Denied Accident Benefits? What to Do Next
- 24.09.2024
- Uncategorized
If you've had your accident benefits denied, you have the option to appeal the decision to the Licence Appeal Tribunal (LAT). In 2016, the Province of Ontario granted the LAT with the exclusive jurisdiction to resolve disputes between claimants and insurers, particularly under Ontario’s Statutory Accident Benefits Schedule (“SABS”), which governs accident benefits for motor vehicle accidents.
Steps to Appeal to the LAT:
- Filing an Application: a claimant wanting to dispute their insurer’s denial of benefits must first complete and file an application to the LAT. The application form asks you to identify the benefits that were denied and explain why you believe your insurance company’s denials should be overturned. To file your application with the LAT, you will need to pay a non-refundable filing fee of $106.00.
- Response from the Insurer: once you file your appeal, your insurance company will be notified of the application and will be required to file a response to the LAT providing its position on the issues in your application. This is their opportunity to provide their rationale for the denial of your benefits.
- Case Conference: A case conference is then scheduled, where you, your insurance company, and an adjudicator discuss the case. The case conference may be an opportunity to settle the dispute before moving to a formal hearing. The adjudicator may provide guidance on the strengths and weaknesses of the case.
- Hearing: If the case is not settled during the case conference, it moves to a hearing. LAT hearings can be conducted in writing, via teleconference, or through video calls, depending on the circumstances.
- Decision: After the hearing, the adjudicator reviews all the evidence and issues a written decision, which typically happens within 60-90 days of the case conference.
Tips for a Successful Appeal:
- Gather Strong Evidence: It's essential to present comprehensive medical documentation and proof that supports your ongoing need for the denied benefits. Insurers may deny benefits based on disputes over the medical necessity of the treatment recommended, your ability to return to work, or the legal classification of your injuries.
- Meet Timelines: the Common Rules of Practice & Procedure for the LAT imposes deadlines for certain steps to be taken and filings to be made. You may wish to consult with a personal injury lawyer or accident benefits lawyer to ensure that you understand the deadlines and that you meet the deadlines.
- Consider Legal Representation: although you’re not required to have a lawyer represent you at the LAT, having legal counsel can increase your chances of success. A lawyer can help with evidence gathering, case strategy, and navigating the complexities of the tribunal.
Although the LAT provides a structured and impartial way to resolve these disputes, self-represented litigants may still find appealing an accident benefits denial to be a daunting process. Ensuring you meet all requirements and presenting a well-supported case can greatly improve your chances of a favorable outcome.
For more detailed information and guidance on this process, consult with our accident benefits lawyers in Toronto. Our lawyers know the LAT system and will ensure you receive a fair resolution to your claim.
Denied Accident Benefits Lawyer Toronto
If your accident benefits claim has been denied by your insurance company, a denied accident benefit lawyer in Toronto can help you challenge that decision and secure fair compensation you're entitled to. Our legal professionals specialize in navigating complex insurance policies and advocating on behalf of injured individuals. Our Accident benefit lawyers assist in appealing denied claims, negotiating with insurance providers, and ensuring that their clients receive the support needed for recovery, including medical expenses and income loss. With our expertise, you can increase your chances of a successful claim outcome.