Joint Statement from BC Allied Health Care Clinic Owners and Practitioners on ICBC Provider Agreement Concerns

Feb 15, 2025

To: Insurance Corporation of British Columbia (ICBC)
CC: Physiotherapy Association of BC (PABC), Canadian Physiotherapy Association (CPA), BC Ministry of Finance, BC Office of the Information and Privacy Commissioner

Subject: Collective Objection to ICBC’s Health Care Services Provider Agreement Terms (https://www.icbc.com/policies/health-care-services-terms

We, the undersigned health care clinic owners and practitioners across British Columbia, are writing to formally express our deep concerns regarding the terms and conditions outlined in ICBC’s Health Care Services Provider Agreement that go into effect on March 22, 2025. While we recognize the importance of ensuring accessible care for individuals recovering from motor vehicle accidents, the structure of this agreement places an undue burden on clinical owners, jeopardizing both the sustainability of our businesses and the quality of care we provide to patients. 

Key Concerns:

Unilateral Control & Lack of Negotiation

ICBC has retained the ability to amend terms at any time without provider consultation, creating significant financial and operational uncertainty for clinics. This means that clinics have no ability to negotiate or challenge new rules that could negatively impact their business operations. For example, if ICBC decides to lower reimbursement rates or introduces new administrative requirements, clinics must comply or opt out without any say in the matter.

Remuneration, Performance Management and Key Performance Indicator (KPI) metrics are entirely determined by ICBC, without input from providers. Clinics may be evaluated based on arbitrary or unrealistic KPIs that prioritize cost-cutting rather than quality patient care. If a clinic does not meet ICBC’s evolving performance expectations, it could face penalties or removal from the provider network, even if the clinic is delivering effective and ethical treatment within the requirements of our colleagues. 

Intrusive Oversight & Privacy Concerns

ICBC has granted itself the right to conduct on-site audits, enforce KPIs, and access clinical records and all staff electronic devices. This raises serious concerns about patient confidentiality and clinical autonomy. For instance, ICBC could demand access to a clinical’s treatment records and electronic devices, which could include sensitive patient health information. This level of oversight is unprecedented and could put clinics in violation of privacy laws, including BC’s Personal Information Protection Act (PIPA).

Allowing ICBC auditors to enter clinics at will and assess operations without clear guidelines could disrupt patient care and create an environment of constant surveillance. 

Financial & Administrative Burden

ICBC dictates pricing structures and prohibits clinics from billing patients directly for any additional necessary services, even if the services provided exceed what ICBC covers. For example, if a patient requires a longer treatment session or specialized rehabilitation techniques that go beyond ICBC’s fee structure, clinics are restricted from billing for the actual cost of care. This forces clinics to either absorb the financial loss or provide suboptimal care within ICBC’s rigid limitations.

The administrative burden placed on clinics is excessive. The time and resources required to comply with ICBC’s reporting and documentation demands (much of which is not billable to ICBC) take away from actual patient care. Many small and mid-sized clinics do not have the administrative staff to handle these increasing requirements, making participation in the ICBC provider network financially unviable.

ICBC currently does not pay for treatment plan reporting and adjuster communication that is required of clinicians who work with ICBC patients. These new terms and conditions make no mention of increasing fees for reporting and administration and include more risk, more administration time and more communication expectations which appear to be unpaid. This places clinic owners, clinicians and their administrative teams at an even more unjust pay structure while ICBC already currently pays less than market value for clinical work.

Disproportionate Liability on Clinics

Clinic owners are expected to assume full responsibility for compliance, including the actions of their practitioners, with no clear support or recovery from ICBC. This means that if a practitioner unknowingly fails to meet ICBC’s unclear expectations, the clinic owner could face consequences, including financial penalties or removal of all clinical staff from the network. Many clinicians operate at clinics as independent contractors and passing the risk on to clinical owners on their behalf is not only unfair to the clinical owners, but undermines the independent nature of the contractors ’ businesses as per the Canada Revenue Agency. 

There is no fair dispute resolution process for clinics to challenge ICBC’s decisions. If ICBC decides to penalize or audit a clinic based on unclear metrics, clinical owners have little to no recourse as in the terms it states that “ICBC’s interpretation is final. ” For example, if ICBC retroactively determines that a treatment plan did not meet its evolving standards, the clinic may be required to refund payments with interest or be subject to disciplinary action without a transparent appeal process.

As independent health care providers, we take our professional and ethical responsibilities seriously. These terms and conditions however, place clinic owners and practitioners in an untenable position, forcing many to choose between continuing to offer health care to MVA patients in need under ethical terms and unprecedented risk, or to opt-out of this agreement creating even more scarcity for patients in need of health care in a province that is already in a state of health care crisis and a shortage of medical professionals. As health care providers, our primary goal is high quality care and ethical standards of practice for our patients and we entered this profession to help people in need. Operating our businesses under these terms and conditions is a massive compromise not only of our professional standards,but of what we would define as quality care to clients. Ultimately, it is the clients who will suffer under both the new terms and conditions or with lack of access to quality care. 

We urge ICBC to engage in meaningful discussions with health care providers, professional associations, and legal experts to review these terms in a way that ensures fairness, sustainability, and respect for the professional autonomy of physiotherapy clinics.

Sincerely, the practitioners and clinic owners signed below.