Study 3 Flashcards
What did early AUTOMOBILE POLICIES cover?
THIRD-PARTY LIABILITY and DAMAGE to the insured vehicle—NOT injuries to drivers or passengers if the insured driver was at fault.
What happened when an AT-FAULT driver was injured in an accident?
They were OUT OF LUCK—no financial assistance from insurance!
What was the major financial issue when waiting for LIABILITY to be determined in accidents?
It could take MONTHS or YEARS, leaving injured people with URGENT EXPENSES.
How did more CARS on the road affect INSURANCE CLAIMS?
More CARS → More ACCIDENTS → More LAWSUITS → Higher CLAIM COSTS → Rising INSURANCE PREMIUMS.
Where did a large chunk of rising insurance costs go?
LEGAL FEES—not necessarily to help the injured.
What pressure led to the creation of NO-FAULT INSURANCE and ACCIDENT BENEFITS?
Governments and the public pushed for FASTER financial support for injured persons at a REASONABLE COST.
What was introduced in 2021 by ICBC to improve accident benefits?
ENHANCED CARE PLAN.
TRUE or FALSE: Enhanced Care provides ONLY medical benefits.
FALSE! It covers medical, rehabilitation, income replacement, death benefits, and more.
Name THREE benefits included in ICBC’s ENHANCED CARE plan.
Possible answers: HEALTH CARE, INCOME REPLACEMENT, PERMANENT IMPAIRMENT COMPENSATION, DEATH BENEFITS, FUNERAL EXPENSES, GRIEF COUNSELLING, etc.
What benefit does ENHANCED CARE offer for CATASTROPHIC INJURIES?
A dedicated CATASTROPHIC INJURY BENEFIT.
TRUE or FALSE: Before accident benefits, at-fault drivers got financial help from insurance.
FALSE! They were on their own.
Why did the insurance industry need to come up with solutions for accident benefits?
To REDUCE LAWSUITS, LOWER LEGAL COSTS, and provide QUICKER financial support for injured persons.
What additional support does ENHANCED CARE provide for families?
FAMILY & CAREGIVER BENEFITS, plus FUNERAL & GRIEF COUNSELLING.
What major change occurred in BC’s automobile insurance system in May 2021?
The TORT system transitioned to a NO-FAULT system with ENHANCED CARE COVERAGE.
What law introduced ENHANCED CARE in BC?
BILL 11 – 2020: Attorney General Statutes (Vehicle Insurance) Amendment Act.
TRUE or FALSE: Accidents before May 2021 follow the Enhanced Care rules.
FALSE! They follow the previous accident benefits under the Insurance (Vehicle) Regulation.
What does the INSURANCE (VEHICLE) ACT outline?
Benefits and compensation for DRIVERS, PASSENGERS, CYCLISTS, and PEDESTRIANS injured in accidents.
What financial risks do accident benefits help cover?
MEDICAL TREATMENTS not covered by public health care and LOSS OF INCOME from inability to work.
What happens to some ENHANCED CARE coverage limits over time?
They are INDEXED using BC’s CONSUMER PRICE INDEX to adjust for inflation.
TRUE or FALSE: Only drivers with ICBC insurance qualify for Enhanced Care benefits.
FALSE! Even CYCLISTS and PEDESTRIANS qualify, regardless of insurance status.
Who qualifies as an “INSURED” under accident benefits?
- VEHICLE OWNERS and their HOUSEHOLD MEMBERS
BC RESIDENTS named in a DRIVER’S CERTIFICATE
OCCUPANTS of BC-licensed vehicles
CYCLISTS or PEDESTRIANS hit by a vehicle with an owner’s certificate
BC RESIDENTS injured by an UNINSURED or UNIDENTIFIED vehicle
TRUE or FALSE: A person ENTERING or EXITING a vehicle is considered an OCCUPANT.
TRUE!
Who is NOT covered under Enhanced Accident Benefits while working on a vehicle?
GARAGE SERVICE OPERATORS—they are covered under their own insurance.
Give three examples of EXEMPTED VEHICLES under accident benefits.
- Vehicles owned by the FEDERAL GOVERNMENT
Vehicles from OTHER PROVINCES/COUNTRIES
Vehicles used for EXTRA-PROVINCIAL TRANSPORT of goods or passengers
Can BC RESIDENTS get accident benefits if they are injured in the U.S.?
YES! Enhanced benefits apply anywhere in CANADA, the U.S., or on a VESSEL between them.
TRUE or FALSE: A BC resident with no ICBC insurance can still receive Enhanced Care benefits.
TRUE! ALL BC RESIDENTS are eligible, even if they don’t have ICBC insurance.
What was the biggest change in BC’s insurance system with ENHANCED ACCIDENT BENEFITS?
It switched to a “CARE-BASED” model, eliminating most LAWSUITS for accident injuries.
TRUE or FALSE: Under Enhanced Accident Benefits, injured parties can always sue for damages.
FALSE! Lawsuits are mostly eliminated, except in certain cases.
What are the main benefits covered under BC’s ENHANCED ACCIDENT BENEFITS?
HEALTH CARE, REHABILITATION, INCOME REPLACEMENT, DEATH BENEFITS, FAMILY SUPPORT, and more.
How much is the total allowance for HEALTH CARE and REHABILITATION benefits?
At least $7.5 MILLION per person!
What are three examples of TREATMENTS covered under health care benefits?
PHYSIOTHERAPY, CHIROPRACTIC, MASSAGE THERAPY.
What are three examples of SUPPORT SERVICES covered under health care benefits?
COUNSELLING, MEDICAL EQUIPMENT, HOME ALTERATIONS (like ramps and stair lifts).
TRUE or FALSE: Travel and accommodation expenses for medical appointments are covered.
TRUE! Even FAMILY MEMBERS’ expenses may be covered if necessary.
What is required for medical equipment to be covered under Enhanced Benefits?
A PRESCRIPTION from an AUTHORIZED HEALTH CARE PROVIDER.
What kind of compensation is available for INSUREDS with PERMANENT IMPAIRMENTS?
A LUMP SUM PAYMENT.
TRUE or FALSE: If a person with a permanent impairment dies from an unrelated cause, ICBC pays their estate a lump sum.
TRUE! Their estate receives the estimated payment they would have gotten.
How much of their pre-collision income can injured full-time earners receive under INCOME REPLACEMENT benefits?
UP TO 90% of NET income, minus any other payments received.
When do INCOME REPLACEMENT benefits start paying out?
8 DAYS after the accident.
TRUE or FALSE: If an insured can work but earns less than before, ICBC provides a “TOP-UP” benefit.
TRUE! ICBC will top up to 90% of their pre-collision income.
Until what age can injured workers receive INCOME REPLACEMENT benefits?
Until AGE 65, at which point they transition to RETIREMENT BENEFITS.
Who is NOT eligible for ICBC income replacement if injured at work?
WORKERS covered by the WORKERS COMPENSATION ACT—unless ICBC benefits exceed WCB benefits.
TRUE or FALSE: PART-TIME and TEMPORARY workers may qualify for income replacement.
TRUE! If they lose their job or an EI benefit due to the accident.
For how long can a NON-EARNER receive accident benefits?
UP TO 104 WEEKS, or longer if still disabled.
What special rule applies to STUDENTS receiving income replacement benefits?
They qualify if they were UNABLE TO WORK due to their injuries.
TRUE or FALSE: MINORS injured in an accident may qualify for both LOSS-OF-STUDIES and INCOME REPLACEMENT benefits.
TRUE! They can get study benefits AND income benefits if they had a job or would have worked.
What happens to income replacement benefits at AGE 65?
They CONVERT into a RETIREMENT INCOME BENEFIT.
What benefit is available for CAREGIVERS injured in an accident?
FAMILY AND CAREGIVER BENEFITS—covering costs to hire help for 180 DAYS.
What factors affect the amount of a DEATH BENEFIT payout?
- The insured’s ROLE in the HOUSEHOLD
The number of DEPENDANTS
Whether the surviving spouse is DISABLED
TRUE or FALSE: FUNERAL EXPENSES are covered under Enhanced Accident Benefits.
TRUE! Burial and funeral costs are reimbursed up to a prescribed limit.
What types of injuries qualify for the CATASTROPHIC INJURY benefit?
QUADRIPLEGIA, PARAPLEGIA, SEVERE TRAUMATIC BRAIN INJURY, and similar life-altering conditions.
TRUE or FALSE: VOLUNTEERS who provide emergency aid at an accident can be reimbursed for clothing damage.
TRUE! They can get expenses covered for damaged clothing and other costs.
What’s an example of how the RECREATIONAL BENEFIT can help after an accident?
It can pay for ADAPTIVE SPORTS EQUIPMENT or COVER AN ASSISTANT’S TICKET to an event.
TRUE or FALSE: Under Enhanced Care, a stay-at-home parent who dies in an accident may still qualify for caregiver benefits.
TRUE! The benefit can be paid to their surviving spouse.
What are three examples of mobility-related expenses covered under rehabilitation benefits?
VEHICLE ADAPTATIONS, HOME ALTERATIONS, MOBILITY EQUIPMENT like wheelchairs.
Who receives the PERMANENT IMPAIRMENT lump sum if the insured dies from accident injuries?
NO ONE—the benefit is only paid if they survive with a permanent impairment.
What happens to a MINOR who turns 19 during the school year and is unable to study or work due to an accident?
They QUALIFY for INCOME REPLACEMENT while they remain unable to study or work.
TRUE or FALSE: A minor who can study but can’t work after finishing school gets income replacement benefits.
TRUE! The benefit kicks in once they finish or stop studying but can’t work.
If a minor CAN return to school but CAN’T hold a job after an accident, when do they start receiving income benefits?
When they FINISH SCHOOL and remain UNABLE TO WORK.
TRUE or FALSE: Enhanced Care allows lawsuits for injury compensation in most cases.
FALSE! The care-based model replaces most lawsuits with accident benefits.
TRUE or FALSE: ICBC will always pay accident benefits, no matter the situation.
FALSE! There are many exclusions where benefits are NOT paid.
Who is NOT eligible for ICBC accident benefits if injured in BC?
- OUT-OF-PROVINCE residents in NON-ICBC-insured vehicles
Occupants of UNLICENSED vehicles (unless they had reason to believe it was licensed)
Riders of EXEMPT VEHICLES like snowmobiles and ATVs
TRUE or FALSE: If a person attempts suicide in a car accident, they are still covered by ICBC accident benefits.
FALSE! Suicide and attempted suicide are exclusions.
What happens if someone drives a ONE-TONNE TRUCK full of ILLEGAL FIREARMS and crashes?
NO BENEFITS—vehicles used for ILLEGAL TRADE or TRANSPORT are NOT covered.
TRUE or FALSE: If an injury is caused by a sickness or disease unrelated to the accident, ICBC will still pay benefits.
FALSE! Benefits are only paid if the sickness/disease was directly CAUSED BY the accident.
Which GOVERNMENT VEHICLES are EXEMPT from Autoplan coverage?
Vehicles owned by the FEDERAL government (like CANADA POST, RCMP) or OTHER PROVINCES.
TRUE or FALSE: Drivers of BC GOVERNMENT vehicles are covered by ICBC accident benefits.
TRUE! BC Government vehicles MUST participate in Autoplan.
Name three situations where ICBC may REDUCE, SUSPEND, or CANCEL accident benefits.
- The accident was INTENTIONALLY CAUSED by the insured.
The insured LIED to ICBC about the accident.
The insured FAILED to provide required documents.
What happens if an insured provides FALSE or INACCURATE information to ICBC?
Their BENEFITS can be DENIED, REDUCED, or CANCELLED.
TRUE or FALSE: If an insured refuses to provide necessary paperwork (proof of claim, reports, etc.), ICBC can deny benefits.
TRUE! Cooperation is REQUIRED.
Name THREE ways a driver can BREACH coverage conditions and LOSE accident benefits.
- Driving WITHOUT A LICENSE or while SUSPENDED
Using a vehicle for ILLEGAL TRANSPORT (like smuggling)
FLEEING from POLICE
TRUE or FALSE: If you get caught street racing and crash, ICBC will still cover your accident benefits.
FALSE! Racing and speed tests VOID your benefits.
Who can ICBC RECOVER accident benefits payments from?
- VEHICLE MANUFACTURERS or SELLERS responsible for a defective vehicle
GARAGE OPERATORS if their repairs caused the accident
INSUREDS CONVICTED of serious CRIMINAL CODE offenses (like impaired driving)
TRUE or FALSE: If you cause an accident while DRIVING DRUNK, ICBC can recover benefits paid out.
TRUE! Benefits can be RECOVERED from drivers convicted of DANGEROUS or IMPAIRED driving.
What is a key consequence of being CONVICTED of a prescribed CRIMINAL CODE offense (like DUI) in an accident?
ICBC can RECOVER any accident benefits paid out.
What is the common theme among ALL exclusions and limitations of Enhanced Accident Benefits?
Benefits are NOT paid if the insured engages in ILLEGAL, DECEPTIVE, or RECKLESS behavior.
What is the main reason NO-FAULT INSURANCE was introduced?
To REDUCE LEGAL COSTS and SPEED UP claim payments.
TRUE or FALSE: The no-fault system has completely eliminated fraud.
FALSE! Fraud still exists, especially in accident benefits claims.
What is a FRAUD RING?
A group of people working together to SCAM INSURERS through fake accident claims.
Name three common tactics used by FRAUD RINGS.
- Using RENTAL VEHICLES in multiple accidents
Claiming benefits from MULTIPLE INSURERS
Using FAKE NAMES or variations to avoid detection
What is a “SEAT FOR SALE” scam in staged accidents?
Fraudsters PAY A FEE to be listed as a PASSENGER in a staged accident (even if they weren’t there).
TRUE or FALSE: In PLANNED ACCIDENTS, the location is often chosen to avoid independent witnesses.
TRUE! These accidents are staged in secluded areas like behind buildings.
Why are many STAGED ACCIDENTS done at NIGHT?
FEWER WITNESSES and LOWER RISK of getting caught.
What is the typical setup of a REAR-END COLLISION FRAUD SCHEME?
Two colluding drivers stage a REAR-END collision.
What must an EE be listed as in a staged accident?
A PASSENGER, even if they weren’t there.
What is the typical setup of a REAR-END COLLISION FRAUD SCHEME?
Two colluding drivers stage a REAR-END CRASH, allowing MULTIPLE PASSENGERS to file fake injury claims.
What is an ‘INTERSECTION TRAP’ in accident fraud?
A fraudster PRETENDS to turn, lures an innocent driver into a turn, then ACCELERATES to cause a collision.
TRUE or FALSE: Insurers often settle fraudulent injury claims because proving them false can be difficult.
TRUE! Many settle to AVOID LONG legal battles.
Name three SIGNS of a STAGED ACCIDENT.
- Accident happens in a LOW-TRAFFIC AREA
- Minimal VEHICLE DAMAGE but MANY INJURY CLAIMS
- ALL PASSENGERS claim SOFT TISSUE or PSYCHOLOGICAL injuries
TRUE or FALSE: A driver in a staged accident usually claims injuries.
FALSE! The DRIVER often doesn’t claim injury to avoid involving their OWN insurance.
What kind of vehicles are often used in staged accidents?
- OLD RENTAL CARS
- SALVAGE VEHICLES
- Vehicles with LOW ACTUAL CASH VALUE (ACV)
TRUE or FALSE: Some medical providers commit FRAUD by billing for services that were never provided.
TRUE! This is called PAPER BILLING.
Name three SIGNS of MEDICAL SERVICE PROVIDER FRAUD.
- Billing for SERVICES NEVER PROVIDED
- Billing for the SAME SERVICE MULTIPLE TIMES
- Providing services OUTSIDE NORMAL BUSINESS HOURS
What illegal practice have some clinic owners been caught doing?
PAYING THIRD PARTIES for patient REFERRALS.
TRUE or FALSE: Only low-income individuals commit insurance fraud.
FALSE! Fraud occurs across ALL income and social levels.
What is the biggest risk insurers face when cracking down on fraud?
FRAUDSTERS making their scams MORE SOPHISTICATED over time.
What is the goal of REHABILITATION FRAUD?
To FAKE or EXAGGERATE treatment needs to collect MORE insurance payouts.
TRUE or FALSE: Some fraudulent medical providers use therapists who NO LONGER WORK at their clinic.
TRUE! They bill under old employees’ names.
Why do fraudsters prefer SOFT TISSUE INJURIES in fake claims?
HARD TO PROVE or DISPROVE, making it easier to scam insurers.
What are the two main types of ACCIDENT FRAUD?
STAGED ACCIDENTS and MEDICAL SERVICE FRAUD.
TRUE or FALSE: BC residents must have ICBC insurance to qualify for Enhanced Accident Benefits.
FALSE! ALL BC RESIDENTS qualify, even if they don’t have ICBC insurance.
Where must an accident occur for a BC resident to receive ENHANCED ACCIDENT BENEFITS?
In CANADA, the U.S., or on a VESSEL traveling between them.
Where can you find the details of BC’s ENHANCED ACCIDENT BENEFITS?
PART 10 of the INSURANCE (VEHICLE) ACT and PART 7 of the INSURANCE (VEHICLE) REGULATION.
Name three types of benefits provided under Autoplan’s ENHANCED ACCIDENT BENEFITS.
- HEALTH CARE & REHABILITATION
- INCOME REPLACEMENT
- PERMANENT IMPAIRMENT COMPENSATION
TRUE or FALSE: Funeral expenses and grief counselling are included in Enhanced Accident Benefits.
TRUE! These are covered along with DEATH BENEFITS.
Name three reasons why someone would NOT receive accident benefits under Enhanced Care.
- They are NOT an INSURED PERSON under the policy.
- The injury was from SUICIDE or ATTEMPTED SUICIDE.
- They were involved in ILLEGAL TRADE or TRANSPORT.
TRUE or FALSE: If someone crashes a car while transporting illegal goods, they can still claim accident benefits.
FALSE! Benefits are NOT payable for ILLEGAL activities.
What can cause ICBC to REDUCE, SUSPEND, or CANCEL accident benefits?
- LYING to ICBC about the claim
- REFUSING to provide required DOCUMENTS
- BREACHING coverage CONDITIONS (like driving without a license)
What is the impact of FRAUD on automobile insurance premiums?
FRAUD INCREASES COSTS, which leads to HIGHER INSURANCE PREMIUMS for everyone.
TRUE or FALSE: Staged accident recruiters sell ‘seats’ in fake accidents.
TRUE! Fraudsters PAY to be listed as ‘PASSENGERS’ and file fake claims.
Name two types of common ACCIDENT BENEFITS FRAUD.
- STAGED ACCIDENTS (fake crashes to collect benefits)
- MEDICAL PROVIDER FRAUD (billing for fake treatments)
What is a common scam involving fraudulent medical providers?
Billing for TREATMENTS that were NEVER PROVIDED.
TRUE or FALSE: Medical fraud can involve overbilling or billing for services outside business hours.
TRUE! Both are RED FLAGS for fraud.
What is the BIGGEST downside of fraud in the insurance system?
It puts the PUBLIC AT RISK and raises EVERYONE’S PREMIUMS.
What is ENHANCED ACCIDENT BENEFITS?
A NO-FAULT insurance system in BC that provides ACCIDENT BENEFITS regardless of WHO CAUSED the accident.
What is INCOME REPLACEMENT BENEFIT?
Compensation that covers UP TO 90% of NET INCOME for injured workers who can’t work due to an accident.
What is a PERMANENT IMPAIRMENT BENEFIT?
A LUMP SUM PAYMENT for insureds who suffer a PERMANENT disability due to an accident.
What is a CATASTROPHIC INJURY BENEFIT?
Coverage for SEVERE injuries like QUADRIPLEGIA, TRAUMATIC BRAIN INJURY, or AMPUTATION, providing ongoing medical and rehabilitation support.
What is a FRAUD RING?
A group of criminals who work together to STAGE ACCIDENTS and FILE FAKE CLAIMS to scam insurers.
What is a STAGED ACCIDENT?
A PLANNED COLLISION designed to LOOK REAL so fraudsters can collect insurance payouts.
What is MEDICAL SERVICE PROVIDER FRAUD?
When clinics or doctors OVERBILL, BILL FOR FAKE SERVICES, or COLLUDE with patients to inflate claims.
What is the RETIREMENT INCOME BENEFIT?
A benefit that REPLACES INCOME for insureds who were receiving income replacement but have reached AGE 65.
What is a BREACH OF COVERAGE CONDITION?
Any VIOLATION of policy terms (like DRIVING WITHOUT A LICENSE) that causes LOSS OF INSURANCE BENEFITS.
What is an EXCLUDED VEHICLE?
A vehicle NOT COVERED under ICBC, like SNOWMOBILES, ATVs, or FEDERAL GOVERNMENT-OWNED vehicles.
What is NO-FAULT INSURANCE?
A system where ACCIDENT BENEFITS are paid REGARDLESS of WHO CAUSED the accident—lawsuits are mostly eliminated.
What is THE INSURANCE (VEHICLE) ACT?
The LAW that governs AUTO INSURANCE in BC, including ENHANCED ACCIDENT BENEFITS.
What is a REHABILITATION BENEFIT?
Coverage for PHYSICAL THERAPY, MEDICAL EQUIPMENT, and HOME or VEHICLE MODIFICATIONS to help an injured person RECOVER.
What is FAMILY AND CAREGIVER BENEFIT?
Compensation for NON-PAID CAREGIVERS (like stay-at-home parents) who can no longer perform their duties due to an accident.
What is an INNOCENT THIRD-PARTY COLLISION?
A STAGED ACCIDENT where fraudsters INTENTIONALLY crash into an UNSUSPECTING DRIVER to make the fraud seem real.
What is a LOSS-OF-STUDIES BENEFIT?
Compensation for STUDENTS who can’t continue their EDUCATION due to INJURIES from an accident.
What is a VOLUNTEER EXPENSE BENEFIT?
Reimbursement for VOLUNTEERS who DAMAGED CLOTHING or INCURRED EXPENSES while HELPING at an ACCIDENT SCENE.
What is ICBC (INSURANCE CORPORATION OF BRITISH COLUMBIA)?
The CROWN CORPORATION that provides AUTO INSURANCE and manages ENHANCED ACCIDENT BENEFITS in BC.
What is FRAUDULENT MEDICAL BILLING?
When HEALTHCARE PROVIDERS charge for SERVICES NOT PROVIDED or EXAGGERATE treatment costs to scam insurers.
What is a TOP-UP INCOME REPLACEMENT BENEFIT?
OPTIONAL INSURANCE that allows HIGH-INCOME EARNERS to receive MORE than the STANDARD INCOME REPLACEMENT LIMITS.
