On the Right Side of the Bed
|Authority||Insurance Corporation of British Columbia|
Leah was injured in a car accident. Already quadriplegic from a prior accident, Leah received disability assistance and supplements that included a special medical bed that helped with her medical condition. Unfortunately, the bed was old, broken and no longer fully met Leah’s medical needs after the latest injury. Leah asked the Ministry of Social Development and Social Innovation for a new bed, but it declined, explaining that Leah could seek funds from ICBC’s insurance claim process instead.
With the support of her physician, Leah asked ICBC to buy her a new bed that met her medical needs.
When ICBC denied Leah’s request for a new medical bed, Leah went to the ICBC Fairness Commissioner. The Commissioner told ICBC to make a new decision on the basis of medical evidence.
An occupational therapist conducted an assessment of Leah for ICBC, confirming that Leah’s most-recent injuries would benefit from a new bed. Next, ICBC offered to split the cost of the bed with Leah 50-50. Without funds to split the cost, Leah did not understand why ICBC would not pay the full amount. Leah contacted us and we began an investigation.
We were concerned that the reasons ICBC gave Leah did not reference any law, regulation or policy. ICBC did not clearly explain its decision-making process.
Investigating the entire accident claim, we noted that ICBC did not apportion any of Leah’s other benefits 50-50. We also asked if ICBC had considered some recent case law that we noted was relevant to Leah’s request. ICBC acknowledged that the decision to pay only half of the bed’s cost was not consistent with this current interpretation of the law.
In response to our investigation, ICBC explained the processes managers use to stay up-to-date on case law and policy changes. ICBC policy states that decisions to deny benefits must be discussed first with a manager. Our investigation determined the decision to split the cost of Leah’s bed was likely not discussed with a manager and, consequently, case law was not fully considered.
After reviewing Leah’s request in light of the new case law, ICBC agreed to fund the entire bed and contacted Leah to make arrangements for its purchase and delivery.
Leah was happy and relieved when her new bed arrived.
|Category||Driving and Transportation|