October 18, 2017

Effects of the Latest License and Appeals Tribunal (LAT) Rules on Accident Benefit Claim Disputes

As of April 1, 2016, any disputes a car accident victim has with his or her insurance company must be heard by an adjudicator at the License and Appeals Tribunal (LAT).

The LAT – also known as the “Tribunal” – is not a new adjudication body. Established in 1999, the LAT is one of the tribunals under the Safety, Licensing Appeals and Standards Tribunals Ontario (SLASTO).

Right to Sue under the LAT

With the implementation of Licence Appeal Tribunal (LAT) Rules of Practice and

Procedure Version 1, which took effect on April 1, 2016, any disputes relating to an auto accident victim’s insurance benefit or the amount of insurance benefit must be filed before the LAT. The Tribunal currently conducts hearings, resolves disputes, and makes decisions relating to the disagreements between auto accident victims and insurance companies about accident benefits.

Prior to the implementation of the latest Rules of Practice and Procedure of LAT, disputes arising from car accident claims were filed before the Financial Services Commission of Ontario (FSCO). Aside FSCO, prior to the LAT’s latest Rules of Practice and Procedure, car accident victims and insurance companies could pursue their accident benefit dispute by filing a court action.

With the implementation of the latest Rules of Practice and Procedure of LAT, the victims’ right to sue their own insurance company has been taken away. The decisions of LAT adjudicators can only be appealed to the Superior Court of Justice (Divisional Court) in cases where there are questions of law.

Tribunal Award under the LAT

In all of the LAT decisions published to date, I have not seen them order a Tribunal Award, previously called “Special Award,” pursuant to Regulation 664 – a regulation under the Insurance Act.

During the time when auto accident benefit disputes were still under FSCO, the authority to give a Special Award came from section 10 of Regulation 664 which states:

“If the Licence Appeal Tribunal finds that an insurer has unreasonably withheld or delayed payments, the Licence Appeal Tribunal, in addition to awarding the benefits and interest to which an insured person is entitled under the Statutory Accident Benefits Schedule, may award a lump sum of up to 50 per cent of the amount to which the person was entitled at the time of the award together with interest on all amounts then owing to the insured (including unpaid interest) at the rate of 2 per cent per month, compounded monthly, from the time the benefits first became payable under the Schedule.”

 

 

 

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