What the CL489A is for
The CL489A is the Extended version of the family physician’s first ICBC report. It applies when the patient is not able to complete their work, training or studies, either because they’re off entirely or on modified duties or hours, or when the injuries significantly impair activities of daily living. ICBC uses it to support recovery, plan return to work and inform the other benefits on the claim.
It shares most of its sections with the CL489 Standard report and adds a block on return to work, plus disability and recovery dates. ICBC wants one first report per new claim, either the CL489 or the CL489A.
Who completes it
The form says it’s to be completed by the primary care provider whenever possible. You complete every section. The patient has no part to fill in, though you need their ICBC claim number and either their consent or a formal ICBC request before you send it.
How to fill in the CL489A
Invoice information, Patient information and Physician information
ICBC can’t pay without the claim number, date of crash, payee name, payee address, patient name and date of report. Add your vendor number and your own invoice or reference number if you use one. Dates are dd/mmm/yyyy. Note whether you’re the patient’s regular physician and whether an interpreter is needed.
Subjective, and Relevant pre-crash history
Subjective complaints are optional. Questions 1 to 3 ask about earlier symptoms or treatment in the injured areas, other conditions contributing to the current symptoms, and any investigations or specialist referrals since the crash.
Vocational status
Questions 4 to 7 record employment type, job position, absence from work, training, school or caregiving, and whether duties and hours are full or modified. Questions 8 to 13 apply when the patient is off work or on modified hours or duties. Say which specific duties or physical demands the patient can’t perform and to what degree, for example “can’t lift over 10 kg” rather than “limited lifting”.
Give a disability start date and an anticipated end date. Say whether you support a graduated return to work, with the earliest start date and duration in weeks, and whether specialized services or adaptive equipment would help the patient return.
Avocational status
Questions 14 to 16 cover activities of daily living outside work, whether the patient can do them as before, and the earliest date they could return.
Assessment, restrictions and barriers
Enter the primary diagnosis with nature of injury, body part, orientation and ICD-9 code, then other crash-related diagnoses. The appendix lists common codes. Describe restrictions, whether they’re temporary or permanent, and barriers to recovery, including employer or psychosocial ones.
Care plan, prognosis, treatment notes and certification
Recommend treatments, investigations or referrals, and say whether you expect a return to pre-crash function. Give the prognosis and recovery timeline. Under Treatment notes, list medication and give an anticipated date of full recovery and a treatment reassessment date. Tick the certification and one of the two consent options, consent from the patient or an ICBC request under the Insurance (Vehicle) Act. Use the Lock button only once the report is final, because it can’t be edited afterwards.
Common reasons it’s delayed or unpaid
- Missing claim number, payee name or payee address.
- Restrictions described in general terms with no specific duties.
- No disability start date or anticipated end date.
- A CL489 and a CL489A both sent for the same claim.
- No consent or ICBC request box ticked.
Submitting and who pays
Fax the report to ICBC at 1-877-686-4222 or mail it to ICBC, PO Box 2121, Stn Terminal, Vancouver, BC V6B 0L6, within 30 days of the assessment. ICBC has built the family physician reports into several common EMRs. ICBC pays the report fee, currently $398 under code A94565, on receipt of the report.
ICBC doesn’t prepay for reports or pay for missed appointments. A physician conference with ICBC or other treatment providers about barriers and the care plan is paid separately, at $64.14 per 15 minutes under code A94569, up to 45 minutes a day per claim, with its own invoice.