Treatment Extension Requests: The Evidence ICBC Actually Wants to See
And the answer is: specific, measurable evidence that the patient still needs treatment and is making progress toward functional recovery.
Do you want a straightforward guide to how to write a treatment extension plan?
Not hope. Not "the patient says they’re still in pain, 7/10." Not vague goals. Specific, defensible, measurable evidence.
Let me break down what gets approved and what gets denied, because there's actually a pattern here.
ICBC Extension Request Template: Step-by-Step
Before we talk about what they want to see, understand what they're deciding:
Reason 1: Treatment is contributing to recovery. The patient started at X level of function, we intervened, and they're now at Y level of function. That's progress. Continuing treatment to get to Z makes sense.
Reason 2: Treatment prevents progression to chronic pain or permanent disability. ICBC knows there's a critical window. Research shows that early intervention with education and active treatment prevents the chronic pain of whiplash associated disorders.
If a patient develops chronic pain, they're expensive forever—ongoing medication, lost work capacity, lifetime wage replacement. But if you catch them in their acute window when they're starting to plateau, a few more weeks of intensive treatment can prevent that progression. That's the cost-benefit analysis: approve 4 weeks now to prevent years of chronic pain management later.
Everything else flows from these two principles. If your extension request doesn't speak to one of these, ICBC has no framework to approve it.
ICBC Approval Criteria: What Works
Example 1:
“Patient presented with shoulder pain 7/10 with overhead reaching.
Baseline: cannot put on shirt or bra without 20-minute rest afterward, cannot reach kitchen cabinets, cannot wash hair.
Limited to 10 minutes of overhead activity before pain spikes to 8/10, requiring rest and pain medication for remainder of day.
Post-8-week treatment: overhead pain 3/10. Patient can now put on own clothing without assistance, can reach kitchen cabinets for meal prep, can wash hair.
Tolerates 45 minutes of overhead activity before pain increases.
Functional goal: return to warehouse position that requires stocking items on high shelves (sustained overhead reaching, 6+ hours daily). Continuing physiotherapy 2x/week for 4 weeks to build tolerance to 6-hour overhead work threshold based on current trajectory."
Why approved: Clear pain story (7→3), specific functional activities (dressing, hygiene, kitchen tasks), measurable progress (10 min → 45 min), specific work demand (6+ hours of overhead stocking), realistic timeline.
Example 2:
“Patient presented with lumbar pain 6/10 with sitting.
Baseline: unable to sit through a meal, cannot attend children's school events, takes medication to manage pain during 5-minute car rides.
Currently able to sit for 20 minutes (can now eat a meal, attend meetings at work) with pain 4/10 before position change needed. Still cannot complete 30-minute school pickup routine or attend full-length child sporting events. Work demands require 60-minute sitting tolerance for office position.
Four additional weeks of treatment expected to achieve 60-minute sitting tolerance, which will allow patient to return to office work and manage family activities without medication."
Why approved: Pain story (6/10 baseline with life impact), functional activities (meals, events, driving, work), measurable progress (5 min → 20 min), clear gap (20 → 60 minutes), work-life connection.
Example 3:
“Patient off work since crash.
Baseline: unable to stand for more than 15 minutes, cannot help with household tasks, managing only 2-hour work shifts with baseline pain 3/10 increasing to 6/10 by end of shift (requiring rest for 3+ hours after work, unable to care for family).
Physician cleared for gradual return.
Return-to-work goal: 4-hour shifts with pain staying ≤4/10, able to manage home responsibilities after work. Treatment focused on endurance and activity tolerance. Two more weeks of kinesiology expected to support tolerance of 4-hour shifts based on weekly improvements.”
Why approved: Real impact story (standing limitations, family care limitations), current capacity (2 hours, pain-dependent recovery needs), specific work goal (4 hours), functional endpoint (can manage home life again), treatment rationale.
Why ICBC Denies Extension Requests: Common Mistakes
Now here's what we see denied:
Example 1:
“Patient continues to have pain. Recommending ongoing massage therapy for pain management.”
Why denied: No baseline measure of pain, no progress marker, no functional goal. "Pain management" could mean forever. ICBC funds recovery, not ongoing maintenance. (And yeah, sometimes massage therapy IS the right move for ongoing management, but you have to frame it differently than this.)
Example 2:
"Patient making slow progress. Recommend continuing physiotherapy."
Why denied: "Slow progress" is relative. What is progress? What was the baseline? "Continuing" with no endpoint is vague. ICBC approves time-limited treatment toward specific goals, not open-ended care.
Example 3: "Patient needs ongoing counselling for anxiety related to the crash."
Why denied: This might be legitimate—post-crash PTSD is real—but you need to frame it in terms of recovery milestones, not symptom management. Better: "Patient has hypervigilance affecting return to driving. Counselling sessions focused on gradual exposure and CBT strategies. Expected timeline for driving reintegration: 4 weeks."
Example 4: "Regular assessment shows patient still has limitations."
Why denied: Whose limitations? Compared to what baseline? What are you treating toward? This is passive observation, not active treatment planning.
The Month 6-8 Switch: When ICBC Standards Change
ICBC will approve extension requests with sloppy documentation for the first 6-8 months. They're lenient. They expect variation in charting quality. They'll approve requests that don't meet the standards we outlined above.
But around month 6-8 of treatment, they flip a switch. Suddenly they want clear baselines, objective measures, FIDs (Frequency, Intensity, Duration) and 24 hours pain pattern documentation. They want proof.
This is where the trap happens: If you spent the first 6 months charting poorly—"patient continues to have pain," "slow progress," vague functional notes—you'll get those extension requests approved. But by month 8, when ICBC expects professional documentation with actual baseline data, you can't retroactively prove what the patient presented with. You don't have FIDs. You don't have pain pattern documentation. You have nothing but subjective notes.
Then you hit a chronic pain patient who needs ongoing care, and you're stuck. ICBC says "show us the baseline." You can't. Denial.
This is why proper intake and documentation from day one matters. You won't need it for the first extension requests—those will slide through anyway. But you absolutely need it by month 6-8 when ICBC gets serious.
For chronic pain patients who need care beyond 12 months, start documenting FIDs and pain patterns immediately, even in the first weeks. When you hit month 8 and ICBC demands objective proof of progress, you'll have it.
Stop guessing on intake. We've created a free 25-minute course on doing initial assessments properly—the kind that gives you the baseline data ICBC will demand by month 6-8. The course walks through what to document, what questions to ask, and how to set up your notes from day one so you're ready when ICBC gets serious.
Get the Free Initial Assessment Course
How to Structure an Extension Request That Works
Section 1: Key Subjective Findings (750 characters max.)
Start with the pain story. What does the patient do for work or home? How often? How is the pain affecting that? Then add objective measures: pain scale (base and aggravated), FIDs (Frequency, Intensity, Duration), 24-hour pain pattern, ROM, functional tests, time-to-onset-of-pain, distance walked, grip strength—anything measurable.
This is your full clinical documentation (what goes in the patient chart):
"Patient works as warehouse stocker, required to reach overhead to shelves 6+ hours daily. At initial assessment [date], unable to perform job duties.
Base pain 2/10 at rest, increasing to 7/10 with overhead reaching. Pain frequency: 3-4 episodes daily when attempting overhead work. Each episode lasts 30-45 minutes, after which patient requires 20-30 minute rest before attempting activity again. Unable to reach above shoulder height without triggering pain spike. Pain onset with overhead arm movements after 3-5 minutes of activity.
24-hour pattern: pain minimal in morning at rest (1-2/10), increases to 6-7/10 with any overhead activity attempt. After work attempts, pain prevents evening family activities."
ICBC’s form will limit you to 750 characters per field. Here's what you submit (compressed for form submission):
"Warehouse stocker, overhead reaching 6+ hrs daily. At initial assessment: unable to work. Base pain 2/10 rest, 7/10 overhead. Pain episodes: 3-4 daily, 30-45 min each, 20-30 min rest between. Cannot reach above shoulder. Cervical ROM 20° extension (normal 45°). Pain onset after 3-5 min overhead activity. 24-hr pattern: 1-2/10 morning, increases to 6-7/10 with activity. Prevents evening family activities."
What got cut: "Patient works as" → "Warehouse stocker" | "At initial assessment [date], unable to perform job duties" → condensed to "At initial assessment: unable to work" | Removed "triggering pain spike" (emotional, not measurable) | Removed redundancy on activity description.
Section 2: Initial/Previous Findings (750 characters max.)
Add objective measures: pain scale (base and aggravated), FIDs (Frequency, Intensity, Duration), 24-hour pain pattern, ROM, functional tests, time-to-onset-of-pain, distance walked, grip strength—anything measurable.
Patient Chart:
"Patient works as warehouse stocker, required to reach overhead to shelves 6+ hours daily.
At initial assessment [date]:
unable to perform job duties
Base pain 2/10 at rest, increasing to 7/10 with overhead reaching
Pain frequency: 3-4 episodes daily when attempting overhead work
Each episode lasts 30-45 minutes, after which patient requires 20-30 minute rest before attempting activity again.
Unable to reach above shoulder height without triggering pain spike.
Pain onset with overhead arm movements after 3-5 minutes of activity.
24-hour pattern: pain minimal in morning at rest (1-2/10), increases to 6-7/10 with any overhead activity attempt. After work attempts, pain prevents evening family activities.”
ICBC Form Submission (750 character limit):
"Warehouse stocker, overhead reaching 6+ hrs daily.
Unable to perform job duties.
Base pain 2/10 rest, 7/10 overhead.
Pain frequency: 3-4 episodes daily, 30-45 min duration, 20-30 min rest required between.
Cannot reach above shoulder.
Pain onset: 3-5 min with overhead activity.
24-hr pattern: 1-2/10 morning at rest, increases to 6-7/10 with activity. Pain prevents evening family activities after work."
Character count: 404/750
Section 3: Current Findings (750 characters max.)
Show the pain story improvement. What can they now do that they couldn't before? How has the pain pattern changed? Then show the objective measures.
Patient Chart:
"patient able to perform light warehouse duties for 1-2 hours with manageable pain
Base pain 1/10 at rest, aggravated pain 4/10 with overhead reaching (previously 7/10).
Pain frequency: 1-2 episodes per session, each lasting 15-20 minutes
Pain onset with overhead movements now after 10-12 minutes of activity
24-hour pattern: pain minimal in morning (1/10), mild increase (3/10) only after overhead work attempts
Patient able to help with light household tasks and participate in family activities after short work attempts."
ICBC Form Submission (750 character limit):
"performing warehouse duties 1-2 hrs.
Base pain 1/10 rest, 4/10 overhead (previously 7/10).
Pain frequency: 1-2 episodes per session, 15-20 min duration (previously 3-4 episodes, 30-45 min).
Pain onset after 10-12 min overhead activity (previously 3-5 min).
24-hr pattern: 1/10 morning, 3/10 after work attempts.
Managing household tasks and participating in family activities after work."
Character count: 386/750
Cut: "patient able to" → removed opening | "manageable pain" (opinion) | "light warehouse" → "warehouse" | "performing light warehouse duties for 1-2 hours" → "performing warehouse duties 1-2 hrs" | "able to help with light household tasks and participate" → "managing household tasks and participating"
Section 4: What's Still Missing - Additional comments (750 characters max.)
"Patient currently [pain story - what can they do now]. To return to [work/home duty], they need [specific pain pattern/functional improvement]."
Then add the clinical goal.
Patient Chart:
"Patient can now manage 2-3 hours of warehouse stocking but still unable to complete a full 6+ hour shift without pain limiting performance.
To return to full warehouse duties, pain frequency needs to decrease to 0-1 episodes per shift, base pain must stay ≤1/10, and aggravated pain during overhead work must stay ≤3/10.
Patient requires ability to sustain overhead reaching for full shift without requiring rest breaks due to pain.
Continue physiotherapy 2x/week to build endurance and reduce pain frequency/intensity during sustained activity."
ICBC form submission:
Current capacity: 2-3 hrs warehouse stocking.
Cannot complete 6+ hr shift.
Functional goal: full warehouse duties requiring sustained 6+ hr overhead work. \
Required improvements: pain frequency 0-1 episodes per shift, base pain ≤1/10, aggravated pain ≤3/10 with overhead activity.
Must sustain overhead reaching full shift without rest breaks.
Treatment plan: physio 2x/week to build endurance and reduce pain episodes during sustained overhead reaching.
Character count: 385/750
Cut: "Patient can now manage... but still unable to complete" → "Current capacity: 2-3 hrs... Cannot complete" | "To return to" → "Functional goal:" | Removed "without pain limiting performance" (implied by pain goals) | "requires ability to sustain" → "Must sustain" | Removed "due to pain" (redundant)
Section 5: Recommended treatment:
Recommended treatment: [treatment type]
Treatments to date: [X weeks, Y sessions completed]
Sessions remaining: [from pre-approved window]
Current treatment frequency: [e.g., 2x/week]
Sessions requested: [specific number - maximum 10 sessions]
Expected discharge date: [maximum 3 months from now]
Strategic note: Always ask for the maximum. Request 10 sessions and a 3-month timeline, not what you think the patient needs. Here's why: real recovery includes unexpected scheduling gaps, flare-ups, plateaus, and regressions. If you ask for 6 sessions and the patient has a flare-up in week 3, you've run out of sessions before you can help them recover. If you ask for 10 sessions, you have that buffer.
Planning for a doctors note
For patients awaiting extension approval: Have them book a backup appointment 1-2 weeks after the extension deadline. If ICBC denies their extension request without a doctor's note, the patient will already have an appointment on the calendar - they won’t have to wait long to get an appointment with their MD after finding out they need an appointment. Then they won’t have a gap in their treatment
they need treatment immediately without a gap. If ICBC approves, they can cancel. This way, a denial doesn't leave them without care while they figure out next steps.
Timing your Treatment Extension Request Submission
Here's a tactical point: Submit your extension request two weeks or 2 appointments before it’s due.
If you submit at week 12, you're asking for urgent approval and you've left no buffer. If the request takes 1-2 weeks to process and gets denied, now you're past the 12-week window and the patient has no coverage for the next session.
Submit early. Give ICBC time to review. If there's a back-and-forth, you've got time to provide additional evidence without gaps in treatment.
One More Thing: Know When to Refer Out
You're not the answer for every patient. That's not failure. That's honesty.
Watch for the signs: You've plateaued with a patient and don't know what's next. Their energy is draining you. You're frustrated because you can't figure out how to help them get that last bit of progress. Or the patient is at 90% function but you know—really know—that your modality can't get them to 100%.
That's when you refer out. Not because the patient failed. Not because you failed. Because they need a different modality or a different practitioner's expertise. Maybe someone with a completely different skill set. Maybe someone who specializes in what they still need.
Just because you've hit your ceiling with a patient doesn't mean they should stop getting help. Identify the gap, acknowledge it's not your specialty, and refer them to someone who can help.
That takes integrity. It also builds referral relationships and a reputation as someone who actually cares about patient outcomes, not just closing files or protecting your ego.
Looking to sharpen your ICBC extension strategy? We run a course that walks through real extension requests, common denials, and how to structure arguments that actually work. It's the stuff they don't teach you in school but every busy clinic needs to know.
Learn more about our ICBC Care Coordination course.
Capria Care Collective | Coquitlam, BC | Training practitioners across BC on ICBC mastery.