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Phone: 604-502-5615
Toll Free: 1-800-750-5122

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7929 120th Street
North Delta, BC V4C 6P6

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Vancouver, BC V5Z 1K5

Richmond:

Suite 610 - 6081 No. 3 Road
Richmond, BC V6Y 2B2

South Surrey & White Rock:

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Surrey, BC V4A 2J2

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Langley, BC V3A 7R3

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9912 Lougheed Highway
Burnaby, BC V3J 1N3

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Vancouver, BC V5R 5W2
The documents ICBC asks you to sign. BACK
 
Q: How can I revoke the ICBC medical consent I signed or at least ensure that my doctor does not release irrelevant records prior to my accident?
 

A: Many physicians will release your medical records that were created before your accident when they receive this completed consent form from ICBC—even if the records have nothing to do with your injuries and may be personal and embarrassing. Lawyers for injured people almost always revoke this consent when they advise ICBC that they are involved.

If you are not represented by a lawyer, you may want to print by hand on the consent form that you are not consenting to the release of any medical records created before your accident or before a certain date such as six months before your accident. Alternatively, if you signed or decide to sign ICBC’s prescribed consent without changing it, you may want to write a letter to each of the physicians who treated you before the accident. It might read something like this:

“[Date]

Dr. [xxx]

Re: [Your name]; instructions to not release medical records to ICBC created prior to [date of motor vehicle accident] MVA

Please keep this letter on the inside front or top of my file at all times. I was injured in a motor vehicle accident on xxxx, 200x. ICBC asked me to sign a very broad medical authorization. I signed it because I did not want to harm my chances of receiving ICBC’s assistance. I did not intend it to include the release of any of my clinical records prior to my accident. If you feel that you must send ICBC any of my pre-accident clinical records, please do not do so until we have reviewed these records together face-to-face. I want to ensure that no irrelevant clinical records are released to ICBC. I also want us to decide together how much time before the accident, if at all, relevant records should be released. Thank you for respecting my privacy.

Yours Truly,
xx”

Deliver this letter personally to your physician. If you disagree with what your physician wants to disclose to ICBC, you could prepare and personally deliver to ICBC and your doctor a letter as follows:

“To: ICBC
And to: Dr. xxx

I hereby revoke the authorization I signed giving ICBC authority to obtain any of my medical records.

Yours Truly,

Xxxx”

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