When your auto insurer refuses to pay benefits

When your auto insurer refuses to pay benefits
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Unfortunately, many a person injured in a motor vehicle accident is familiar with at least one denial of statutory accident benefits (“SABs”).

If you have requested benefits from your insurer following an automobile accident, has your adjuster refused to pay benefits for medical or rehabilitation treatment recommended by your physiotherapist or other health care provider? Do you think that your income replacement benefits (“IRB”) or non-earner benefits (“NEB”) have been wrongly terminated?

A denial of benefits can be frustrating and upsetting for a number of reasons. You might be going without badly-needed medical or rehabilitation treatment because you cannot afford to pay the expenses yourself. You might be a single parent, unable to work because of your accident-caused injuries and, without an IRB, you might have absolutely no money coming in. Recovering from an accident is a very difficult process – physically, emotionally, and financially. You need all of the treatment and financial assistance to which you are entitled.

Fighting your insurance company’s improper refusal to pay benefits

You do not need a lawyer to dispute a denial of SABs, but the process is overwhelming and a lawyer who takes on the task for you can significantly reduce your stress. Your insurance company will most likely have a lawyer.

Most personal injury lawyers will handle claims for SABs. And most personal injury lawyers work on a contingency fee basis, meaning that you do not pay them “up front” for their legal services. Instead, their fee is paid out of your settlement once your case is finished.

A lawyer can review the denial and, if he or she agrees that it is improper, can file on your behalf a formal dispute against your insurance company.

You might also find that having a lawyer helps matters move ahead quicker than if you had proceeded on your own, although that is not a guarantee. The dispute resolution process is typically a lengthy one.

The dispute resolution process

In Ontario, disputes between insured persons and their automobile insurance companies are not heard in court. They are heard at a “hearing” overseen by an adjudicative (i.e. decision-making) tribunal known as the Licence Appeal Tribunal (the “LAT”).

However, arriving at the LAT hearing stage is a multi-step process, and not every dispute results in a hearing. There will be opportunities to attempt to resolve your dispute with your insurance company prior to a hearing. You and your lawyer will be able to speak with a representative of your insurance company (i.e. an adjuster) and the company’s lawyer on more than one occasion for the purposes of negotiating a settlement of the dispute. If an agreement cannot be reached, you will need to proceed to a hearing for a decision.

If your insurance company has refused to pay medical and rehabilitation benefits for treatment that has been recommended for you, or if you think it may have wrongly terminated income replacement benefits or another financial benefit, we can help you. A consultation with a lawyer from our office is free. Call us at 519-946-4300.

This article is not a substitute for legal advice.