Occupational therapist's initial assessment report on an ICBC claim.
- Completed by
- Occupational therapist
- Issued by
- ICBC
- Format
- Fillable PDF
- Language
- English
ICBC CL750: Personal Care Assistance Assessment Report
Occupational therapists use this 28-page template to assess how much help an ICBC customer needs to safely complete basic activities they did before the crash but cannot do because of their injuries. The resulting score goes to ICBC for a standardized calculation of the Activities of Daily Living (ADL) benefit, which requires a minimum score of 9.
Who completes it
An approved occupational therapist completes the whole report and scoring sheet, while the ICBC recovery specialist decides eligibility and funding. The OT does not determine causation and relies on ICBC and the customer for confirmed crash-related diagnoses and pre-crash function.
Submitting and payment
- How to submit it
- Approved OTs submit it through the Health Care Provider Portal (HCPP), either as a standalone report or with an OT Initial or Progress Report, as ICBC requests, and keep the original in their own file.
- Who pays
- ICBC funds up to two hours of report completion time at the Enhanced Accident Benefit Regulation hourly rate, billed as Personal Care Assistance Report.
Good to know
- Activities are scored in Classes 1 to 4, meaning assistance with up to 25%, 50%, 75% or more than 75% of the activity, as defined in the Enhanced Accident Benefits Regulation.
- Only claims with a crash date of May 1, 2021 or later qualify, and the report is completed only when ICBC asks for it.
- The September 2026 template must be used with version 2.0 of the PCA Assessment Report Guide (CL750A), which replaces all earlier editions.
- On reassessment, sections that have not changed can be marked No Change, with a reference to the previous PCA Assessment Report.
Get the official form
Download the current version from the source each time; forms change without notice.
Personal Care Assistance Assessment Report
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.
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.
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Frequently asked questions
What activities does the ICBC PCA assessment score?
The template groups activities into Level 1, home and community management; Level 2, mobility and self-care; and Level 3, bowel and bladder care, plus a section for customers who need supervision. A developmental scale applies to customers under 16. Activities not listed in the template are not compensated.
Does the PCA score cover help with family responsibilities?
No. ICBC's PCA Assessment Report Guide says the ADL benefit covers only the customer's own personal care needs. For example, help preparing a large family meal is not funded if the customer can cook for themselves. Caregiving needs are discussed with the recovery specialist because other benefits may apply.