Being involved in a car accident can be a stressful experience, leaving you physically injured and financially strained. Ontario’s Statutory Accident Benefits Schedule (SABS) aims to ease this burden by mandating auto insurance companies to provide benefits for medical expenses, lost income, and rehabilitation costs. However, disagreements between you and your insurance provider regarding your entitlement to, or amount of, benefits can arise.
This is where the Licence Appeal Tribunal (LAT) comes in. The LAT’s Automobile Accident Benefits Service (AABS) is a specialized tribunal dedicated to resolving disputes arising from accident benefits claims in Ontario.
What Can You Dispute at the AABS?
The AABS handles a wide range of accident benefits disputes, including:
- Denial of Benefits: If your insurance company denies your claim for any SABS benefit.
- Dispute about Benefit Amount: If you disagree with the amount of benefits offered by your insurer.
- Termination of Benefits: If your insurer decides to stop providing benefits you believe you’re entitled to.
The Dispute Resolution Process:
The AABS offers a streamlined process to resolve your dispute. Here’s a breakdown of the key steps:
- Filing an Application: You initiate the process by filing a formal application with the AABS. This application outlines the details of your accident, the benefits in dispute, and the basis for your claim. The AABS website provides resources and online forms to assist with this process https://tribunalsontario.ca/lat/automobile-accident-benefits-service/.
- Responding to the Application: Your insurance company will have 14 days to respond to your application. Their response will outline their position on the dispute.
- Case Conference: The AABS will schedule a case conference, typically held over the phone. An adjudicator, a neutral third party trained in accident benefits disputes, will facilitate the discussion. Here, the adjudicator aims to resolve the dispute through mediation, where both parties attempt to reach a mutually agreeable solution.
- Preparing for the Case Conference:
- Gather Documentation: Be prepared to present evidence supporting your claim, such as medical reports, income statements, and communication with your insurance company.
- Know Your Rights: Familiarize yourself with your rights and entitlements under SABS. You can find relevant information on the Financial Services Commission of Ontario (FSCO) website https://www.fsrao.ca/consumers/auto-insurance.
- Consider Legal Representation: While legal representation isn’t mandatory, consulting a lawyer specializing in personal injury law can be beneficial.
- Case Conference Outcome: There are three potential outcomes from a case conference:
- Settlement: Both parties reach an agreement on the disputed benefits.
- Hearing: If no agreement is reached, a formal hearing will be scheduled.
- Hearing: The hearing is a formal proceeding where both parties present their arguments and evidence. The adjudicator will then issue a written decision outlining their findings and ruling on the dispute.
Additional Considerations:
- Time Limits: There are strict time limits for filing an application with the AABS. Generally, you have two years from the date your insurance company denies or terminates your benefits to file a dispute.
- Costs: While filing an AABS application is $106.00, there may be associated costs, such as legal representation or expert witness fees.
- Appealing a Decision: If you disagree with the adjudicator’s decision, you can appeal to the Superior Court of Justice within 30 days of the decision. However, appeals are complex and legal advice is strongly recommended.
Benefits of Using the AABS:
- Relatively Inexpensive: The process is generally less expensive than going to court.
- Specialized Expertise: AABS adjudicators have a strong understanding of accident benefits and SABS regulations.
Conclusion:
Disputes with your insurance company regarding accident benefits can be frustrating. However, the AABS offers an efficient process for resolving these disagreements. By understanding the dispute resolution process and your rights under SABS, you can navigate this challenge and ensure you receive the benefits you’re entitled to. Remember, seeking legal guidance can be valuable in navigating the complexities of accident benefits claims and the AABS process.