Benefits Coverage for Employees on ICBC or WorkSafeBC Claim

Nov 17, 2014

When an employee goes on a “sick leave” because of a disability caused by an ICBC (BC’s automobile insurer) or a Worker’s Compensation (WorkSafeBC or WCB) claim, how long does the employer have to cover health and dental benefits?

ICBC covers medical claims relating to a driving-related claim. They often ask claimants to cover the claim first and have the claimant ‘settle’ the medical claims at a later date. Employees and employers must be diligent in getting settlements from ICBC otherwise, their group coverage will pay for claims that ICBC should normally cover.

For a WCB claim, the situation is a little different. If a WCB claim is accepted, they will pay for medical services and supplies required to help the employee to recover from their compensable injury and to assist their return to work. WCB will pay for most necessary claims, such as hospital charges, physiotherapy, tests and nursing care. Very often they will also compensate the practitioner directly, so there is no out-of-pocket expenses for the employee or a cost impact to their group benefits plan.

If a WCB claim is not accepted, the employee will be responsible for paying all medical services. Likely what will happen is that the costs for these services will be forwarded to their group benefits plan.

During the time that the employee is on a “sick leave” because of a disability caused by an ICBC or WCB claim, their benefits must still be maintained for a ‘reasonable’ period. WCB suggests one year but ultimately, this falls under reasonable employment practices.

Under the Employment Standards Act, employers are not legally obligated to maintain health and dental benefits indefinitely. They must continue benefits to an employee until the ‘employment contract’ ends or what is referred to as ‘frustration of contract’. If an employee is not able to perform the regular work duties, then the employment contract ends. This extends to ICBC and WCB.

It is recommended that employers be consistent with all employees by establishing a clear, written corporate policy for the continuation of benefits for such situations. As always, when in doubt, consult with a labour lawyer about employment issues

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By Carlo Nichini on October 28, 2014



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