Injury Lawyers provide a summary of some of the most important upcoming changes to Ontario Accident Benefits and the License Appeals Tribunal (LAT).
Ontario drivers and residents will continue to see an erosion in insurance coverage and Accident Benefits. Here is what you need to know:
As of April 1, 2016, accident benefit arbitration applications are to be sent to the Licence Appeals Tribunal (“the LAT”) instead of the Financial Services Commission of Ontario (FSCO). Further changes were made in relation to Ontario’s Statutory Accident Benefits Schedule (SABS) for accidents that occur on or after June 1, 2016, which include the following:
- Catastrophic limits changed to $1 million combined for medical/rehabilitation and Attendant Care (reduced from $2 million to $1 million)
- Medical/rehabilitation and Attendant Care benefits for non-catastrophic injuries are to be combined totalling $65,000 (reduced from $86,000 to $65,000)
- Medical/rehabilitation benefits for non-catastrophic injuries limited to 5 years instead of 10 years
- The 6-month waiting period for non-earner benefits is eliminated, but the non-earner benefits will only be available for 2 years
- An update to the ‘catastrophic impairment’ definition consistent with more up-to-date medical information and knowledge to reflect modern medicine
LAT Dispute Resolution System
The Ontario Government maintains that the new LAT dispute resolution system is more streamlined than its predecessor. Additionally, FSCO mandatory mediations have been eliminated, and applicants are now expected to apply for arbitration as soon as a benefit is denied or terminated. The arbitration process will be as follows:
- The applicant will file an Arbitration with LAT via a new form.
- The insurer will file a response and a case conference will be scheduled.
- Prior to the case conference, each respective party will file a case conference brief/summary.
- A case conference will then take place. This will be similar to the FSCO pre-hearing.
- If the matter doesn’t settle, a hearing will occur by way of written, electronic, or in-person hearings.
- Appeal – either party may request the Chair to reconsider the matter. Or, the matter can be appealed to the Divisional Court.
The transition to LAT from FSCO is not going to be easy. We are expecting backlogs. Moreover, the majority of FSCO mediators who developed expertise in this very specific area of law did not transfer over to the LAT. In other words, knowledge and expertise will be lost in the transition. Further, appealing to the Divisional Court may be a difficult hurdle for applicants since courts are often hesitant to overturn arbitrators. With all that being said, it appears as though applicants suffering from catastrophic impairments will be impacted the most by this legislation.
