Shifting toward health

Issue: BCMJ, vol. 61, No. 5, June 2019, Page 197 Editorials

Surely there are primary care physicians who enjoy dealing with the Insurance Corporation of British Columbia (ICBC)—I just haven’t met any of them. I am pretty confident that the family physicians in my community don’t look forward to this part of their practice. Listening to patients’ complaints and recording soft tissue tenderness with painful reduced spinal range of motion isn’t that onerous, so why do we all hate it? It has something to do with the looming shadow of secondary gain involved in these visits, as they become more about compensation than health and wellness. Even the best-intentioned patients can get caught up in the whole claim process. Compounding this is involvement by lawyers and other health professionals. Patients painstakingly list all their symptoms and disabilities while relating what their physiotherapist, chiropractor, and massage therapist are telling them. They often relay requests from their lawyer about investigations, treatment, and required frequency of visits. Redirecting them to focusing on health by getting active is an uphill battle.

As of 1 April 2019, new ICBC regulations have come in to effect for treating patients who have been in motor vehicle accidents. This new model aims to reduce ICBC’s litigation costs while increasing patient care. A cap of $5500 has been put on payouts for pain and suffering for minor injuries. More choices in types of treatment will be available, including kinesiology, acupuncture, massage therapy, and counseling. In addition, the overall allowance for medical care and recovery expenses has doubled to $300 000. Doctors of BC was significantly involved as a key stakeholder to help raise issues and inform the new process and I appreciate all of the work that went in to this process.

Previously, when a patient was seen post-accident, a history and physical were recorded and a treatment program was designed. The patient was then seen in follow-up as needed. ICBC would send a request for records along with a patient consent at their discretion. If a patient had legal representation, ICBC was only entitled to a CL-19 form summarizing the patient’s history, findings, treatment, and disability.

Under the new care-based model, physicians are asked to collect consent from patients to proactively send either a standard medical report if there is no work loss or an extended medical report if the patient is unable to work, study, or train. Based on this report, ICBC will decide whether the patient has suffered a minor or major injury. An independent dispute resolution process will take place through the Civil Resolution Tribunal if patients are unhappy with their injury designation. If a patient refuses to give consent, physicians are expected to collect their information but not send in the initial medical report. However, ICBC believes they are entitled to the patient’s information and expect to receive it once requested; in their opinion, the Insurance Vehicle Act overrides the Personal Information Protection Act. If a minor injury lasts more than 12 months or if concussion symptoms and accident-related mental health issues are present after 4 months, it becomes a major injury, no longer subject to a financial cap.

Through my experience in dealing with ICBC patients for over 20 years, I would agree that ICBC costs are excessive, mostly due to the litigation process. Retaining legal counsel leads to more investigations, treatments, and consultations—all of which cost money. In addition, one-third of settlements go directly to the lawyers. I hope that the new regulations will lead to a reduction in costs and improved patient outcomes, but I remain a little skeptical. I am suspicious that after seeking legal counsel a significant number of patients will surprisingly have concussion symptoms and mental health issues after 4 months or remain symptomatic from their soft tissue injury a year later.

I’m interested to see how all of this plays out, but in the meantime I will continue to do my best to shift patients’ focus away from financial compensation and toward health, where it belongs.

David R. Richardson, MD. Shifting toward health. BCMJ, Vol. 61, No. 5, June, 2019, Page(s) 197 - Editorials.

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