my concentration, memory, information processing and executive functioning are seriously impacted. I have had treatment expense reimbursements and care-related decisions take over eight months to resolve, requiring continued follow-up and advocacy on many different issues. A system intended to support recovery should not require injured people to use up capacity they simply do not have in order to access the care and benefits they need. The system places its greatest administrative burdens on those least capable of carrying them.

Third, the system needs to evolve with the claimant’s circumstances. Recovery is not always linear, and treatment does not necessarily have to restore function to be clinically valuable. For someone with chronic disability, treatment can maintain function, prevent deterioration, maximize independence and support active rehabilitation. However, in my experience, enhanced care does not recognize this principle.

Additionally, functional capacity should be assessed in the context of what a person can do reliably and consistently, not simply what they may be able to do occasionally. This is particularly important for people with invisible disabilities, including neurological, cognitive, autonomic, mental health, migraine and chronic pain conditions.

In my own case, I can occasionally carry out some activities of daily living, but I cannot do them reliably or consistently. On many days, I cannot prepare a meal or maintain my household without assistance. Yet I was told that I do not qualify for the personal care assistance benefit because I need to be completely incapable of carrying out personal and household activities.

My recommendation is that permanent impairment benefits and other benefit frameworks recognize the real functional impact of invisible conditions, including severe and prolonged disabilities.

[3:30 p.m.]

The question for this committee is whether enhanced care is actually fulfilling its purpose for people whose recovery doesn’t fit a predictable pathway. In my experience, it does not.

The system needs to recognize three things. Health care decisions need to remain with health care providers, injured people need meaningful independent advocates, and the system needs to evolve with the claimant’s circumstances. An injured person should not be worse off because their injury resulted from a motor vehicle accident.

Stephanie Higginson (Chair): Thank you, Anne-Marie.

I’ll look to my colleagues for questions.

Jennifer Blatherwick: Thank you so much, Anne-Marie, for your presentation and sharing your story, and I appreciate any time that people have three clear asks and then reiterate them at the end of the presentation too. Well done. Yeah, it was very good.

If we could just walk through the evolution of the system with your circumstances, which was point 3. You outlined in one of your earlier points, about whether…. The system wasn’t evolving with your needs as your medical circumstances changed and you need more care or different care or whatever. Can you just give me a little bit more example of…? How do you think that they could have responded better in your circumstance?

Anne-Marie Lamarche: Well, I think that the issue becomes that after the initial 12-week period, which is kind of the mandated “everybody gets this amount of care,” you are put in the position as an accident victim to have to advocate for yourself on everything.

And even though my care practitioners and my entire health care team determines that I am doing everything I can, that I’m doing the treatments they recommend, that I’m doing all these things, ICBC does not value those treatments in the same light, so then it doesn’t evolve with the circumstances.

Like I said, I’m now almost three years out from my accident, and I am still unable to access certain resources, still paying a lot of benefits and/or treatments out of pocket, because ICBC will not cover them based on this assessment that’s now two years old that was done at the demand of ICBC by a mandated doctor who saw me for all of an hour of my life, compared to my care team who takes care of me, who has taken care of me for years prior and years since.

So I think that there is a real disconnect there between putting the onus back in the hands of the health care providers who actually treat the patients….

I think that that was one of the strengths of the old system — that the care wasn’t dictated by the insurance company. The insurance company also doesn’t actually cover the full treatments. Like, they don’t actually provide the amount of money that the care providers are asking for those treatments.

Jennifer Blatherwick: Mm-hmm. That’s something we’ve heard from some of the care providers today. It’s their concern over direct treatment and then indirect treatment, where they’re filling out forms and they’re unevenly paid or not like…. It’s disincentivizing for them.

Anne-Marie Lamarche: The other big issue is that passive therapy is viewed as something that’s unnecessary — chiropractic and massage therapy being treatments that are covered in the first 12 weeks but after that are severely contested by ICBC as being necessary for anything, despite there being clinical evidence to the contrary that it can be beneficial.

For people dealing with chronic conditions like myself, they keep me as functional as I currently am and enable me to participate in physiotherapy and other therapies. And while that fact was recognized actually by ICBC….

A year ago I got a new adjuster. I asked for reassessment based on my evolving condition and diagnosis. And they said: “Well, we normally will support with one passive therapy, so which one do you want covered?” I said: “I’d like to have the chiropractor covered, please.” And he’s like: “Okay, we’ll cover it retroactively to a year.” Not 15 days later, he went back on that decision. He said: “I apologize. I didn’t realize that you were denied this, because it was in your comprehensive medical assessment, and therefore we can’t provide it.”

[3:35 p.m.]

And like I said, it was never contraindicated in that assessment. It just didn’t make it into the recommendations section.

Jennifer Blatherwick: Mm-hmm. Sorry, if I can just follow up?

I think one of the other things you mentioned was about having an independent advocate. I can’t imagine how difficult it would be to go through the assessment system; analyze the assessment and try and figure out what’s in there, what isn’t in there, what’s missing, what should be in there; and then not have a clear pathway to appealing the assessment, especially on your own and independently. You’re not the only person. This is a very big theme — some kind of independent advocate system to ensure that people are getting support.

Stephanie Higginson (Chair): I’m just going to hold on that second question, because there are only five minutes left. I just want to see if other people have questions.

Jennifer Blatherwick: Oh yes, of course. My apologies. Go ahead.

Brennan Day (Deputy Chair): Thank you for sharing. I’ve worked in mental health, and quite a few of our members crossed over with brain injury, so I certainly understand the struggles people have day to day navigating the system, whether it’s benefits or injury.

With the caregiver benefit, where do you think the current rule fails families like your own? Is it eligibility? I mean, the common theme we’re getting here is that we’ve effectively replaced one bureaucracy with another, and now we’re putting the onus on the individual to do self-advocacy work. If you’re struggling, certainly, with a head injury…. That’s challenging for people that don’t have any sort of long-term cognitive impairment. So where would you like to see that go? Is it sort of like an aid navigator? What would help you better access those services, given those issues?

Anne-Marie Lamarche: Is your question about personal care assistance benefit, or is it about the independent advocate to get to those services?

Brennan Day (Deputy Chair): Probably about the independent advocate to get to those services. You’re in the unique position where you can do it with challenges, and there are other people that can’t do it at all. And that’s sort of my concern. You’re able to stand here and give us this testimony. I suspect there are a lot of people in the system that just get dropped out of the system because they just, quite frankly, can’t do what you’re doing.

Anne-Marie Lamarche: I would argue that I am recovering from a severe migraine day, and the drive to the Legislature wasn’t even possible for me today. That’s why I’m virtual.

And this is the issue. I think that I fall through the cracks, in a sense, because to somebody who is not educated on all my health issues, I would potentially look like I’m capable of doing things. But if you can’t do things consistently and independently, reliably, then to me, that’s not function. If you can take one shower a week because that’s all your condition allows you to do, you can’t function.

So I think we do need to have independent advocates. It doesn’t necessarily have to go back to a tort system, but the beauty of the lawyers in the previous system was that they would deal with ICBC and your demands and whatever you needed, and your sole job as a victim of an accident was to recover — to work with your care professionals that you chose, the treatments that you decided as a group were appropriate. That was your focus.

We’ve gone away from the system, and now we’ve gone into a system that puts emphasis on wearing down the victims until they give up, rather than actively supporting them.

Stephanie Higginson (Chair): Okay. I don’t see other hands, so I’ll go back to you for your follow-up question.

Jennifer Blatherwick: It’s okay. He covered it.

Stephanie Higginson (Chair): Okay. I see no other questions.

Thank you, Anne-Marie, for your time, for your submission, for your presentation and for answering our questions. I know that some of these circumstances are difficult, and I appreciate that you were able to come and present to us today.

Anne-Marie Lamarche: Thank you for having me.

Stephanie Higginson (Chair): Our next presenter is not here yet, so we’ll have a five-minute recess. If people could be back by — I’m losing track of time — 3:45 please.

The committee recessed from 3:39 p.m. to 3:46 p.m.

[Stephanie Higginson in the chair.]

Stephanie Higginson (Chair): I’m going to call the committee back to order from our short recess. We have a virtual presentation from Ross Smyth. I understand Ross is in the virtual meeting room.

Okay. Ross, you have five minutes for a presentation. Then we have ten minutes for questions. If you start to go over time, I will gently remind you to start wrapping up once you’re over five minutes, okay?

Thank you very much. We look forward to hearing from you.

Ross Smyth

Ross Smyth: All right. I don’t think I’ll be over five minutes.

The basic is having had an accident under this new procedure, and how it works, I think, in my advice, it’s a total disaster. I put down a number of points, and I call them all disaster.

Disaster in advice. When I had the accident and I advised that I was having the headaches immediately, no one advised me that there was any coverage, anything to do. It’s just that basically I tried to function.

It wasn’t until my wife…. After almost two months, her physiotherapist said, “You can get all kinds of treatment for the first three months,” which I then started. But it was not till a couple of months, almost two months, after the accident happened, and I was suffering from severe migraines, severe concussion.

There’s also disaster in what treatment someone should get. Nothing is left to yourself. If you don’t know what’s going on, how do you know what to do? There were basically no guidelines, no anything. It was just left to the person to figure out how they’re supposed to do it.

I took, as well, with the agent at ICBC…. While they maybe do a very good job, my suggestion is that they do a terrible job at listening, and they do not understand medical issues. They are insurance people, and they have no idea what is going on with a person.

Then with that is the disaster in ensuring approval for minimal treatment. When you finally get on the program, there’s no idea of how long this will be, what type of treatment you’re entitled to. And when the…. In the case of the physiotherapist and the massage, they have to wait until they have the last treatment that’s been approved and submit saying the person needs more treatment.

[3:50 p.m.]

Then depending upon the agent, how fast they’ll approve, most times it took a week, ten days, etc., to reapprove. By that time, you have lost your slot with your approved person, and you have to then figure out when you can redo your time and get back into treatment.

Now, they do ask how you’re doing, but I find it’s just a kind of a false asking. You know: “How are you doing, Mr. Smyth?” But they don’t really listen.

I can say that, in my case, it got worse and worse. In late September, I was holding my head in my hands and trying to run my business. I had to give away several clients because I just could not service them because of the headaches that I was getting.

My thing is that the phone calls I was getting from ICBC were, basically: “How do we get you off of this program? How do we get rid of you?” There was no idea of getting…. Make sure that you got the appointment.

If it wasn’t for my own family doctor…. Once I saw him, he sent me to various places, which advised — the physiotherapist advised and a specialist with migraines advised — that I had severe concussion, probably PTSD. There was no follow-up from ICBC on this.

When I had a flood in my basement at my house, the insurance company took over. They arranged for the restore people to come in and got it done, got it fixed. I didn’t do anything other than, yes, I had to pick out some new furniture that got damaged.

There was no understanding when I’m telling them that I’ve got this severe migraine headache, concussion. They don’t seem to pick up on it, and it’s just that. Then there is no, when I suggested…. I did some alternate treatments. I went to a chiropractor, told them I was going. He and the physiotherapist were doing — I forget the treatment. It’s electric shock, basically. I had to pay for that myself. There was no coverage, even though it was mentioned to them. So there’s the fact of no additional treatment.

I just find the program sucks. It does not work. It’s only from one side. If it was another company, I would have an insurance agent that would be going against ICBC, I presume, and there would be a follow-up. But when it’s ICBC, it’s all in-house and the fact to get the person off.

That’s my summation, that they don’t follow up. They don’t do it on a timely basis. They say they do, but when you’ve got ten days, what you do is you regress in your treatments. You have to then build up again to get back to where you were ten days before.

That’s my thing with regard to the present insurance program through ICBC.

Stephanie Higginson (Chair): Okay. Thank you, Mr. Smyth. Thank you for your presentation and your honesty. I appreciate it.

I will turn to my colleagues for questions.

Brennan Day (Deputy Chair): You laid out that there were a few situations where the treating provider recommended additional care, but ICBC limited or delayed it. Was that before or after the 12-week period elapsed?

Ross Smyth: No, ICBC never…. From my wife, I got into a health place where she was getting physio and massage because of a previous accident of hers, which is under this program as well. If it wasn’t for her, I wouldn’t have got into anything.

My doctor did things to get me to try to solve what were the issues, but in no case did ICBC recommend any further treatments, any going anywhere else, that I can remember. It was totally up to me with a head that wasn’t properly functioning.

I’m a CA. I had my own practice. I had to sell it at that point in time, in whatever — I can’t remember now the year. I actually put my practice up for sale, because I did not believe that I could continue. I already had lost a couple of good clients, and there was no help.

[3:55 p.m.]

As far as I was concerned, it was absolutely zero, never a recommendation for anything else.

Jennifer Blatherwick: Thank you so much, Mr. Smyth, for sharing this, and I appreciate you taking the time to come here and walk through what was clearly a really difficult experience.

When you were saying that in the beginning you didn’t get advice — I just want to be sure. When you went to ICBC to report the accident, you’re saying that they didn’t guide you through the process at that time of what was available to you, what possible services you could have received?

Ross Smyth: Correct.

Jennifer Blatherwick: When you went to your family physician, were they able to give you a better idea of the options that were available to you?

Ross Smyth: Well, I didn’t go to the family physician because — I hate to tell you this — I’m a man. You always think these things are just going to get better, and they don’t.

It was my wife who said: “I’m making you an appointment with my physiotherapist.” She was the one that outlined that I was entitled to whatever treatment I wanted for the first, I don’t know, two or three months. But we were already two months along.

I just followed what the…. I was then in physio and massage and thought that was it, but the headaches would not leave, the pain in the head, etc. It was just…. Shoulder, back — that just kept going. I had to change massage therapists because the massage therapist my wife was using is more of a light treatment, and I needed deep. It was actually recommended that I get a much deeper massage because of the muscle, backache, shoulder.

But it all came from them. My doctor was trying to solve…. He didn’t give me the insurance side of it. He sent me to this specialist and he sent me to that specialist to try figure out what was wrong.

Was it just a normal accident? No, they came back, having done tests and that, that it was a severe concussion.

Jennifer Blatherwick: Okay, thank you.

I have so many more questions, but I think I will let….

Stephanie Higginson (Chair): Go ahead.

Jennifer Blatherwick: We’re good? Thank you.

Do you feel…? One of the things we’ve talked about a lot today is that it would be really helpful to have a better understanding, at the point where you get the insurance or the point where you get into the accident, of having a comprehensive list of the things that you could get.

Do you feel like that would have helped you?

Ross Smyth: It might have. But it is more…. When you’ve had that kind of an accident…. Somebody pulled out from McDonald’s, backing up, and hit me full force on the right side of the car. My head hit the left side. Severe shaking of the brain, so you can’t think. You don’t know what to do. You have this problem. You think it’s going to go away, and it doesn’t go away, and then it gets worse and worse.

There’s no guidance. The normal would be, if you have insurance, the insurance takes over and says: “Okay, we’ve got to get you into this treatment and that treatment.” My wife is going through cancer right now, and yes, we go to the hospital. The hospital then recommends X specialist. He says this is beyond my pay grade down at the cancer agency, and they determine it. Next thing you’re getting scans, ultrasounds. You’re getting an operation, etc. They keep following up. The delivery specialist called today just to check how things are going.

Jennifer Blatherwick: Having somebody that was organizing your course of treatment or being a coordinator for your course of treatment would have been really helpful.

Ross Smyth: Yes, it would.

[4:00 p.m.]

Stephanie Higginson (Chair): Okay, I don’t see any other questions.

Mr. Smyth, I want to….

Oh, we’ve got a last question.

Jeremy Valeriote: Thanks, Mr. Smyth, for sharing. I appreciate that sometimes we hope that things will get better, and that’s a very optimistic and noble thing to do.

We’ve heard a little bit about some of the attitude that maybe some people have received, and I understand there’s a wide variety. I’m just wondering. Was it ever suggested to you that you should have taken this more seriously sooner? As in, were you ever kind of made to feel like it was your fault that you hadn’t taken advantage of the 12 weeks of treatment?

Ross Smyth: No, there was never any “my fault,” but there was never any suggestion of anything else. It’s just that the only phone call you get is: “How are you doing? Okay, we’ll extend it.”

Then, well, you get to a point where you feel better, but you regress because you’re not getting a treatment. In between…. I can’t say that I’m fully recovered yet, but I’m not getting any treatments. I’m just living with whatever situation is there.

But I recovered enough that I hired somebody to sell my practice because I just couldn’t, at that time, handle it. I was a sole practitioner. As I say, I lost some clients — too bad. That’s not a cost to ICBC, that you have to lose clients.

The treatments that I paid to the chiropractor and the extra to the physiotherapist for the shock treatments that finally broke the concussion or the headache problem, my migraine problem…. Never a suggestion of: “Well, send us the bill. We’ll cover those.” Nothing.

Jeremy Valeriote: Thank you. I’m sorry for what happened to you.

Stephanie Higginson (Chair): Do we have other questions for Mr. Smyth?

No? Okay.

Mr. Smyth, I want to commiserate a little bit with you, as someone who has also suffered a concussion and had to navigate that system. It wasn’t in a car accident, but I found the ability to navigate the system while suffering from a concussion quite difficult.

Ross Smyth: It is.

Stephanie Higginson (Chair): That experience sort of guides some of my reflection here, because the circumstances of the concussion are that there’s a number of small symptoms that, after a while, build up to make people realize that something is wrong with you. Often that is close to or after this 12-week timeline, and that’s a question that I’ve had myself about: how would that have been, if I had ICBC? What would that have been like, to have that experience?

I’m hearing from you….

Ross Smyth: Awful. I would say awful.

Stephanie Higginson (Chair): Difficult. Yeah, difficult.

So I appreciate your time. I know that these types of presentations can be difficult when you are suffering from the condition that you are. So thank you for taking the time to be an advocate for yourself and for other people who have experienced this.

Ross Smyth: All right. Glad to do it. Thank you.

Stephanie Higginson (Chair): Linda, we’re going to ask you to come up because our other presenter is not in the waiting room yet. Since you’re here, then if you’re ready to go, that would be great.

Linda Chisholm: You’re going to see me all week.

Stephanie Higginson (Chair): Good. I hope so too.

Okay, Linda. You’ve been here all day, so you know all the rules, and we are looking forward to hearing from you. Thank you.

Linda Chisholm

Linda Chisholm: Good afternoon, and thank you for allowing me the opportunity to speak to you today. My name is Linda Chisholm, and before I start talking, I want to show you…. This is my family. This is who I’m going to be talking about today. I should say this was my family.

Before I talk about the legislation, I want to briefly tell those who haven’t read my submission what brought me here today. On June 1, 2023, my daughter Courtney and my eight-year-old twin granddaughters Taylor and Hailey were on their way to school when they were struck head-on by a fully loaded logging truck.

[4:05 p.m.]

The truck had put a patched tire on the front steering tire, which you just don’t do. There’s no law against it. It’s a totally negligent action on their part. They crossed the centre lane, and all three girls were killed instantly.

No criminal charges were filed, and so there were no convictions, and there has to be a conviction in order to get recourse or a final answer to this terrible accident.

That devastation cannot be described, and the trauma that followed was made worse by a system designed to process files rather than help grieving families. That is how my family became victims of this flawed system.

I have provided the details of our experience in my written submission, and my hope is that you have all read that complete document. If you haven’t, I think it’s important that you do. It’s been 1,210 days since the accident, and I spent more than a year trying to find someone or somewhere to go that would hear what happened to my family and help me understand why there were no consequences.

I went to ICBC, and they recommended organizations I could contact for help: CRT, fair practices and the Ombudsman. None of those deal with fatalities. I contacted all of them, and I had to wait for the Ombudsperson. Someone else said that too. They don’t get back to you. None of them deal with fatalities.

I contacted government. I contacted MLAs, MPs. One MP said: “I don’t deal with that. Call your MLA.” My MLA said: “Call the MP.” I had one good experience. I’ll never forget her name: Samantha Pearce. She was a helper for Todd Stone. I don’t even know if he’s still in the government. She told me how I could petition parliament to get things changed. You people know what kind of process that is. I couldn’t do it.

I contacted lawyers, advocacy groups, oversight bodies. I was sent from one place to another, and all ended with no answers, but a lot of condolences were offered. A lot of people cried on the phone. I had to comfort them.

For families suffering a catastrophic loss, this creates a profound sense of helplessness, and I was always left with the question. If three people can die and the family can’t find an independent place where the question of responsibility can be heard, then has the legislation failed the victims? I think it has.

I’m not asking the committee to decide who is responsible for our accident. You can’t. What I’m asking you to consider is whether a family should ever be left with nowhere to go to have that question independently examined.

To me this is bigger than simply saying “no-fault.” No-fault enhanced care may determine how compensation and benefits are provided — and that’s another area that I would discuss if I had more time — but no-fault should never mean there’s no place for justice. Justice does not mean that a family wins a lawsuit. It does not necessarily mean returning to the old system. It means there’s somewhere to go where a family can tell their story, where their evidence can be examined, somewhere where their questions of responsibility can be considered and answered, and somewhere reasons can be given other than: “It’s the law.”

In our case, we could not find that place. That is the gap I am asking you to look at. I’m asking you why the opportunity for independent review no longer exists. And why is it that rigid application of the legislation results in outcomes that reasonable people consider profoundly unjust?

I think that distinction is important. I don’t know whether another process would have found someone responsible. Would we have won? I don’t know, because we were never given that opportunity for someone independent to examine the case.

I’m asking the committee for one thing, not the seven recommendations in my submission. I’m asking the committee to please recommend a legislative amendment to part 10. I am asking you to make sure there is a truly independent justice or review process for exceptional fatality and catastrophic cases. There has to be one.

Let this committee determine what that process should look like, but please make sure that that door exists, because there are circumstances so extraordinary that simply providing benefits and closing that door is not enough.

[4:10 p.m.]

Three people were killed in my family — Courtney, Taylor and Hailey — and three other children were left without their mother and their little sisters. How is it that no one was held accountable?

Nothing this committee recommends can change that, but what you do here can change what happens to the next mother or grandmother who finds herself sitting where I’m sitting. I spent more than a year looking for a door. I’m asking you to make sure the next family has one.

I want to say that if you’re going to ask me questions, please ask me questions about how the staff are trained and how the compensation affects those poor surviving children.

Thank you for listening to me. Thank you for somebody finally hearing me.

Stephanie Higginson (Chair): Thank you, Linda. I thank you for your courage and your tenacity on behalf of your daughter and your granddaughters. I’m sorry you had to go through that.

Linda Chisholm: We’re all crying.

Stephanie Higginson (Chair): This isn’t menopause, either. Often it is, but this isn’t.

I will look to my colleagues for questions.

Jennifer Blatherwick: We have some more time for you to answer our questions. What else would you like to tell us?

Linda Chisholm: I’ll talk a little bit more, if you don’t mind.

The first thing. ICBC contacted us a few days after the accident. I didn’t even know anything about no-fault. Nobody does when they don’t use it.

In my first meeting with my expert specialist, he handed us some forms. He said: “You need to fill these forms out before we can go further.” They were three accident ambulance release forms. I said: “Why do I have to do that?” He said: “That’s part of how we do things. We can’t go further until they’re released.” I said that they didn’t need an ambulance. There was no ambulance for them. They were killed instantly. It was just one of those things. It was one thing after the other.

Then they give you this support guide. It’s got a list in there, the checklist of the items that you’re going to have to come up with and their chart for how much your person is worth. This guy was telling us all on this first day. I was, like: “I don’t even know what you’re talking about.” Needless to say, I got rid of him because he didn’t know what he was doing. The poor guy had to deal with my husband and me, who are in this overwhelming grief.

I’ve had eight specialists on, and I’ve had a couple of really good ones. I have one that’s not too bad now. But you can’t get answers. You can’t. People don’t call you back. That was all…. I think the training needs to be better. There has to be a dedicated person for catastrophic cases who goes with you through the whole thing. They help you fill out the forms. I had to supply three death certificates. I had to make sure all the funeral stuff…. Yes, they did pay for all the funerals. Have you ever been to a three-person funeral? Not too many people have.

Then the compensation…. She has three surviving children — 12, 14 and 16. These rates that they grant these kids are unbelievable, somewhere between $36,000 and $71,000 per child. But it’s put into a public trust until they’re 19. So there is nothing. My 12-year-old granddaughter waits till she’s 19 years old to get…. I think hers was like $48,000. If you need that money in between, they will charge you fees, but they also get commission on that money that sits in a public trust.

There is no help for these surviving kids from the time their mother dies until they turn 19. It’s absolutely ridiculous. I don’t know. That needs to be changed too. It has to be looked at more. The real value of someone losing their mother or their father…. It takes $17,000 a year to raise a child. My grandson just turned 19 and got his money. He got enough to live for two years. It’s bizarre.

Nobody looks at the human part of this. They were in the wrong place, wrong time. Nobody is responsible. The logging truck company did not even get a ticket because they didn’t break a law. They did something negligent and stupid, but they didn’t break a law, so there’s no recourse for anybody. There’s no justice for those three girls.

I could talk all day.

[4:15 p.m.]

Stephanie Higginson (Chair): Thank you, Linda.

Other questions?

Brennan Day (Deputy Chair): Could you just walk me through what support services there were after the accident in terms of counselling and supports for you and the kids?

Linda Chisholm: Things that we had to look for. All our immediate family gets up to $5,000 per claim, so our family gets $15,000, which…. It’s just bizarre to even think that way.

The kids go to counselling, and I have to pay because most counsellors will not accept ICBC. They don’t want to bill ICBC because it takes too long to get their money. My Visa is on file with two different counsellors. When the grandkids go, I get the bill, I submit it to ICBC, and they pay me partial because they don’t pay what a counsellor charges nowadays. Their rate just went up, so I might see in the next thing, but I have to do all that myself.

There’s nobody at ICBC reaching out. I have a girl that I send the receipts to, and she sends me a cheque, but there’s no…. There was no…. I had to go up the ladder to some lady in, I don’t know, Vancouver or something, and she said, “Okay, we’ll take over the case,” but it was: “We can’t help you. There is no recourse. There is nothing. This is black and white. This is what these children will receive when they’re 19 years old. This is it.”

Stephanie Higginson (Chair): Other questions from people?

Linda, your submission was very comprehensive, and I think that reflects in why there are not a lot of questions for you. I do want to assure you, because I know you’ve travelled to be here today and that you’re going to be with us all week….

Linda Chisholm: Yeah, I am.

Stephanie Higginson (Chair): We hope. But whatever happens with this committee, all of this work — your submission, your presentation, the questions we’ve asked, all of this — continues with whatever the iteration is of another committee. I want to reassure you of that.

Linda Chisholm: Okay.

Stephanie Higginson (Chair): If I don’t have other questions from anyone, thank you very much for your time and for being an advocate for your daughter and your granddaughters and for the surviving family members, as well, as they navigate this system. They’re lucky to have you.

Linda Chisholm: I have to tell you, I’m not a crier. Really, I’m not, but this is good.

Stephanie Higginson (Chair): Thank you.

Linda Chisholm: Thank you.

Stephanie Higginson (Chair): Okay. Is there any other business from the committee members?

No? Okay, I’ll ask for a motion to adjourn today’s hearing.

Motion approved.

Stephanie Higginson (Chair): On that note, then, the committee stands adjourned until tomorrow morning at 8:30.

The committee adjourned at 4:20 p.m.