ICBC Treatment Plan Extension Form Guide: How to Get Approved
You've got 8-10 sessions in. Your patient is improving. Now you need to fill out the ICBC Treatment Plan Extension Request Form. The form looks simple but filling it out can be nuanced.
Here's how to fill it out so it gets approved.
Critical: Document All Functional Limitations in Your Initial Assessment
Before you even think about extension requests, understand this: Document ALL of the patient's functional limitations in the initial assessment. Not just the primary complaint. Everything that's affected.
Why? Because 8-10 sessions in, your primary functional goal might plateau. Your patient might hit 90% on desk work tolerance but still can't do overhead reaching or can't drive without pain. If you only documented desk work initially, you're stuck when it plateaus.
But if you documented desk work AND overhead reaching AND driving AND household tasks AND sleep positions, you always have something to report progress on. You always have functional goals you're still working toward. This keeps the extension request viable even if Goal #1 has stalled.
Example:
Goal 1: Return to desk work (requires 8+ hours daily sitting, typing, rotating head for phone calls)
Goal 2: Overhead reaching (access files from cabinet, requires reaching above shoulder height)
Goal 3: Driving (requires sustained head rotation and left neck rotation tolerance)
Goal 4: Sleep (currently wakes at 2am with neck pain, unable to sleep through the night)
By session 6:
Goal 1 is progressing nicely.
Goal 3 (driving) might plateau. Good. You shift focus in your narrative to Goals 2 and 4, showing progress there
ICBC sees you're still treating toward functional recovery across multiple domains.
Document comprehensively in initial assessment. Use that documentation strategically in extension requests.
Quick Checklist: ICBC Extension Form Essentials
- ✓ Document ALL functional limitations in initial assessment
- ✓ Include baseline AND current pain metrics (scale, frequency, duration)
- ✓ Show measurable functional progress (hours worked, ROM degrees, distance walked)
- ✓ Tie goals to specific work/home/ADL demands
- ✓ Request maximum sessions (10) with 3-month timeline
- ✓ Submit 2 weeks before current sessions expire
- ✓ Address barriers honestly if they exist
- ✓ Match "Overall Progress" checkbox to actual data shown
Full section-by-section breakdown with character counts and examples below.
ICBC Treatment Extension Form: Section-by-Section Breakdown
Section 1: How Well Does the Patient Feel They Are Recovering?
This is straightforward. Pick the checkbox that matches reality: Completely Better, Much Improved, Slightly Improved, No Change, Slightly Worse, Much Worse, Worse Than Ever.
Be honest. If they're Slightly Improved, select that. ICBC sees through inflated recovery claims.
Section 2: Key Subjective Findings (750 character limit)
This is your opening. Tell the pain story in one paragraph.
❌ "Patient reports continued pain. Slow progress with treatment."
✅
"Administrative assistant with ongoing right-sided cervical pain.
Baseline pain now 4/10 in morning (was 6/10 at initial assessment).
With desk work, pain increases to 5/10 (was escalating to 8/10).
Pain episodes currently 1 per workday lasting 1-2 hours (was 1-2 episodes daily, 2-3 hours each).
Can now tolerate 3 hours of desk work before pain escalates (was 2 hours).
After work, able to participate in light family activities.
Patient reports motivation to continue treatment and return to full work capacity."
What you included: baseline pain, aggravated pain, frequency change, duration change, work tolerance improvement, functional participation. All measurable. All relevant.
Character count: 398/750
Section 3: Is the Patient Currently Missing From Work/School/ADLs?
The ICBC form has three separate categories for return to work, return to school, and return to ADLs. Choose any and all that apply to your patient. This establishes what functional recovery they need to achieve. If the patient is missing ANY element of work or school, this counts. If the patient is still going to work/school but function is impaired in any way, this also counts.
Return to Work
Return to School
Return to ADLs (Activities of Daily Living)
For each category you select, you'll fill in ONE 750-character Initial/Previous section and ONE 750-character Current section. If your patient has multiple related limitations within one category (e.g., desk work AND overhead reaching AND phone use for work), you’ll need to condense your words into that single 750 character max. section, or report the other aspects of the injury in a later treatment extension plan .
This is why comprehensive documentation in the patient file is critical. You document everything. On the ICBC form, you condense related goals into single sections per category.
Return to Work - Initial/Previous Findings (750 character limit)
Include all work-related functional losses here: sitting tolerance, reaching, rotation, fine motor, typing, phone use—whatever applies.
❌ "Patient unable to work. Has neck pain."
✅
"Administrative assistant unable to perform desk work duties.
Sitting tolerance: only 2 hours before pain escalates to 8/10 (requires 8+ hours daily).
Head rotation for phone work: pain onset at 5 degrees rotation, escalates to 8/10.
Overhead reaching for files: cannot reach above shoulder height.
Baseline pain: 6/10 in morning, aggravated to 8/10 with work activity.
Pain frequency: 1-2 episodes daily lasting 2-3 hours.
24-hour pattern: minimal in morning (2/10), escalates to 6-8/10 throughout workday. After work attempts, pain prevents family participation."
Character count: 495/750
You've condensed: sitting, rotation, reaching, pain baseline, aggravated, frequency, duration, 24-hr pattern, functional impact—all the work-related limitations—into one section.
Return to Work - Current Findings (750 character limit)
Show progress on ALL those work-related areas simultaneously.
✅
Sitting tolerance improved to 3 hours (was 2 hours), pain at 6/10 (was escalating to 8/10).
Head rotation for phone work: pain onset now at 15 degrees rotation (was 5 degrees).
Overhead reaching: improved from unable to reach above shoulder to reaching at 45-degree angle.
Baseline pain now 4/10 in morning (was 6/10), aggravated pain 6/10 with work (was 8/10).
Pain frequency reduced to 1 episode daily lasting 1-2 hours (was 1-2 episodes, 2-3 hours).
24-hour pattern: morning 2/10, increases to 4-5/10 with activity (was escalating to 8/10). After work, patient able to participate in light family activities."
Character count: 491/750
Same structure. All work-related progress in one section. Shows improvement across sitting, rotation, reaching, pain metrics.
Overall Progress Towards Goal
Check one: Resolved, Improved Significantly, Improved Moderately, Improved Minimally, Unchanged, Regressed.
For this example: Improved Moderately
Patient is progressing on multiple work-related fronts (sitting up, rotation improving, reaching improving) but hasn't achieved full work capacity yet. This justifies continuing treatment.
Return to School - Initial/Previous Findings (750 character limit - if applicable)
If your patient is a student, use this separate category. Include all school-related functional losses: sitting in classes, note-taking, reading, computer use, concentration, attendance.
✅ Example:
"High school student unable to attend classes.
Baseline cervical pain 6/10, aggravated to 8/10 with reading and note-taking.
Sitting tolerance in classroom setting only 45 minutes before pain escalates to 8/10, requiring rest (classes are 75 minutes).
Cannot perform overhead reaching for whiteboard viewing.
Pain frequency 1-2 episodes daily during school hours, each lasting 2-3 hours. Concentration affected by pain. Missing school due to pain and fatigue after activity."
Character count: [varies]
Return to School - Current Findings (750 character limit - if applicable)
✅ Example:
"Student attending classes with improved tolerance.
Sitting tolerance improved to 60 minutes (was 45 minutes),
pain at 6/10 (was escalating to 8/10). Baseline pain 4/10 (was 6/10).
Pain frequency reduced to 1 episode per school day (was 1-2 episodes).
Note-taking less painful. Concentration improving.
Attending most classes, missing minimal school days."
Overall Progress Towards School Goal
Check one: Resolved, Improved Significantly, Improved Moderately, Improved Minimally, Unchanged, Regressed
Return to ADLs (Activities of Daily Living)
If the patient has ADL limitations independent of work, this is your second category. Use this when work-related goals plateau but ADL improvements keep showing progress.
Common ADLs impacted by cervical injury: Dressing/Undressing, Grooming/Hygiene, Eating/Drinking, Home access, Washing/Bathing, Driving, Sleep.
Return to ADLs - Initial/Previous Findings (750 character limit)
Include all relevant ADL losses in one section.
✅
"Patient unable to dress self due to overhead restriction (cannot lift arms above shoulder height).
Cannot brush hair or perform grooming without pain 8/10.
Sleep disrupted: wakes multiple times nightly due to pain (4-5 hours interrupted sleep), unable to find comfortable sleeping position.
Cannot wash hair or shower without assistance.
Requires support for dressing
Daily activities significantly limited by pain and mobility restriction."
Return to ADLs - Current Findings (750 character limit)
Show improvement on those ADL areas.
✅
"Patient can now dress self with minimal pain (3/10 during activity).
Can brush hair and perform grooming, though overhead tasks still trigger pain at 6/10
Sleep improved to 6-7 hours with only 1-2 wake episodes nightly
Finding comfortable sleeping positions with pillow support
Can shower independently with adaptive techniques
Increased independence with daily activities."
This second category shows progress independent of work-related goals. If work plateaus, ADL improvements keep the extension viable.
Treatment Modalities (Checkboxes)
Check the boxes for what you're actually using:
Specialty modalities: Vestibular, Concussion, Spinal cord, Neurological, Hand Therapy, Complex MSK, Mobile/Community
Passive modalities: Massage, Manipulation, Manual Therapy, Active Release, Acupuncture, IMS, Ultrasound, Electro-modalities, Shockwave, Laser, Mechanical traction
Active modalities: Stretching, Range of Motion, Hydrotherapy, Cardiorespiratory, Strengthening, Work Simulation
For our example: Check Manual Therapy, Stretching, Strengthening.
Self-Management: (Provide Detailed Description)
Home exercises, education, self-management techniques, bracing. Whatever the patient is doing at home.
✅ Home exercise program:
“patient performing 3x daily cervical range of motion exercises (gentle rotation, extension, lateral flexion), 10-minute sessions.
Education on ergonomic desk setup, screen height, keyboard position. Self-management: heat application post-work, postural awareness during phone use.
Patient compliant with program, reports exercises reduce end-of-day pain intensity."
Any Barriers Delaying the Patient's Progress? Additional Comments (750 character limit)
Be honest. If there are barriers, say so. ICBC expects reality.
✅
"No significant barriers
Patient is motivated and compliant with treatment plan
Workplace ergonomics are supportive (patient able to adjust desk/chair)
Patient has consistent schedule allowing 2x/week treatment
Main factor limiting faster progress is that patient works 5 days/week, which continuously challenges the recovery of the cervical spine
Continued treatment is indicated to build tolerance for sustained 8+ hour work demands."
Or if there ARE barriers:
✅
"Patient had 2-week gap in treatment due to work schedule conflicts and vacation (weeks 3-4 of treatment).
This caused minor regression in pain pattern (frequency increased from 0-1 to 1-2 episodes daily)
Current sessions to re-establish of progress
Recommend continuation of 2x/week to prevent further gaps."
Character count: 319/750
Recommended Treatment Section
# treatments to date: [Enter actual number completed]
# sessions remaining: [From pre-approved window - if you used 8 of 25 pre-approved, you have 17 remaining]
Current treatment frequency: 2x/week
# sessions requested: [Always request maximum: 10 sessions]
Discharge date: [Maximum 3 months from today's date]
Do You Expect the Patient to Return to Pre-Accident Level of Function at the End of This Recommended Treatment?
Three options:
Option 1: "Yes, patient expected to return to pre-accident status and will be discharged by provider at end of Recommended Treatment."
Use this if you genuinely believe 10 more sessions will get them to baseline. Pain pattern resolved or near-resolved, work tolerance achieved.
Option 2: "No, patient will require additional treatment following completion of the Recommended Treatment, subsequent Treatment Plan to follow (please explain)."
For chronic pain cases, don't just say "ongoing maintenance is needed." Instead, find and document the minute improvements still occurring. Focus on small changes in FIDs (Frequency, Intensity, Duration) that prove treatment is still working.
You're showing ICBC that treatment is still working through small, measurable improvements—not just saying pain is "stable."
Option 3: "No, the patient has plateaued but will be discharged by the provider at the end of the Recommended Treatment (please explain)."
Use this when you've done your part and the patient needs referral. "Patient has plateaued with physiotherapy at 90% function. Remaining 10% requires different modality approach. Recommending referral to [other provider] for evaluation of [specific deficit]."
Additional Comments (750 character limit)
Final space for anything else ICBC needs to know.
✅
"Patient is a good candidate for continued treatment
Pain pattern shows consistent improvement over 6 sessions
Baseline pain reduced from 6/10 to 4/10, work tolerance increased from 2 hours to 3 hours
Current trajectory suggests 10 more sessions will achieve baseline pain ≤2/10, aggravated pain ≤4/10, and work tolerance of 6+ hours (patient currently works 5 days/week, 8 hours/day).
At that point, patient will require ongoing maintenance management but should be able to sustain full work duties with home exercise program."
Common Reasons ICBC Denies Extension Forms (And How to Fix Them)
You're filling this form 8-10 weeks into treatment. ICBC's expectation: Show progress. Show the patient is on track toward goals. Show you know what you're treating and why continuation makes sense.
What gets denied:
Vague progress ("patient improving")
No measurable change between initial and current
Goals that are too ambitious or too vague
No justification for 10 sessions (why not 5?)
Goals that look resolved but you're requesting extension anyway
What gets approved:
Clear pain story with numbers that have changed
Specific functional goals tied to work/home
Measurable progress (pain baseline down, frequency reduced, tolerance up)
Honest assessment (if moderate progress, check "Improved Moderately")
Clear rationale for continued treatment
One Checklist Before You Submit
Section 2 includes complete pain story (baseline, aggravated, frequency, duration, 24-hr pattern, impact)
Initial/Previous findings for each goal tell the full story of what couldn't be done
Current findings show specific changes (baseline pain 6→4, frequency reduced, tolerance improved)
Overall progress checkbox matches the actual improvement shown in the data
Functional goals are specific and tied to actual work/home demands
Barriers are addressed honestly
Modalities checked match what you're actually doing
Sessions requested = 10 (maximum)
Discharge date = 3 months from today
Additional Comments explain why continued treatment is justified based on the progress shown
One more thing: Read the entire form like you're a busy ICBC adjuster. Does the progress story make sense? Would you approve this? Good. Now submit it.
Capria Care Collective | Coquitlam, BC | Making ICBC extension requests actually work for you.