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Since 1990, there have been many changes in the Ontario no-fault system. More changes are coming soon with the dispute resolution system for such claims. When you claim no-fault benefits the insurer has a right to dispute your claim and refuse to pay some things. To be payable, a medical treatment must be considered both “reasonable and necessary due to the accident”. Insurers may have their own medical advisors who disagree with recommended treatment. There also are disputes over loss of income claims where the insurance pays income replacement benefits to a person who is off work because of accident injuries.  Where there is a dispute, a person must request Mediation where an independent government employed mediator tries to help the person settle with the insurer on some compromise basis. If mediation fails to get an agreement, the person may request Arbitration or sue in court. The arbitrator or the court after hearing evidence can impose a ruling on the parties to the dispute.

A judge recently reviewed the auto insurance accident benefits system for the government and made recommendations for streamlining the dispute resolution process. The Ontario Government is going ahead with changes through Bill 15 that was introduced in the Ontario Legislature on July 15 with final Legislature approval and Royal Assent in November 2014.Under the new system there will be no more actual Mediation and no option to go to court if mediation fails to resolve a dispute. There will be an Arbitration process using members of an independent panel of decision-makers who are paid by the Government for each day they work. It will be part of the Licence Appeal Tribunal (LAT) which currently handles decisions and appeals of a variety of Ontario Government regulated disputes. We can expect new postings for LAT panelists soon and it is anticipated that current FSCO arbitrators and mediators will be among those appointed to handle these claims.  Many current FSCO mediators are soon to receive training in arbitration.  Persons who dispute an insurers decision will then have a right to file for arbitration with LAT.  There will be a settlement meeting during the process instead of a mediation to encourage parties to a dispute to settle. This will be part of the arbitration process and, in fact, it already is done as part of arbitration in the current system. With the initial mediation process removed, the system will do less to encourage settlement but claims will proceed more cheaply and quickly.  (Credit: M Muskin)

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