Oct 20, 2015 in News Accident Benefits Claims

Accident Benefits Claims: Insurance dispute lawyers take notice of amendment to Ontario Insurance Act

For victims of motor vehicle accidents, physical pain and suffering are often only a small part of a larger ordeal. Besides fighting through a long recovery process and dealing with the potential mental effects of a serious motor vehicle injury, accident victims may also face difficulty in receiving the compensation needed to finance their recovery. Resolving disputes with an insurance company can be a time consuming and costly process, and, to the displeasure of insurance dispute lawyers and accident victim advocates – such as FAIR and NeuroConnect – resolving accident benefit disputes will soon be more difficult.

Currently, disputes between insurance companies and claimants are handled by the Financial Services Commission of Ontario (FSCO). When a dispute occurs, the insurer and the claimant can apply for mediation with the FSCO and, if no resolution is reached, the claimant can either apply for arbitration or proceed, with the help of insurance dispute lawyers, to argue the case in court.

However, under an amendment to the provincial Insurance Act which was passed last November, handling of benefit disputes is being transferred away from the FSCO to the Licence Appeal Tribunal (LAT), an agency with a mandate to provide means to appeal decisions around compensation claims and licensing activities by several ministries of the provincial government, including the Ministry of Transportation. The LAT will begin accepting applications under the new Auto Insurance Dispute Resolution System (AIDRS) in April 2016. Leading up to that point, an advisory committee representing “groups that have an interest in the areas of law, business, government, consumer groups and the insurance industry” is meeting regularly to provide advice on the design and implementation of the new AIDRS.

As April 2016 approaches, several voices have raised concerns regarding the LAT’s ability to provide fair and balanced judgement to Ontario’s car accident injury victims. FAIR is a non-profit association supporting auto accident victims through advocacy and education. The group believes the current insurance system fails to provide the rehabilitation coverage and benefits necessary for accident victims to regain control of their lives. On September 30, FAIR released a letter to Ontario Attorney General Madeleine Meilleur stating that the LAT’s advisory committee “is composed of insurer defence lawyers and legal experts and consultants without any presence of consumers or MVA [motor vehicle accident] victims or those who represent them.” The letter insists the makeup of the committee will “underscore the public’s perception that Ontario’s insurance industry interests are of greater concern to our government than justice for Ontario citizens.”

FAIR’s letter focuses on the most important issue at hand: ensuring accident victims are treated fairly on the road to recovery. Injury victims rely on insurance coverage to pay for care and rehabilitation efforts, and FAIR believes the province is more concerned with the health of insurers than residents.

Toronto Sun legal columnist Alan Shanoff, meanwhile, published an article in January 2015 suggesting auto insurance benefit disputes could be “stacked against” the public. In the article, Shanoff cites a report from Canadians for Properly Built Homes (CFPBH) which looked at LAT decision making from 2006 to 2013. Over that eight year period, the LAT gave homeowners a 96 per cent failure rate on claims of major deficiencies, and over the final three years of the study, homeowners had a failure rate of 82, 83, and 94 per cent for all issues brought forward. The number of cases presented to the LAT also fell from 119 per year over the first four years of the study to 69 in the last four. The report concludes that the LAT’s “operations and performance need improvement both in relation to the adjudicators themselves (specifically in relation to self-represented parties) and the LAT’s management and administrative processes.”

In short, the amendment to Ontario’s Insurance Act has caused worry for representatives of and advocates for motor vehicle accident victims in the province, including insurance dispute lawyers and members of non-profit organizations like FAIR and NeuroConnect. Insurance disputes can be arduous processes, and an unbalanced LAT could make them worse still for injury victims.

If you or a loved one has been involved in a motor vehicle accident and is seeking benefits, contact the insurance dispute lawyers at Neinstein and Associates today. Call 866-920-4242 for a free, no obligation consultation.