"Why Did ICBC Deny My Treatment Request?" A Patient's Guide to Getting Back on Track

 

Your practitioner submitted your treatment plan extension. You waited. Then your adjuster let you know: "Not approved."

And now you're sitting there thinking, "But my physio said I need this treatment. My pain still exists. What do I do?"

First: You're not stuck. This is not the end of your treatment. It's a bump, and there's a whole process to work through it.

Let me walk you through what just happened and how to actually fix it.

 
 

Why ICBC Says No ( - it’s debatable.)

ICBC doesn't deny extensions to be mean. They deny them when they don't have enough evidence that you still need treatment. It’s important to understand this because it changes your strategy.

The problem is usually one of these:

Your documentation isn't specific enough. Your practitioner wrote, "Patient still has pain and needs ongoing treatment." ICBC reads that and thinks: "Okay, but what pain? What has changed since last assessment? What specific goals are we working toward?" Vague does not work with ICBC. Your practitioner needs to be really specific about how you are improving, where you’re not improving and what they’re going to do to continue helping you progress. 

There's a gap in the narrative. You saw someone for six weeks, then life happened and there was a two-week pause. ICBC looks at that gap and wonders if you've stopped treatment because you’ve improved (which is fair—sometimes we do improve on our own). If there's no documentation explaining why there’s a pause in your treatment, they're working blind. ICBC will also ask your practitioner if there are barriers to your recovery, and if the reason is because you are not booking appointments at the recommended cadence, your practitioner is obligated to report that. 

The plan doesn't show progress. If your treatment plan from week 4 looks exactly the same as your treatment plan from week 10, ICBC reasonably asks: "Is this actually working?" Progress looks like: "Patient came in with 40% shoulder mobility. Now has 65%. Next goal: 80% to return to work." Stagnation looks like: "Patient has shoulder pain. Continuing massage."

It's been longer than they expected and they need updated medical info. If you're at week 11 asking for extension, your doctor's initial assessment from week 1 might not be current enough, and let’s be real, ICBC doesn’t always fund your case based on the word of one practitioner. ICBC sometimes needs a refreshed report  from multiple practitioners saying, "Yeah, they still need this."

Here's the thing: most denials aren't actually about your need. They're about insufficient evidence of your need.

 
 


What You Actually Need to Do Right Now

Step 1: Ask your practitioner what went wrong.

Text or call and say: "I got a denial letter. Can we talk about why?" Your practitioner has likely seen this before. They should know what ICBC asks for (we do at Capria). They might say, "Oh, they need an updated doctor's note" or "I need to be more specific about your functional goals." This is fixable information.

Step 2: Get a current medical statement (if needed).

If your doctor assessed you six weeks ago and you're still in treatment, a current note helps. "Patient continues to show functional limitations and requires ongoing physiotherapy to achieve pre-crash mobility" is way better than nothing. Call your doctor's office. It's a quick note. You might pay a small fee ($20-30) but it's worth it.

A great objective measurement is your recurring need for pain medication or nerve blocking meds. You can have your doctor inform your adjustor of what meds you are taking, and how often. If you are slowly moving away from a higher dose of meds, let your adjustor know, that’s a valuable sign of improvement. 

Step 3: Have your practitioner resubmit with better documentation.

This is usually the move. Your physio or massage therapist needs to redo the treatment plan extension request with:

  • Specific, current and functional limitations (not vague pain)

  • Progress made since the start of treatment (or last treatment plan extension)

  • Realistic goals for the next phase

  • Why stopping now would be counterproductive

That's what ICBC actually wants to see.



How to Appeal If the Second Request Gets Denied

Before you go nuclear with formal appeals, try this first.

Step 1: Ask your adjuster for a manager review.

Your adjuster is required to escalate your claim to a manager if you ask for one.

Email your adjuster and say: "I'd like to request a manager review of this denial. I believe the decision was based on incomplete information. Please escalate this claim."

They’ll give you the contact info of the manager and you can appeal to them. You can add more detail to your claim, add more functional limitations or improvements, if necessary then the manager will take another look. Sometimes a fresh set of eyes from someone with more authority changes the outcome.

Step 2: Consider switching practitioners (Real talk).

If your practitioner submits a denial appeal and gets rejected, and they're not willing to dig deeper or try again—maybe they're not the right fit for your recovery.

A good practitioner will:

  • Understand why you were denied

  • Know how to address that specific reason

  • Resubmit with stronger documentation

  • Fight for your claim because they believe in your recovery

If your practitioner says "Yeah, ICBC denied it, so that's that," they're not advocating for you. And advocacy matters. It’s their job to provide the feedback and maybe they aren’t doing that sufficiently. 

This is where a care coordinator becomes valuable. Our care coordinator has ICBC expertise and knows exactly what gets denied claims overtuned. If your current practitioner won't fight for your claim, a care coordinator can step in, review the denial, identify the gap, and resubmit with documentation that gets approved.

Step 3: Formal appeal (if needed).

If the manager review doesn't work, you have more formal options:

  • Claims Decision Review (CDR): An internal ICBC review by their Fair Practices Office. Takes about a month, free, sometimes gets approvals the first adjuster missed.

  • Civil Resolution Tribunal (CRT): BC's independent dispute resolution body. You can represent yourself. If you've done the work (good documentation, medical support, clear evidence), they usually side with you.

For most treatment denials, you won't need a lawyer. You'd only involve one for bigger disputes (catastrophic injury, major income replacement). For treatment extensions, a lawyer costs more than what's in dispute.

But here's the thing: before you reach the formal appeals stage, get someone who actually knows ICBC in your corner. That might be your practitioner. Or it might be a care coordinator whose work is focused on getting claims approved. .

What Will Work in an Appeal

If you're going to appeal (or resubmit), here's what you’ll need:

Be specific about function, not just pain. "I can't lift my arm above shoulder height, which prevents me from pulling groceries out of my cabinet" beats "I have shoulder pain"

Show the progression. "At assessment, I couldn't put on socks or shoes due to hip limitation. After 8 weeks of treatment, I can put on socks with minor difficulty but still struggle with shoes. Goal is to independently put on socks and shoes each morning, which is needed before returning to work." Real activities beat percentages. Adjusters understand function.

Get your doctor on the record. "My doctor states I require ongoing physiotherapy" is better than your therapist saying it. ICBC respects the medical authority.

Include objective measures if possible. Range of motion numbers. Functional tests. "Patient can now walk 15 minutes without pain (previously 5 minutes)" is objective. "Patient is feeling better" is not.

Explain what happens if treatment stops. "If I stop now, I'll regress and need more intensive rehab later, which delays my return to work." ICBC gets this math: 4 more weeks now is cheaper than 12 weeks of more intensive rehab later.

When ICBC Still Says No—And How to Reframe

Sometimes ICBC will say no, and you'll have to accept it. Not because you're not entitled to care—but because they've decided your condition has plateaued or stabilized enough that self-management is reasonable.

Here's the real talk: that decision might be wrong. It might be right. But you've got avenues to push back.

The people who succeed with appeals are usually the ones who reframe the conversation from "I still hurt" (subjective, hard to argue) to "I can't return to normal function yet, and here's the evidence" (objective, provable, aligned with what ICBC cares about).

If You Do Get Approved for an Extension

Great. Now treat it like you treated the first 12 weeks. This is your second window. Most people can get extension denials overturned. Use it strategically. Don't coast. The goal is actually getting back to pre-crash function, not just getting treatment paid for.

 
 

Resources:

Feel like your denial doesn't make sense? We've helped plenty of people work through this. We can review your denial letter and help you figure out next steps. Reach out. 

Located in Coquitlam and serving Port Moody, Anmore, and the Greater Vancouver area.

 
Richelle SekiCapria Care Collective