If you are not rewarded with accident benefits, of if you disagree about the amount of benefits that should be paid, you can apply for mediation. Although, you do not need a lawyer for dispute resolution at Financial Services Commission of Ontario, the process can be complicated, and it is always good to have somebody with experience and legal knowledge to help you out. The accident benefits disputes can be resolved at the specially designated branch of the Financial Services Commission of Ontario (FSCO) called Dispute Resolution Services (DRS).
Dispute Resolution Services
Dispute Resolution Services is the branch of the Financial Services Commission of Ontario that helps claimants and insurance companies resolve accident benefits disputes. The services include:
- Neutral evaluation
- Variation and revocation
Accident Benefits Dispute Process
Mediation at FSCO is a mandatory first step in dispute resolution. An impartial FSCO mediator will help the involved parties reach a mutually agreeable resolution of their dispute. If mediation fails to settle the dispute, there are three ways to have the dispute decided:
- The claimant can apply for arbitration with a FSCO arbitrator. Insurance companies are not allowed to apply for arbitration, but can raise new issues if the claimant applies for arbitration.
- Either party (the claimant or the insurance company) can start a civil proceeding (law suit) in the courts.
- If both parties agree, the dispute can be decided by a private arbitrator who is not employed by FSCO.
FSCO arbitrators have authority to:
- order the claimant to pay all or part of the insurance company’s arbitration expenses,
- order the insurance company to pay all or part of the claimant’s arbitration expenses, or
- order no expenses, leaving it to each party to pay their own expenses
The rules for dispute resolution at FSCO are set out in sections 279-288 of the Insurance Act and in the Dispute Resolution Practice Code.
Important Time Limits
You must apply for mediation within TWO YEARS after the insurance company refuses to pay the accident benefits claimed. If mediation fails and you decide to apply for arbitration, you must apply within TWO YEARS after the insurance company refuses to pay the accident benefits claimed, or within 90 DAYS after the mediator issues the Report of Mediator, whichever is later. The same rules apply if you start a private arbitration or a law suit. There are different rules if you participate in neutral evaluation. You may not be able to proceed through dispute resolution if you do not apply for mediation or arbitration on time.
Accident Benefits Disputes
You can claim accident benefits (also known as statutory accident benefits or no-fault benefits) from the insurance company if you have been injured in an automobile accident. Accident benefits are provided according to the Statutory Accident Benefits Schedule (SABS), which is a regulation made under the Insurance Act. You should be aware that the benefits and the rules differ depending on when you had your accident. Dispute Resolution Services only provides services to help resolve Statutory Accident Benefits (SABS) disputes.
Dispute Resolution Services does NOT provide with disputes services about:
- damages for pain and suffering
- damage to your automobile or other property
- at fault accidents
- determining which insurer is responsible for your claim
Even if you are unable to resolve your dispute in mediation and you apply for arbitration, you may be able to settle your dispute without an arbitration or appeal hearing and decision. The settlement regulation describes the obligations of claimants and insurers in settling claims. If you and the insurance company reach an agreement, the settlement regulation requires the insurance company to give you a written disclosure notice confirming the details of the settlement. You can change your mind about the settlement if the insurance company does not give you the required disclosure notice.
The insurance company will probably ask you to sign a written release that gives up your right to renew your claim, apply for mediation, or start arbitration or other legal proceeding about the same benefits.
Once you sign the disclosure notice or release, you can change your mind by giving the insurance company written notice of your decision within two business days. You must also return any money you received as part of the settlement.
It is strongly recommended to consider seeking legal advice BEFORE agreeing to a settlement of your dispute.