ICBC CL489: Family Physician Standard Medical Report

ICBC expects this first report from a family physician after assessing a patient injured in a motor vehicle crash when the patient can still fully complete work, training or studies with no absence or reduction. It gives ICBC early information on diagnosis, function and the care plan to support recovery goals, return to activities and benefit decisions. Once ICBC receives it, the report also serves as your invoice.

Who completes it

The family physician completes the entire form, and ICBC asks that the primary care provider complete it whenever possible. The patient's part is consent to share it with ICBC; without consent, the report is released only after ICBC sends a formal request letter (CL491).

How to fill it in

Invoice information

Enter the ICBC claim number, date of crash and date of the FP report (dd/mmm/yyyy), your ICBC vendor number, your own invoice or reference number, and the payee name and address. ICBC treats the report as the invoice once received, so no separate bill is sent. It cannot pay a report that lacks the claim number, accident date, payee name and address, patient name or report date.

Patient information and Physician information

Record the patient's first and last name, date of birth and Personal Health Number (PHN), and whether an interpreter is required. In the physician block, give your name and MSP/practitioner number and answer whether you are the patient's regular physician. ICBC asks that the primary care provider complete this report whenever possible.

Subjective (optional) and Relevant pre-crash history (questions 1 to 3)

Key subjective complaints are optional. Question 1 asks whether the patient ever had symptoms, treatment or medication for the areas injured in this crash, and question 2 whether non-crash medical conditions contribute to the current diagnosis or symptoms; describe each and its possible impact on recovery. Question 3 asks for any crash-related investigations or referrals to physicians providing specialized services.

Vocational status (questions 4 to 7)

Tick every activity that applies (full time, part time, self-employed, seasonal, training or apprenticeship, student, retired, homemaker or caregiver, not employed) and give the job position. Question 5 asks whether the crash caused absence from work, training, school or homemaking, and questions 6 and 7 whether duties and hours are full or modified. Any absence or reduction means the Extended report (CL489A) is the right form.

Avocational status (questions 8 to 10)

Describe the patient's activities of daily living and other non-work activities. Question 9 asks whether the patient is currently unable to take part in pre-crash avocational activities and, if so, the earliest date they could return. Question 10 records whether duties and hours in those activities are regular or modified; if modified, explain your reasoning and recommendations.

Assessment: Primary diagnosis and Other diagnosis

Name the most serious or significant injury as the primary diagnosis, then every other diagnosis caused by or related to the crash. Each row takes nature of injury, body part, orientation (right, left, both or N/A), ICD-9 code and comments. The fillable PDF offers pick lists, including sprain and strain grades, WAD I to IV and concussion, and page 5 lists common ICD-9 codes.

Key Objective Findings (optional), Medical restrictions and/or limitations, Barriers to recovery

Physical exam findings and key objective complaints are optional. Question 11 asks you to describe medical restrictions or limitations, and question 12 whether they are temporary or permanent, with details. The barriers box covers anything that may hold back recovery: functional, physical, psychosocial, employer, medical or compliance factors.

Recommended Care Management Plan (questions 13 to 15)

Give management recommendations: the treatments, medical investigations or referrals appropriate for the crash injuries. Question 14 asks whether you expect a return to pre-crash function with this plan (yes, no or unable to determine, with comments unless yes). Question 15 asks whether the patient will likely need therapy beyond the plan and, if so, what.

Prognosis and recovery timelines (questions 16 and 17)

Describe the prognosis and the anticipated recovery timeline. With the care plan, these answers give ICBC the early information it uses to support recovery goals such as return to daily activities and work planning, and to inform other benefits. If recovery later strays from this timeline, the Reassessment report (CL489B) is how you update ICBC.

Treatment notes, Additional comments and certification

Question 18 asks whether an established protocol, such as OPTIMa or ODG, informs your treatment plan, and question 19 whether medication was prescribed for the injuries. Add any comments, tick the box certifying the information is true and correct, then select either the patient consent statement or the statement that ICBC requested the report under section 28 or 28.1 of the Insurance (Vehicle) Act.

Common mistakes

Leaving out the claim number, date of accident, payee name and address, patient name or report date; ICBC states it cannot pay without them.
Filing both a Standard and an Extended report after the initial assessment. ICBC expects one or the other, chosen by the impact on work, school and daily living.
Sending the report without patient consent or an ICBC request letter (usually a CL491), contrary to ICBC's consent guidance for physicians.
Selecting the Lock button before the report is final. Once locked, the PDF can no longer be edited.
Holding the report past 30 days from the assessment date; ICBC asks for reports within that window and does not prepay them.

Submitting and payment

How to submit it: Fax or mail it to ICBC, send it from an EMR that has ICBC's template built in, or upload it with ICBC's online submission tool, which accepts physicians' medical reports. ICBC asks for reports within 30 days of the assessment date.
Who pays: ICBC pays the physician under fee code A94564 with the report itself as the invoice, while follow-up visits without a report are billed to MSP through Teleplan using standard visit codes.

Good to know

After the initial assessment, complete either this report or the Extended report (CL489A), never both. Use CL489A if the crash caused missed or modified work, school or training, or significant impairment of daily living.
ICBC cannot pay a report missing the claim number, date of accident, payee name and address, patient name or report date. Get the claim number from the patient or ICBC before sending.
ICBC does not prepay reports, and it does not pay for missed or cancelled appointments or for visits after a claim has closed.
Physicians completing a consultation requested by another physician or nurse practitioner, including specialists and sports medicine family physicians, use the Physician Specialized Services Report (CL489S) for crashes on or after May 1, 2021.

Get the official form

Download the current version from the source each time; forms change without notice.

Family Physician (FP) Standard Medical Report

Official page PDF

Fill it with Vero

Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

See how Vero Documents works

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

Sources for this guide

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Frequently asked questions

When should I use CL489 instead of CL489A?

Use CL489 when, at your first assessment after the crash, the patient can fully complete work, training or studying with no absence or reduction. If the injuries caused missed or modified work, school or training, or significant impairment of daily living, complete the FP Extended Medical Report (CL489A) instead. ICBC expects one or the other after the initial assessment, not both.

What if my patient won't consent to sending the report to ICBC?

Complete the report but hold it. Tell ICBC's Health Care Inquiry Unit that consent was not obtained, and bill MSP for a standard office visit with ICBC selected as the insurer. ICBC then sends a Health Care Provider Report Request Letter (CL491) citing the Insurance (Vehicle) Act, and you submit the report once that letter arrives.

Where do I find my ICBC vendor number?

If you already bill ICBC, your vendor number appears on a recent ICBC cheque or EFT statement, and ICBC's Health Care Inquiry Unit can confirm it. Physicians not yet serving ICBC patients, and physician-only clinics, apply online for a vendor number so ICBC can pay them by electronic funds transfer.

Can I bill ICBC for follow-up visits after the CL489?

No. Follow-up visits without a medical report are billed to MSP through Teleplan using standard MSP visit codes. If the patient is not recovering as expected and the care plan or diagnosis needs updating, the next report you bill to ICBC is the FP Reassessment Medical Report (CL489B).