Part 2: RoadSafetyBC’s Driver Medical Fitness Manual Policies and Procedures

2.1.1 Overview

The flowcharts on the following two pages highlight the four key activities of the Driver Medical Fitness Program: Screening, Assessment, Determination and Reconsideration.

Screening identifies individuals who have a known or possible medical condition that may impair their functional ability to drive, commercial drivers and aging drivers. Screening policies are documented in Chapter 2.2 of this Manual.

Assessment is the process of collecting information required to make a driver fitness determination. The key assessment used for driver fitness determinations is a driver’s medical examination completed by an individual’s general practitioner and documented on the Driver Medical Examination Report (DMER). A variety of other assessments may also be required, such as specialist examinations or on-road assessments. Assessment policies and procedures are documented in Chapter 2.3 of this Manual.

Determination involves reviewing:

• The information obtained from assessments
• Any other relevant file information, such as driving history, and
• The medical condition guidelines outlined in Part 3 of this Manual and determining whether an individual is fit to drive. Policies and procedures that govern the determination process are outlined in Chapter 2.4 of this Manual.

Reconsideration is the process of reviewing a driver fitness determination upon request of an individual who was found not fit to drive, or who had restrictions or conditions imposed. Policies and procedures that govern the reconsideration process are outlined in Chapter 2.5 of this Manual.

2.2.1 Overview

The following flowchart is an excerpt from the overview flowchart presented in 1.3.2 that highlights the steps involved in screening.

Screening identifies individuals with a known or possible medical condition that may impair the functions necessary for driving, commercial drivers and aging drivers. Screening occurs when:

• An individual applies for a British Columbia driver’s licence, renewal of a licence, or a licence class upgrade and discloses a medical condition that may impair the functions necessary for driving,
• A medical practitioner or nurse practitioner, optometrist or psychologist reports a driver to RoadSafetyBC pursuant to MVA s. 230,
• Police, health care practitioners or other individuals submit a credible report to RoadSafetyBC,
• An individual attends for a follow-up medical assessment for a previously identified medical condition that may impair the functions necessary for driving,
• An individual first applies for a commercial class driver’s licence and at scheduled intervals pursuant to the CCMTA, Medical Standards for Drivers if an individual holds a commercial class driver’s licence, and
• A driver reaches the age of 80, 85, and every two years thereafter.

Once identified, a DMER is mailed to the individual with instructions to take the DMER to their physician for a driver’s medical examination. The DMER may be initiated:

• By staff at an ICBC Point of Service,
• By RoadSafetyBC staff upon receipt of a credible report or report pursuant to MVA s.230, or
• Automatically by RoadSafetyBC system in the case of commercial drivers, aging drivers and other drivers who have scheduled re-assessment intervals.

2.2.2 Screening individuals with known or possible medical conditions

Definitions

Credible report means an unsolicited report from:

• A health care professional
• The police
• ICBC front-line staff
• A government agent
• A family member, or
• A concerned member of the public

that provides objective information about a driver’s functional ability to drive.

RoadSafetyBC will not make licensing determinations based on anonymous reports. 

Medical condition

is any injury, illness, disease or disorder that is identified in Part 3 of this Manual or that may impair the functions necessary for driving. For purposes of the Driver Medical Fitness Program, impairment resulting from medications and/or treatment regime that have been prescribed as treatment for a medical condition is also considered a medical condition. General debility and a lack of stamina are also considered as medical conditions that may impair the functions necessary for driving.

Policy

1. The Driver Medical Fitness program screens individuals whose functional ability to drive may be impaired by a known or possible medical condition.
2. An individual with a known medical condition that may impair the functions necessary for driving will be screened when:
   • A physician or other health care professional reports to RoadSafetyBC that the individual has a medical condition that may impair the functions necessary for driving,
   • The individual discloses a medical condition that may impair the functions necessary for driving when they apply for, or renew, their driver’s licence, or
   • A RoadSafetyBC -scheduled re-assessment interval for an individual with a previously reported medical condition expires.
3. An individual with a possible medical condition that may impair the functions necessary for driving will be screened when RoadSafetyBC receives a credible report that documents a concern regarding the individual’s functional ability to drive.

Policy rationale

Sections 25 and 29 of the MVA authorize the Superintendent to examine an individual’s fitness and ability to drive. While RoadSafetyBC operates other programs that are concerned with fitness and ability to drive, such as its Driver Improvement Program, the Driver Medical Fitness Program is specifically concerned with individuals whose fitness and ability to drive may be impaired by medical conditions. This includes individuals who may be impaired by medications or treatment regime prescribed as treatment for a medical condition, general debility or a lack of stamina.

To ensure that individuals are not screened unnecessarily, the Driver Medical Fitness Program only screens private drivers under the age of 80 where there is evidence that the individual has a medical condition that may impair the functions necessary for driving.

2.2.3 Screening aging drivers

Definitions

Private driver means a driver with a class 5, 6, 7 or 8 licence.

The Driver Fitness Program routinely screens private drivers at the age of 80, 85, and every two years thereafter. 

Policy rationale

Because of the increased risk of medical conditions and adverse driving outcomes associated with aging drivers, drivers over the age of 80 are routinely screened every two years, even if there is no evidence of a known or possible medical condition. A detailed description of the research indicating an increased risk associated with aging drivers is included in Appendix 5.

2.2.4 Screening commercial drivers

Definitions

Commercial driver means a driver with:

• A class 1, 2, 3 or 4 licence, or
• A class 5 licence with endorsement 18, 19 or 20.

Policy

The Driver Medical Fitness Program routinely screens commercial drivers at the time of licence application and then at the following intervals:

• Up to age 45, every 5 years
• From age 45 to age 65, every 3 years, and
• From ages 65, annually

Policy rationale

Commercial drivers drive a variety of vehicles including large trucks and passenger carrying vehicles such as buses. A list of B.C. licence classes is included in Appendix 1. Professional drivers who operate passenger carrying vehicles, trucks and emergency vehicles spend many more hours at the wheel, often under far more adverse driving conditions, than do the drivers of private vehicles. They are usually unable to select their hours of work and cannot readily abandon their passengers or cargo should they become unwell when on duty. Persons operating emergency vehicles are frequently required to drive while under considerable stress by the nature of their work, and often in inclement weather where driving conditions are less than ideal. Should a crash occur, the consequences are much more likely to be serious, particularly where the driver is carrying passengers or dangerous cargo such as propane, chlorine gas, toxic chemicals or radioactive substances.

Because of this greater exposure, commercial drivers are routinely screened at regular intervals, even if there is no evidence that the driver has a known or possible medical condition. To ensure consistency with other provinces, B.C. has adopted the CCMTA Medical Standards for Drivers guidelines for screening commercial drivers.

2.2.5 Transient impairments

Definitions

Transient impairment

Means a temporary impairment of the functional ability to drive where there is little or no likelihood of a recurring episodic, or ongoing persistent, impairment. Examples of transient impairments are:

• The after effects of surgery, e.g. the time to recover from the anaesthetic and the surgery itself
• Fractures and casts, post orthopedic surgery
• Concussion
• Eye surgery, e.g. cataract surgery
• Use of orthopaedic braces (including neck), and
• Cardiac inflammation and infections

Policy

The Driver Medical Fitness Program does not screen individuals with transient impairments.

Policy rationale

RoadSafetyBC does not need to know when a driver has experienced a transient impairment. In these cases, a doctor may rely on best practices to tell a patient, for example, “don’t drive for 6 weeks after your abdominal surgery.”

2.2.6 Cancelling or restricting a licence because of an immediate public safety risk

Policy

If the information obtained during screening reveals an immediate risk to public safety, RoadSafetyBC may direct ICBC to cancel or restrict a licence without further assessment.

Policy rationale

In most cases, RoadSafetyBC will not direct ICBC to restrict or cancel a licence based only on the information obtained during screening. However, there are times when cancellation or restriction may be warranted based on the results of screening. For example, a credible report may indicate that an individual’s functional ability to drive is severely impaired. RoadSafetyBC would direct ICBC to cancel the driver’s licence for public safety reasons and would review the decision once further information was received. The policies are discussed under 2.4.12 and 2.4.13.

In accordance with the principles of administrative fairness, RoadSafetyBC gives individuals an opportunity to dispute the results of a driver fitness determination through its internal reconsideration process and provides written reasons with the results of the reconsideration. The policy is discussed under 2.5.2.

2.3.1 Overview

The flowchart below is an excerpt from the overview flowchart presented in 1.3.2 that highlights in red the steps that take place during assessment.

During assessment, RoadSafetyBC collects the information required to make a driver fitness determination. As the first step in the assessment process, an intake agent reviews the DMER and decides whether the case should be forwarded to a nurse case manager or adjudicator for a determination.

Particularly in the case of commercial or aging drivers, the DMER may indicate that an individual either does not have a medical condition that impairs the functions necessary for driving, or clearly meets the medical condition guidelines. In these cases, further assessment and a driver fitness determination are not required, although a re-assessment may be scheduled. Policies and procedures that guide intake agents in performing these tasks are documented in the Intake Agent Guidelines for Assessing Fitness to Drive and are not duplicated here.

If a determination is required, an adjudicator or nurse case manager reviews the applicable medical condition guidelines, the DMER and the results of any assessments on file and decides whether any further information is required in order to make a driver fitness determination. In many cases, the information from a DMER, read in conjunction with the medical condition guidelines applicable to that particular medical condition, will easily allow a determination to be made. In other cases, more information will be required. Although presented in the flowchart as a linear process, this means that assessment and determination may overlap.

To collect additional information, the adjudicator or nurse case manager requests further medical and/or functional assessments. The policies outlined in this chapter, and the guidelines regarding use of assessments included in each medical condition chapter in Part 3 of this Manual, assist nurse case managers and adjudicators in determining the appropriate assessments to request for each individual. RoadSafetyBC policy on paying for assessments is contained in the Driver Fitness Assessment Payment Policy Manual. Assessments will only be requested if necessary to determine fitness.

2.3.2 Assessments will only be requested if necessary to determine fitness

Policy

A nurse case manager or adjudicator will only request assessments that are necessary to determine driver fitness. If the information available from the DMER, and any other relevant materials on file, is sufficient for a nurse case manager or adjudicator to determine whether or not a driver is fit, no further assessments will be requested.

If, after reviewing the relevant medical condition guidelines, a nurse case manager or adjudicator decides that further information is required in order to make a determination, the nurse case manager or adjudicator will request further assessments.

If an individual clearly does not meet the medical condition guidelines for one or more of the individual’s identified medical conditions, a nurse case manager or adjudicator will not request further assessments.

Policy rationale

Sections 25 and 29 of the MVA give the Superintendent the authority to request vision tests, medical examinations and other examinations and tests in order to determine an individual’s fitness to drive. In order to save time and costs, and lessen the inconvenience, to drivers, physicians and RoadSafetyBC, RoadSafetyBC will only request an assessment if it is necessary to determine driver fitness.

2.3.3 Requesting medical assessments and additional medical information

Definitions

Medical assessment

is any kind of assessment that provides information regarding an individual’s medical condition and/or their response to, or compliance with, treatment. This includes assessments such as medical imaging , blood tests and other medical tests that are not requested by RoadSafetyBC, but are often submitted by physicians and provide useful information regarding an individual’s medical condition.

Policy

If a nurse case manager or adjudicator decides that further information regarding an individual’s medical condition(s) or the individual’s response to, or compliance with, treatment, is necessary in order to make a driver fitness determination, the nurse case manager or adjudicator may request additional medical information and/or that an additional medical assessment be completed.

If a nurse case manager or adjudicator decides to request a medical assessment, the nurse case manager or adjudicator will review the guidelines regarding the use of assessments outlined in the relevant medical condition chapter(s), and the policies outlined in this chapter, and decide which medical assessment(s) to request. The following table lists the medical assessments that the nurse case manager or adjudicator may request.

Medical assessments

Medical assessments
Driver’s medical examination (documented on the DMER)
Diabetic driver medical examination (documented on the Doctor’s Report on Commercial Driver with Diabetes on Insulin) (See guidelines for requesting assessments of diabetic drivers in Chapter 7)
Specialist assessments completed by a psychologist, addictions specialist or other medical doctor. (See 2.3.4 for policies on requesting specialist assessments)

Policy rationale

To ensure that RoadSafetyBC bases its driver fitness determinations on complete and accurate medical information, nurse case managers and adjudicators request additional medical information or assessments whenever further information regarding an individual’s medical condition, or the individual’s response to, or compliance with, treatment is required.

2.3.4 Requesting specialist assessments

Policy

A nurse case manager or adjudicator may contact the physician who submitted the DMER if further information on an individual’s medical condition, or the individual’s response to, or compliance with, treatment is required that may require a specialist assessment.                                              

The physician will indicate whether:

• The information can only be provided by a specialist
• There is no specialist assessment on the individual's file, and
• A specialist assessment is not medically necessary 

Once an invoice has been received from the medical clinic or from the driver, the Medical Program Manager will review, with the department of Finance, the policies outlined in the Driver Fitness Assessment Payment Policy Manual to determine an appropriate payment.

Policy rationale

Specialist assessments are assessments performed by physicians with a specialization in a particular area of medicine or medical condition. Many individuals are assessed by specialists during the course of the diagnosis and treatment of a medical condition and RoadSafetyBC may request and obtain copies of those assessments from the physician who submitted the DMER. However, in some cases, a specialist assessment will not be medically necessary, but will provide further information that is required in order for a nurse case manager or adjudicator to make a determination of driver fitness.

Because RoadSafetyBC should not pay for specialist assessments that are medically necessary, a nurse case manager or adjudicator will only request a specialist assessment if the physician who completed the initial driver’s medical examination indicates that a specialist assessment is not necessary for medical purposes, even though it is necessary for purposes of a driver fitness determination.

2.3.5 Requesting functional assessments

Definitions

Episodic impairment

is the result of a medical condition that does not have any ongoing measurable, testable or observable impact on the functions necessary for driving but that may result in an unpredictable sudden or episodic impairment. Episodic impairments generally result in sudden incapacitation.

For example, the medical condition that gives rise to the impairment may be testable, e.g. the size of an abdominal aortic aneurysm, or known, e.g. epilepsy, but the precipitating event that negatively impacts the functional ability to drive, e.g. the rupture of the aneurysm or an epileptic seizure, is not predictable. The source of the potential impairment is known and the inevitability of functional impairment is known in the event that the episodic impairment occurs, but when it will occur is not known.

Functional assessment

is any kind of assessment that involves direct observation or measurement of the functions necessary for driving. Functional assessments include:

• Paper-pencil tests
• Computer-based tests
• Eye tests
• Hearing tests
• Driver rehabilitation specialist assessments, and
• On-road assessments

Persistent impairment

is an ongoing or continuous impairment to a function necessary for driving. The potential impacts of persistent impairments on the functions necessary for driving are generally measurable, testable and observable. Although the condition may be progressive, the progression is usually slow and sudden deterioration is unlikely. Persistent impairments may be stable, e.g. loss of leg, or progressive, e.g. arthritis.

Policy

If a nurse case manager or adjudicator decides that further information on an individual’s functional ability to drive is necessary in order to make a driver fitness determination, the nurse case manager or adjudicator will request a functional assessment.

If a nurse case manager or adjudicator decides to request a functional assessment, the nurse case manager or adjudicator will review the guidelines regarding the use of assessments outlined in the relevant medical condition chapter(s), and the policies outlined in this chapter, and decide which functional assessment to request. The following table lists the functions necessary for driving and the functional assessments that a nurse case manager or adjudicator may request that can observe or measure that function.

Driving function	Functional assessment
Cognitive (See 2.3.6 for policies on requesting assessments of cognitive function)	Screening Test such as MOCA, MMSE, Trails B, Global Deterioration Scale (cognitive screen)
	An on-road assessment. One or more of the following may also be required; an occupational therapist or driver rehabilitation specialist assessment, or a gerontologist assessment.
Motor (including sensorimotor) (See 2.3.7 for policies on requesting assessments of motor function	An on-road assessment, or a more comprehensive driving assessment conducted by a driver rehabilitation specialist.
Sensory: hearing (See guidelines for requesting hearing assessments in Chapter 9)	Audiogram (hearing report)
Sensory: Vision (See guidelines for requesting vision assessments in Chapter 22)	Examination of Visual Functions (EVF)
	Visual Field Test (VFT)
	An on-road assessment, or a more comprehensive driving assessment conducted by a driver rehabilitation specialist.

Persistent and episodic impairments

A nurse case manager or adjudicator may request a functional assessment of an individual with a persistent impairment. A nurse case manager or adjudicator will not request a functional assessment of an individual who has only episodic impairments.

Multiple functional impairments

If a nurse case manager or adjudicator decides that more than one of the functions necessary for driving needs to be assessed, the nurse case manager or adjudicator will request functional assessments in the following order:

• Assessments of cognitive function
• Assessments of sensory function, and
• Assessments of motor function

If the results of an assessment indicate that an individual’s cognitive, sensory or motor function is impaired to the extent that the individual presents a high degree of risk to public safety when driving the types of motor vehicles allowed under the class of licence held or applied for, the nurse case manager or adjudicator will make a driver fitness determination without requesting further assessments of the other functions necessary for driving.

Multiple medical conditions

If an individual has multiple medical conditions that result in a cumulative or combined effect on the functions necessary for driving such that the medical conditions cannot be considered individually or independently, a nurse case manager or adjudicator will request functional assessments of each function that may be impaired, even if the medical condition guidelines for each identified medical condition indicate that the individual is fit to drive.

Policy rationale

Consistent with RoadSafetyBC’s functional approach to driving fitness, a nurse case manager or adjudicator will request an assessment of an individual’s functional ability to drive whenever that information is necessary in order to make a driving fitness determination.

Persistent and episodic impairments

Whether or not a functional assessment is appropriate depends upon the type of impairment. Because persistent impairments are measurable, testable and observable, it is possible to assess an individual’s functional ability to drive through observation by a physician or other health care practitioner or an OT or driver rehabilitation specialist. Because episodic impairments are not measurable or testable, RoadSafetyBC cannot functionally assess how the impairment impacts an individual’s ability to drive.

Multiple functional impairments

Some individuals may have impairments to more than one of the functions necessary for driving. In this situation, a nurse case manager or adjudicator prioritizes requests for functional assessments based on the functions that may be impaired. Because there are assessment tools available to specifically measure cognitive impairment as it relates to driving, if an individual’s cognitive function may be impaired a nurse case manager or adjudicator will assess that function first. Sensory functions are assessed next, followed by motor functions. If an assessment indicates that a function is impaired, a driver is not fit to drive and there is no need to continue with further assessments of the other functions that may be impaired.

Multiple medical conditions

The impact of multiple medical conditions on functional ability to drive is very important when making determinations about fitness to drive.

Research results indicate that drivers with multiple medical conditions are, in general, at higher risk for crashes and at-fault crashes than those with a single medical condition.

The medical condition chapters in Part 3 of this Manual each focus on a single medical condition, e.g. cardiovascular disease, and the guidelines are written as if an individual only had one medical condition. This is because the number of combinations of illnesses and medications is simply too large to make reliable and valid driving guidelines that could support making decisions about driving fitness for specific individuals.

This means that the medical condition guidelines cannot always be relied upon in order to make a driver fitness determination for an individual with more than one medical condition. While the guidelines for each individual medical condition may indicate that the driver is fit to drive, if the medical conditions have a cumulative effect on the functional ability to drive, the individual may, in fact, not be fit. Therefore, RoadSafetyBC always requests functional assessments of individuals with multiple medical conditions that cannot be considered independently, unless the medical condition guidelines for any of the identified medical conditions clearly indicate that the individual is not fit to drive.

2.3.6 Requesting assessments of cognitive function

Policy

A nurse case manager or adjudicator may  request a cognitive road assessment  of an individual when cognitive screening indicates further assessment is required.

 A nurse case manager or adjudicator may also request one or more of the following; a driving assessment, an OT or driver rehabilitation specialist assessment, or a gerontologist assessment, of an individual with a persistent cognitive impairment whose cognitive screening test results indicate further assessment is required.

Policy rationale

Historically, there has not been consistent practice amongst medical professionals pertaining to the choice of cognitive screening assessments. The assessment results that have been  most frequently submitted to RoadSafetyBC are the MOCA, the MMSE, Trails A and B, or the SIMARD MD. RoadSafetyBC will accept and consider the results of any or all of these assessments. However, the results of a Global Deterioration Scale (GDS) assessment are preferred as this provides a more definitive assessment of the individual’s level of cognitive function.

The adjudicator will also consider any other available collateral information and determine if the entirety of the file information supports a finding of sufficient cognitive functioning to drive safely, or if additional information is required.

Enhanced Road Assessment

When a cognitive on-road assessment is required, RoadSafetyBC may use an Enhanced Road Assessment (ERA) to assess a driver’s ability to safely drive.  The ERA is designed to evaluate driving skills and behaviours in situtations of increased cognitive demand, similar to the cognitive workload of real-world driving.  The ERA consists of a pre-trip vehicle orientation, on-road drive, and post-trip review.  Half-way through the on-road drive, there is a break in which the driver is provided with feedback to enable the correction of “bad habits” for the remainder of the drive.

2.3.7 Requesting assessments of motor function

Policy

A nurse case manager or adjudicator will request an on-road assessment, if further information is required on an individual’s motor function.  A nurse case manager may also request a more comprehensive driving assessment conducted by a driver rehabilitation specialist to assess individuals with complex motor deficits.

Generally, further information on an individual’s motor function will be required when a medical assessment indicates that there is some loss of motor function and:

• It is unknown whether the individual possesses sufficient movement and strength to perform the motor functions necessary for driving the types of motor vehicles permitted under the class of licence held or applied for
• It is unknown whether pain associated with a medical condition, or the medications used to treat a medical condition, adversely affect the individual’s motor function, and/or
• It is unknown whether the individual can safely operate the type of motor vehicles permitted under the class of licence held or applied for using the vehicle modifications and devices that may be required to compensate for their functional impairment

Policy rationale

Occupational therapists and other specialists with expertise in driver rehabilitation are trained to perform both in-office and on-road assessments of an individual’s functional ability to drive. In particular, driver rehabilitation specialists are trained to evaluate an individual’s ability to compensate for motor deficits during simulated and on-road testing and determine requirements for adaptive driving equipment and vehicle modifications.

2.3.8 Time period during which assessments are valid

Policy

Generally, a nurse case manager or adjudicator will accept the results of any assessment conducted within the previous one-year period, even if completed for another purpose, as long as it provides the nurse case manager or adjudicator with the required information.

Policy rationale

Assessments may be costly and time-consuming for drivers, RoadSafetyBC and health care providers. If an assessment has already been conducted that provides a nurse case manager or adjudicator with the information required for a driver fitness determination, there is no need for an individual to be re-assessed, as long as the results of the assessment are still reliable. Because many conditions are progressive, and an individual’s abilities may change over time, assessment results generally only continue to be reliable for a period of one year after completion of the assessment.

2.3.9 Time limits for drivers to complete assessments

Policy

Whenever a nurse case manager or adjudicator requests an assessment, the nurse case manager or adjudicator will inform the individual of the time period within which the assessment must be completed.

A nurse case manager or adjudicator will typically allow an individual 30-45 days to comply with a request for an

• Examination of visual functions
• Visual field test
• Hearing report

A nurse case manager or adjudicator will typically allow an individual 45 days to comply with a request for a driver’s medical examination or other medical assessment.

A nurse case manager or adjudicator will typically allow an individual 60 days to comply with a request for an OT or driver rehabilitation specialist assessment.

Upon request, a nurse case manager or adjudicator may extend the time period for an individual to comply with a request for an assessment. In considering whether to extend the time period, the nurse case manager or adjudicator will consider information from the individual regarding the circumstances that necessitate an extension, such as

• Work commitments
• The individual's location
• The individual's degree of mobility, and/or
• Availability of assessors

If an individual does not comply with a request for an assessment within the time period or extension set by a nurse case manager or adjudicator:

• The nurse case manager or adjudicator will direct ICBC to cancel an individual’s driver’s licence, in the case of an individual who is already licensed, or
• ICBC will not grant a licence, in the cases of an individual who has applied for a licence.

Policy rationale

Both for public safety and administrative fairness reasons, driver fitness determinations must be made as soon as possible after an individual is identified through screening. Where further information is required in order to make a determination, this means that individuals must comply with requests for assessments in a timely fashion. RoadSafetyBC has set time limits in policy, based on the typical time required to comply with a request for an assessment, considering such factors as assessor availability and the variability of individual schedules. If an individual does not comply with a request for an assessment, RoadSafetyBC has the authority under section 92 of the MVA to direct ICBC to cancel a licence.

2.3.10 Assessment procedures

The flowchart on the following page graphically represents the procedures associated with the assessment process. Because the procedures that guide intake agents are documented elsewhere, the only procedures outlined in this manual are those that guide the work of nurse case managers and adjudicators.

2.4.1 Overview

The following flowchart is an excerpt from the overview flowchart presented in 2.1 that highlights in red the steps involved in determination.

A driver fitness determination is any decision regarding fitness to drive that requires the exercise of discretion. Determinations are made by adjudicators and nurse case managers. To make a driver fitness determination, a nurse case manager or adjudicator considers the information collected through assessment, as well as any other relevant information on file, and determines whether an individual is fit to drive the types of motor vehicles permitted under the licence class held or applied for. The determination may also include a decision to impose restrictions or conditions. If an individual is fit to drive, the nurse case manager or adjudicator will also decide whether re-assessment at a future date is required.

The factors that are relevant to a driver fitness determination for a particular individual vary somewhat depending upon whether the individual has a persistent or episodic impairment, the function that is impaired, whether conditions and/or restrictions may be appropriate and the types of vehicles the individual wishes to drive. The policies outlined in this chapter, and the medical condition guidelines outlined in the medical condition chapters in Part 3, provide guidance to nurse case managers and adjudicators in considering these factors and making driver fitness determinations.

2.4.2 Components of driver fitness determinations

Definitions

Fit to drive

means that an individual’s motor, sensory and cognitive functions are sufficient to drive safely

Policy

As part of each driver fitness determination, a nurse case manager or adjudicator will determine:

• Whether an individual is fit to drive the types of motor vehicles allowed under the class of licence held or applied for
• Whether any restrictions or conditions are required in order for an individual to be fit to drive the types of motor vehicles allowed under the class of licence held or applied for (see 2.4.9 for policies on imposing restrictions and conditions), and if the individual is fit to drive, whether re-assessment at a future date will be required (see 2.4.11 for policies on determining whether re-assessment is required and setting re- assessment intervals).

Policy rationale

A driver fitness determination may include several components. Whether an individual is fit to drive may be dependent upon whether an individual is able to compensate for their functional impairment, or reduce the probability or consequence of functional impairment, through the use of adaptive devices or compliance with a prescribed treatment regime or medications. In order to give individuals the maximum licensing privilege that is consistent with public safety, a nurse case manager or adjudicator may decide in this situation to give restricted or conditional driving privileges to individuals who would otherwise not be fit to drive.

Medical conditions and their effects often change over time. In order to give individuals the maximum licensing privilege for which they are currently fit, while ensuring that any change in an individual’s level of impairment is identified and acted upon, a driver fitness determination will include a determination of whether re-assessment is required for all individuals who are fit to drive.

2.4.3 Making driver fitness determination for persistent and episodic impairments

A nurse case manager or adjudicator will make a driver fitness determination for an individual with a persistent impairment based on evidence of functional impairment.

A nurse case manager or adjudicator will make a driver fitness determination for an individual with an episodic impairment based on the risk of functional impairment.

Policy rationale

Because individuals with episodic impairments are not continuously impaired, nurse case managers and adjudicators cannot make determinations for individuals with episodic impairments based on evidence of functional impairment. Instead, they must rely on a risk analysis that takes into account the probability and consequence of impairment when making a driver fitness determination for an individual with an episodic impairment. To assist nurse case managers and adjudicators in performing this analysis, the medical condition guidelines for medical conditions that result in episodic impairments incorporate expert opinion regarding the risk of functional impairment.

2.4.4 Making driver fitness determinations for individuals whose cognitive ability to drive may be persistently impaired

Policy

If collateral information and cognitive screening indicate that the individual’s cognitive function is sufficient to safely drive, an on-road  assessment will not typically be required.

If an individual performs well on an on-road cognitive assessment, the individual may be found fit to drive.

If an individual performs poorly on an on-road cognitive assessment, the individual’s cognitive function may not be  sufficient to drive safely and the individual may be found  unfit to drive.

Policy rationale

Cognitive screening tests and on-road cognitive  assessments are used to identify impairment of cognitive ability to drive. This means that driver fitness determinations for individuals whose cognitive ability to drive may be persistently impaired can be based on the results of these assessments alone, unless the individual also has possible impairment of their motor or sensory functions.

2.4.5 Making driver fitness determinations for individuals whose motor or sensory function may be impaired or who may have episodic impairment of cognitive function

When making a driver fitness determination for an individual whose motor or sensory function may be impaired, or who may have episodic impairment of cognitive function, a nurse case manager or adjudicator will review and consider:

• Information obtained through medical assessments
• Information obtained through any functional assessments
• The individual's driving record (see 2.4.6 for policies on considering driving records)
• Specific driving or safety requirements associated with the types of motor vehicles that the individual wishes to drive (see for policies on considering specific driving or safety requirements), and
• The medical condition guidelines for the identified medical conditions

Generally, an individual whose motor or sensory functions may be impaired, or who may have episodic impairment of cognitive function, is fit to drive if:

• The medical condition guidelines for the class of licence applied for indicate that they are fit to drive
• The results of an functional assessments indicate that the individual’s sensory, motor and cognitive functions are sufficient to safely drive the types of motor vehicles allowed under the class of licence held or applied for
• The individual's driving record doesn't indicate that the identified medical conditions impair the functions necessary for driving to the extent that the individual presents a high degree of risk to public safety when driving the motor vehicles  allowed under the class of licence held or applied for, and there is no indication that the individual will be non-compliant with any restrictions or conditions that are required in order for the individual to be fit to drive (see 2.4.10 for policies on assessing future compliance with restrictions or conditions)

Generally, an individual whose motor or sensory functions may be impaired, or who may have episodic impairment of cognitive function, is not fit to drive if:

• The medical condition guidelines for the class of licence applied for indicate that they are not fit to drive
•  The results of any recent functional assessments indicate the individual’s sensory, motor or cognitive functions are impaired to the extent that the individual presents a high degree of risk to public safety when driving the types of motor  vehicles allowed under the class of licence held or applied for
• The individual's driving record indicates that the identified medical conditions impair the functions necessary for driving  to the extent that the individual presents a high degree of risk to public safety when driving the motor vehicles allowed under the class of licence held or applied for, and/or
• The individual is not likely to be compliant with any restrictions or conditions that must be imposed in order for the individual to be fit to drive (see 2.4.10 for policies on assessing future compliance with restrictions or conditions)

Policy rationale

Except for individuals with persistent impairment of cognitive function, there are no assessment tools available that can be relied upon to indicate whether an individual is fit to drive. This means that nurse case managers and adjudicators must review information from a variety of sources and exercise discretion and judgment when determining driver fitness for individuals with other types of impairments.

Nurse case managers and adjudicators will generally rely on the medical condition guidelines to make driver fitness determinations. However, because each individual is unique, and individuals may have multiple medical conditions or medical conditions which are not included in this Manual, nurse case managers and adjudicators also review and consider an individual’s driving record, the results of any functional assessments, and any other relevant information on file, when determining whether an individual is fit to drive.

In general, if a review of this information for an individual with a persistent impairment indicates no functional impairment, or a level of functional impairment that does not impact the individual’s ability to drive safely, the individual is fit to drive. For individuals with episodic impairments, if a review of this information indicates a low risk of functional impairment, the individual is fit to drive.

Where any of this information indicates that the individual presents a high degree of risk to public safety, the individual is not fit to drive. In the case of an individual with a persistent impairment, this would be because the level of impairment means the individual cannot drive safely. In the case of an individual with an episodic impairment, this means that the risk, or probability and consequence, of an episodic impairment is high.

2.4.6 Reviewing driving records

Definitions

Driving record includes:

• The length of time an individual has been licensed
• Driving offences
• Driving sanctions applied
• Current and past licence restriction(s)
• Motor vehicle related Criminal Code convictions
• Crash history, and
• Past on-road assessment results

Policy

During every driver fitness determination, the nurse case manager or adjudicator will review the individual’s driving record for any information that indicates whether the identified medical conditions impair the functions necessary for driving.

In particular, the nurse case manager or adjudicator will review:

• Whether there has been a deterioration, improvement or no change in driving safety (i.e. crashes, penalty points and infractions) that can be linked to:
  • The date of onset
  • The date of diagnosis, and/or
  • The date the individual began a new treatment regime; prescribed medication or compensation strategy, and
  • Any evidence on file (e.g. police reports) that indicates that incidents were related to the individual’s medical conditions

Policy rationale

An individual’s driving record may indicate that a medical condition is affecting their functional ability to drive. A lengthy, clean driving record for a driver with a long-standing medical condition may be evidence of:

• A low level of impairment
• An ability to compensate, or
• A condition that is well controlled

A driving record with multiple crashes may indicate functional impairment.

2.4.7 Considering specific driving or safety requirements

Policy

When determining whether an individual is fit to drive the types of motor vehicles allowed under a commercial class of licence, a nurse case manager or adjudicator will consider:

• The number of hours an individual with that type of licence typically spends driving
• Any physical requirements (e.g., load securement) associated with the operation of motor vehicles allowed under that type of licence, and
• Any information provided by the individual or the individual’s employer regarding:
  • The types of vehicles they will be operating, and
  • How many passengers they will carry and for what purpose

Policy rationale

The class of licence held or applied for is a key consideration when making a driver fitness determination. Professional drivers who operate passenger carrying vehicles, trucks and emergency vehicles spend many more hours at the wheel than drivers of private vehicles. Professional drivers may also be called upon to undertake heavy physical work such as loading or unloading their vehicles, realigning shifted loads and putting on and removing chains.

Because the physical and endurance requirements for commercial drivers are generally more onerous than for private drivers, the medical condition guidelines outlined in Part 3 of this Manual often specify different guidelines for commercial and private drivers. Where the medical condition guidelines do not apply, or where an individual provides specific information about their employment, a nurse case manager or adjudicator will consider the factors listed above when determining whether a commercial driver is fit to drive. Where an individual indicates that they will only be operating certain types of vehicles typically allowed under that licence class, or only operating vehicles under certain circumstances, imposition of a restriction or condition may make an individual fit to drive.

2.4.8 Considering whether an individual can compensate

Definitions

Compensation

is the use of strategies or devices by a driver with a persistent impairment to compensate for the functional impairment caused by a medical condition. Treatment for a condition, e.g. medication, is not a type of compensation. Where available or known, possible compensation strategies for each medical condition are included in the medical condition chapters in Part 3 of this Manual.

Policy

The nurse case manager or adjudicator will consider whether an individual can compensate for their functional impairment when making a driver fitness determination.

An individual cannot compensate for an episodic impairment.

Whether an individual can compensate for a persistent impairment depends upon the functional ability that is impaired. Individuals with impairments in motor function, vision or hearing may be able to compensate for those impairments. Individuals with progressive or irreversible declines in cognitive function cannot compensate for a cognitive impairment.

In general, an individual who can compensate for their functional impairment is fit to drive.

Policy rationale

In some situations, individuals who would otherwise not be fit to drive have learned strategies, or utilize devices, that reduce or eliminate their functional impairment. For example:

• A driver with limited peripheral vision may use the strategy of turning their neck to the left and right to ensure they have a full field of view, or
• A driver who is unable to use their lower limbs may have their vehicle modified for hand controls.

In keeping with the decision in Grismer, and the guiding principles of the Driver Medical Fitness Program, RoadSafetyBC makes driver fitness determinations on an individual basis, based on the results of individual assessments. In general, if a review of individual assessment results and the individual’s driving record indicates that an individual is able to compensate for their functional impairment, the individual is fit to drive.

2.4.9 Imposing restrictions and/or conditions

Definitions

Condition

Means a condition that is imposed on an individual by RoadSafetyBC. Unlike restrictions, which are placed on a licence and enforceable at roadside, conditions are placed on a driver and are not enforceable at roadside. Examples of conditions are ‘do not drive if your blood sugar drops below 4mmol/L,’ or ‘do not drive if your dialysis treatment is delayed.’

Restriction

Means a restriction that is printed on a driver’s licence and is enforceable at the roadside through fines. Non-compliance with a restriction is an offence.

Restrictions are commonly used for impairments where a driver can compensate. However, on occasion they may be used for impairments for which a driver cannot compensate. Examples of restrictions where a driver can compensate for their persistent impairment are ‘wear corrective lenses’, ‘must only drive modified vehicle with steering knob’ and ‘use oversized mirrors.’ A restriction where a driver cannot compensate would be ‘do not drive at night’ for persistent night blindness.

Policy

Where applicable, a nurse case manager or adjudicator will refer to the medical condition guidelines to identify the restrictions and/or conditions that may be required in order for an individual with the identified medical conditions to be fit to drive.

Restrictions

If a nurse case manager or adjudicator decides that an individual must:

• Only operate vehicles during daylight hours
• Only operate certain types of vehicles
• Only operate vehicles in certain geographic areas
• Only operate vehicles under a certain speed
• Only carry certain types of cargo
• Wear specific devices, and/or
• Use specific vehicle modifications or adaptations

in order to be fit to drive, the nurse case manager or adjudicator will impose those restrictions on the licence.

The following table lists the restrictions used by the Driver Medical Fitness Program.

Code	Restrictions
12	Restricted to daylight hours only
15	Permitted to operate vehicles with air brakes
16	Not permitted to operate class 2 or 4
17	Not permitted to operate buses
18	Permitted to operate single trucks with air brakes on industrial roads
19	Permitted to operate truck trailer with air brakes on industrial roads
20	Permitted to operate trailer of any GVW without air brakes
21	Corrective lenses required
23	Hearing aid required with class 1,2,3,4 or for 18/19
24	Class 6 or 8 restricted to motor scooters
25	Fitted prosthesis/leg brace required
26	Specified vehicle modifications required
28	Restricted to automatic transmission
35	Not permitted to exceed 60 km/hr
36	Not permitted to exceed 80 km/hr
37	Not permitted to transport dangerous goods
51	Other – specify type of restriction

A nurse case manager or adjudicator will not impose restrictions on an individual who only has episodic impairments.

Conditions

If a nurse case manager or adjudicator decides that an individual must:

• Stop  driving in specific circumstances
• Take prescribed medications
• Comply with a specific treatment regime, and/or
• Attend medical follow-up

in order to be fit to drive, the nurse case manager or adjudicator will impose those conditions on the individual.

A nurse case manager or adjudicator may impose conditions on individuals with persistent or episodic impairments.

Policy rationale

Section 25 (12) of the MVA gives the Superintendent the authority to  place any restrictions or conditions on a person’s licence that the Superintendent considers necessary for the operation of a motor vehicle by the person. Generally, nurse case managers and adjudicators will refer to the medical condition guidelines to determine the conditions and/or restrictions that are required. However, because the medical condition guidelines may not always apply in individual circumstances, the types of restrictions and conditions that are appropriate for driver fitness determinations are also outlined in this policy. The appropriate types of restrictions and conditions are limited to ensure that they are supported by driver fitness research and Driver Medical Fitness Program policy. Also, in the case of restrictions, they must be enforced easily at roadside.

2.4.10 Considering compliance with conditions or restrictions

Definitions

Insight means that a driver:

• Is aware of their medical condition
• Understands how the conditions may impair their functional ability to drive, and has the judgment and willingness to comply with their treatment regime and any conditions or restrictions imposed by RoadSafetyBC

Physicians will often use terms such as “impaired awareness,” “decreased metacognition,” or “lack of awareness regarding deficits” on a medical assessment to indicate that an individual lacks insight.

An individual’s level of insight is a critical consideration when assessing the risk of an episodic impairment of functional ability due to a psychiatric disorder. Because of this, there is a specific guideline regarding insight in the Psychiatric Disorders chapter.

Policy

If a nurse case manager or adjudicator decides that restrictions and/or conditions are required in order for an individual to be fit to drive, the nurse case manager or adjudicator will review:

• Medical assessments on file for information that indicates that the individual has, or lacks, insight into their medical condition or its impact on the functions necessary for driving
• Medical assessments on file for information that indicates that the individual is non-compliant with their prescribed treatment regime or medications
• The individual's driving record indicates the individual has been non-compliant with restrictions or conditions in the past, and
• Any credible reports for information that indicates that the individual has been non-compliant with restrictions or conditions in the past.

Without information to the contrary, a nurse case manager or adjudicator will assume that an individual will comply with a restriction or condition. However, if the information obtained from this review indicates that the individual is not likely to be compliant with any restrictions and/or conditions that are required in order to be fit to drive, the nurse case manager or adjudicator will not impose the restriction or condition and the individual is not fit to drive.

Policy rationale

A key consideration when determining whether or not a restriction or condition is appropriate is whether an individual is likely to comply with the restriction or condition. Because restrictions or conditions are only imposed if required for driver fitness, if a nurse case manager or adjudicator decides that an individual is not likely to comply with the condition or restriction, the individual is not fit to drive.

One key factor for determining whether an individual is likely to comply with restrictions or conditions is the individual’s level of insight. This is because individuals with good insight are more likely to be diligent about their treatment regime, to seek medical attention when needed, and to avoid driving when their condition is likely to impair their functional ability to drive.

2.4.11 Determining re-assessment intervals

Definitions

Re-assessment

is the process of screening, assessment and determination for an individual with a previously reported medical condition. Re-assessment is initiated when a request for a driver’s medical examination or an EVF is sent to an individual at the expiration of a RoadSafetyBC scheduled re-assessment interval.

Policy

If a nurse case manager or adjudicator determines that an individual is fit to drive, or downgrades a commercial licence, the nurse case manager or adjudicator will also determine whether re-assessment is required at a future date and, if so, what the re-assessment interval should be.

Generally, re-assessment will be required if:

• The individual has a medical condition that is progressive
• The driver fitness determination is based upon the effectiveness of a prescribed treatment regime and it is unknown whether the treatment regime is likely to continue to be effective
• The driver fitness determination is based upon the effectiveness of a prescribed treatment regime and it is unknown whether the individual is likely to comply with the treatment regime
• The medical condition results in episodic impairment, the driver fitness determination is based upon an individual having a period of stability without an episodic event, and it is unknown whether the medical condition is likely to continue to be stable
• The medical condition results in an episodic impairment, the driver fitness determination is based upon a pattern of episodes (e.g. nocturnal seizures or auras, and it is unknown whether the pattern of episodes is likely to continue
• It is recommended by a physician), and/or
• The re-assessment interval guidelines for the medical condition indicate that re-assessment is required (e.g. nocturnal seizures or auras, and it is unknown whether the pattern of episodes is likely to continue).
• Is recommended by a physician, and/or
• The re-assessment interval guidelines for the medical condition indicate that re-assessment is required

To determine whether re-assessment is required and, if so, the appropriate interval, the nurse case manager or adjudicator will consider:

• The re-assessment interval guidelines outlined in the relevant medical condition chapter(s)
• The date of onset, diagnosis and/or treatment of the medical condition, if known
• The severity of the medical condition
• Whether the condition is stable and, if so, the period of stability
• Whether the condition is progressive and, if so, the rate of progression
• Whether the condition is controlled
• If the individual is a commercial or aging driver, the date of the next scheduled routine screening
• Whether the individual has been compliant with any prescribed treatment regime, conditions or restrictions
• The results of any functional assessments
• The individual’s driving record, and/or
• The recommendation of a physician

A nurse case manager or adjudicator will not schedule a re-assessment interval for a private driver aged 80 or over, or a commercial driver, if the individual’s next scheduled routine screening will provide RoadSafetyBC with the necessary opportunity for re-assessment.

A nurse case manager or adjudicator can set any re-assessment interval that is appropriate for a particular individual. Generally, a nurse case manager or adjudicator will set a re-assessment interval at either:

• 1 year
• 2 years
• 3 years, or
• 5 years

   Generally, a nurse case manager or adjudicator will set a re-assessment interval at 1 year if:

• An individual’s cognitive function is impaired and the level of cognitive impairment is likely to increase over time
• The driver fitness determination is based upon the effectiveness of a prescribed treatment regime and it is unknown whether the treatment regime is likely to continue to be effective
• The driver fitness determination is based upon the effectiveness of a prescribed treatment regime and it is unknown whether the individual is likely to comply with the treatment regime
• The medical condition results in episodic impairment, the driver fitness determination is based upon an individual having a period of stability without an episodic event, and it is unknown whether the medical condition is likely to continue to be stable the medical condition results in an episodic impairment, the driver fitness determination is based upon a pattern of episodes. e.g. nocturnal seizures or auras, and it is unknown whether the pattern of episodes is likely to continue

In most other circumstances where re-assessment is required, a nurse case manager or adjudicator will schedule a 2, 3 or 5 year re-assessment interval, depending upon the likely rate of progression of the medical condition.

Policy rationale

RoadSafetyBC schedules re-assessments intervals for individuals who are fit to drive at the time of a driver fitness determination, but whose fitness to drive should be examined again at a future date. Without a re-assessment requirement, these individuals may not again be brought to the attention of RoadSafetyBC until their functional ability to drive has deteriorated to the point that they pose a high degree of risk to public safety. Re-assessment intervals may be scheduled for both private and commercial drivers but, to ensure that individuals are not re-assessed unnecessarily, RoadSafetyBC will not schedule a re-assessment interval for a private driver aged 80 or over, or a commercial driver, if the next scheduled routine screening will provide RoadSafetyBC with sufficient opportunity for re-assessment.

To ensure that individuals are not re-assessed unnecessarily, RoadSafetyBC policy sets out the circumstances when re-assessment may be required. For individuals with persistent impairments, re-assessment may be required because their level of functional impairment may increase due to:

• A progression of their medical condition(s), and/or
• A change in their response to, or compliance with, treatment

For individuals with episodic impairments, re-assessment may be required because their risk of functional impairment may increase due to:

• A progression in their medical condition(s)
• A change in their response to, or compliance with, treatment
• A change in stability, and/or
• A change in the pattern of episodes

The medical condition chapters provide guidelines for setting re-assessment intervals for individuals with each medical condition. For some conditions, the recommended interval is provided in the guidelines. In those circumstances where a recommended interval is not provided, or where individual circumstances may require a different interval, e.g. when the individual has multiple medical conditions, the nurse case manager or adjudicator reviews a variety of information to determine whether the individual’s level or risk of functional impairment may increase and the time period over which this increase may take place.

Re-assessment intervals of less than 1 year are generally not scheduled, because the majority of medical conditions do not substantially progress in such a short period of time. Because of the rapid decline in cognitive function associated with many conditions, one year intervals are usually scheduled for individuals with cognitive impairments. One year intervals are also scheduled for individuals with episodic impairments where it is unknown if the stability of the condition, the pattern of episodes or the effectiveness of treatment is likely to change. This is because a period of one year is usually sufficient to determine whether such a change is likely to occur in future.

2.4.12 Urgent driver's licence reviews

Background

On November 19, 2013, the Honourable Madam Justice Fenlon rendered her judicial review decision on Wong v. British Columbia (Superintendent of Motor Vehicles).

This involved a case in which the Superintendent of Motor Vehicles medically cancelled a driver’s licence, and subsequently upheld the cancellation upon reconsideration. 

Impact on Driver Medical Fitness Program

The Wong judicial review decision resulted in the Driver Medical Fitness Program making changes to its driver’s licence cancellation process.

Policy

When RoadSafetyBC receives reliable evidence of a serious medical issue that may affect a driver’s ability to drive safely, RoadSafetyBC undertakes an urgent file review and a driver may receive one of the following letters: 

• Urgent Cancellation Decision
• Notice to Cancel
• Request for Urgent Assessment
• Request for Further Information

Evidence of a serious medical issue may be in the form of a report received from police, a physician or from another health care professional. The information received must not be a result of an on-going correspondence with a driver or from a request for further medical information.

Policy rationale

Urgent Cancellation of a driver’s licence means that a driver’s licence is cancelled immediately without prior notice to the driver. However, reconsideration rights are given to the driver. The driver is given 21 days to request reconsideration of RoadSafetyBC’s decision to urgently cancel the driver’s licence.

In order for a driver’s licence to be urgently cancelled, there must be:

• Reasonably reliable evidence of a medical issue; and
• Reasonably reliable evidence of a road safety risk

The evidence must justify immediate cancellation. Based on the Wong decision, the following criteria must be met before a driver’s licence is cancelled:

• The date of the event/episode must generally not be over a month old;
• The threshold of public safety is high thereby raising immediate road safety concerns; and
• There is evidence of medical urgency

The Motor Vehicle Act requires the Superintendent of Motor Vehicles to ensure that British Columbia drivers are medically, physically and cognitively fit to drive. When making decisions about a driver’s fitness and ability, the Superintendent may consider medical reports, police reports, driving tests/assessments, and opinions of medical practitioners. While each of these is considered, the Act places the ultimate responsibility for determining a person’s fitness to drive on the Superintendent. 

The test to be met for Driver Fitness decisions in reasonableness. A reasonable decision is one which falls within a range of possible, acceptable outcomes which are defensible in respect of the facts and law.

2.4.13 Communicating a decision

Policy

Informing drivers of determinations

A nurse case manager or adjudicator will send an individual a letter that describes the driver fitness determination, the reasons for the determination and the reconsideration process if the nurse case manager or adjudicator decides that:

• An individual is not fit to drive
• Conditions must be imposed on an individual, or
• Restrictions must be imposed on an individual’s licence

Informing ICBC of determinations

A nurse case manager or adjudicator will direct ICBC to cancel a licence if a driver fitness determination indicates that an individual is not fit to drive and the individual currently holds a licence.

A nurse case manager or adjudicator may direct ICBC to issue a class 5 licence to an individual who holds a commercial licence if the nurse case manager or adjudicator determines that the individual is not fit to drive commercial vehicles but is fit to drive private vehicles.

A nurse case manager or adjudicator will inform ICBC that an individual is not fit to be licensed if a driver fitness determination indicates that an individual is not fit to drive and the individual does not currently hold a licence.

Policy rationale

Both for administrative fairness and public safety reasons, an individual must be informed of a driver fitness determination that affects their licensing privileges, the reasons for the determination and the process for requesting a reconsideration of a determination. If conditions or restrictions are imposed, individuals must be made aware of the conditions or restrictions so that they are able to comply with them in the future. If a licence is cancelled, the individual must be told to stop driving and surrender their licence. If RoadSafetyBC determines that an individual is not fit to hold a licence of a particular class, under section 92 of the MVA the Superintendent may direct ICBC to cancel an individual’s licence. Because the medical condition guidelines often specify different standards for commercial and private drivers, an individual may be fit to drive private vehicles, even though they are not fit to drive commercial vehicles. In this situation, a nurse case manager or adjudicator may direct ICBC to issue a class 5 licence after cancelling an individual’s commercial licence.

2.4.14 Determination procedures

The following flowchart graphically illustrates the procedures associated with the determination process.

2.5.1 Overview

If an individual asks RoadSafetyBC to review a driver fitness determination, an adjudicator or nurse case manager will conduct a reconsideration of that decision. The following flowchart is an excerpt from the overview flowchart in 2.1 that highlights the steps involved in reconsideration.

The following flowchart graphically illustrates the procedures associated with the determination process.

During the reconsideration, the adjudicator or nurse case manager may request additional assessments, in accordance with the policies outlined in Chapter 2.3 of this Manual.

Once the adjudicator or nurse case manager collects any additional information that may be required, the adjudicator or nurse case manager applies the policies outlined in Chapter 2.4 of this Manual and decides whether the original driver fitness determination was correct or whether a different determination is required.

In some circumstances, a request for review will trigger a new driver fitness determination, based on new assessment results, rather than a reconsideration of a previous determination. This will occur if an individual:

• Submits new information indicating a change in their medical condition or functional ability to drive, or
• Asks for a review of a determination that is based on assessments that are more than one year old

2.5.2 Conducting reconsiderations

Policy

If an individual asks in writing for a review of a driver fitness determination, and provides detailed reasons for the request, an adjudicator or nurse case manager will reconsider the determination.

If the assessments upon which the determination were based were performed more than one year prior to the date of the request for review, a nurse case manager or adjudicator will generally make a new driver fitness determination, based on new assessments, rather than reconsidering the previous determination.

If an individual submits new information indicating a change in their medical condition, or in their functional ability to drive, a nurse case manager or adjudicator will make a new driver fitness determination, based on new assessments, rather than reconsidering the previous determination.

At the conclusion of a reconsideration, the adjudicator or nurse case manager will either confirm the original driver fitness determination or substitute a new determination.

The adjudicator or nurse case manager will provide the individual with a letter that describes the reconsideration decision and the reasons for the decision.

Policy rationale

In accordance with the principles of administrative fairness, RoadSafetyBC gives individuals an opportunity to dispute the results of a driver fitness determination through its internal reconsideration process and provides written reasons with the results of the reconsideration.

In certain circumstances, a new driver fitness determination, rather than a reconsideration, is the more appropriate response to a request for review. Reconsiderations are an opportunity to review whether the correct determination was made given an individual’s medical condition or functional ability at the time the determination was made. If an individual submits new information reflecting a change in the individual’s medical condition or functional ability, a nurse case manager or adjudicator will make a new driver fitness determination, based on this new information and any additional assessments that the nurse case manager or adjudicator decides to request. Similarly, if an individual requests a review of a determination that is based upon assessments that are more than one year old, a nurse case manager or adjudicator will make a new determination, rather than reconsidering the previous determination. This is because the previous assessments upon which the determination was based may no longer reflect the individual’s current medical condition or functional ability.

2.5.3 Reconsideration procedures

The following flowchart graphically represents the procedures associated with the reconsideration process.