The Licensing Appeals Tribunal (LAT) has two divisions. The General Division deals with various issues such as license suspensions, consumer compensation claims, etc. The other division is called the Automobile Accident Benefit Service (AABS). The AABS mandates to resolve the dispute about the insured person’s entitlement to statutory motor vehicle accident benefit. More specifically, it deals with claims against your automobile insurance provider related to their paying of and quantification of payable benefits. The AABS began receiving applications under the Insurance Act, and the Statutory Accident Benefits Schedule on April 1, 2016.
After receiving a denial letter for accident benefits resulting from an automobile accident, any person in Ontario can apply to the AABS for a hearing. Accident benefits generally refer to very specific types of payable benefits. The first and often largest benefit type, are Income replacement benefits or non-earner benefits. These can be claimed if your injuries leave you unable to work. Accident benefits can also include, attendant care benefits, general medical expenses, as well as medical rehabilitation benefits.
Once you have determined that the denied benefits are inside the scope of what the AABS can decide and you have been given a rejection letter by your insurance company, you can consider filing an application. The application must be filed within 2 years from the date your insurance company denies the policy benefits.
Who Can Apply To AABS:
The person injured by the accident, or an insurance company can apply to AABS if there is a disagreement about the entitlement to accident benefits based on the insurance policy, or the amount of benefits that should be paid, and the dispute cannot be settled.
If an insurance company believes that an individual has been paid too much under their policy, the company can file an AABS application to have the money returned.
It is to be noted that AABS does not hear disputes about:
- damages for pain and suffering;
- damage to cars or other property;
- who was at fault in the accident; and
- which insurer is responsible for your claim
By hiring a personal injury lawyer, you will likely have an easier time navigating the following steps pertaining to the application process:
Starting The Application:
- Complete the application form
- Send a copy of the application form to the other party (the insurance company)
- Complete an AABS Certificate of Service
- Send the application form and the Certificate of Service form to AABS and pay the application fee.
- AABS review the application and assign a file number.
- Once AABS assigns a file number to the application, AABS will contact the insurance company via a Notice of Application, the Notice of Application will ask them to send a response.
Responding To The Application (Insurance Company Steps):
- Complete and send the response form within 10 business days to the other party;
- Send the response to AABS and complete a Certificate of Service.
After AABS receives the response form, AABS will assign a staff member called a Case Management Officer (CMO) to the file who will schedule a case conference. The goals of the case conference include helping the parties in reaching a settlement and plan the hearing, if it is necessary in case the dispute is not settled.
After the Case Conference in Scheduled you submit a Case Conference Summary Form. In the form you must include some details about documents, possible witnesses and evidence that you have related to the case. A copy of the form plus relevant documents must be given to the other side and the AABS at least 10 days before the Case Conference.
At the case conference (can be scheduled in person or over the phone), the adjudicator will try to narrow the issues between the parties. If the parties cannot settle the case, they will likely have to go to a hearing.
All parties will receive a ‘Notice of Hearing’ from the Case Management Officer (CMO) which will include the date, time and location of the hearing. The date of the hearing will be within 60-90 days after the case conference. Sometimes, if the hearing is expected to be long, the case conference adjudicator may use the end of the case conference to schedule dates for the hearing to make sure there is enough time set aside.
Hearings can be scheduled as in person, in writing, or to be heard electronically.
The hearing is a legal proceeding. Each side (the claimant and the insurance company) states their understanding of the case and the issues. They will use evidence to argue their position.
After the hearing, the adjudicator will make a final decision, which is usually sent to the parties later.
Under the Rules of Practice and Procedure, a request for reconsideration of the decision may be filed with LAT. However, it must be done within 21 days of the date of decision. A request for reconsideration from a party must be served on all other parties.
The decision made by AABS adjudicator may be appealed if they contain a legal mistake. Further, the decision must be filed with the Divisional Court within 30 days of the date of the decision.
The AABS is a complex legal process it can be very difficult to navigate without a legal representative. If you have been injured in a motor-vehicle accident, we suggest that you contact an experienced personal injury lawyer immediately. “Ayaz Mehdi Professional Corporation” assists clients with personal injury claims.
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