Disputing Accident Benefits After a Car Crash: The LAT Process
After a car accident in Ontario, you can claim statutory accident benefits from your own insurer, whoever was at fault. Benefits can include medical and rehabilitation costs, income replacement and attendant care. When the insurer denies or cuts a benefit, the dispute goes through a set process ending at the Licence Appeal Tribunal (LAT).
- Report the accident to your insurer quickly and complete the application forms within the time they allow.
- If a benefit is denied, ask for the reasons in writing and keep every letter.
- A dispute generally starts with mediation before an application to the LAT.
- An application to the LAT generally must be made within two years of the insurer's refusal.
Getting benefits started
- Notify your insurer of the accident as soon as possible. There are short time limits for giving notice.
- Complete and return the application package, including the form signed by you and, where required, by a health professional.
- Keep copies of everything, and write down dates of calls with the insurer.
- Attend assessments the insurer requests, and ask for the reports.
When a benefit is denied
- The insurer must explain its decision in writing, including the reasons and the medical basis.
- Compare the reasons with your treatment records and your doctor's opinion.
- If the insurer relies on a paper review or an assessment you disagree with, ask your health professional to respond in writing.
- Note the date of the refusal. The deadline to dispute counts from that date.
Mediation and the LAT
Most disputes begin with an application for mediation. If mediation does not settle the dispute, the next step is an application to the LAT. The time limit is generally two years from the date the insurer refused the benefit. At the LAT, an adjudicator reviews the evidence and makes a binding decision. The tribunal can hold written, telephone or video hearings.
Preparing your case
- Medical records and a clear letter from your doctor tying your limits to the accident.
- Treatment plans and receipts, and proof of lost income such as pay stubs and tax records.
- A diary of symptoms and how they affect daily life and work.
- Witness information, such as family members who see the effects every day.
Who can help
Licensed paralegals can represent clients at the LAT in accident benefits disputes. Serious injuries and claims against a negligent driver are separate matters that are usually handled by lawyers, and their deadlines differ from those for benefits.
Common questions
Does it matter who caused the crash?
Not for accident benefits. They are no-fault, so you claim from your own insurer. A claim for pain and suffering against the at-fault driver is separate.
What if my claim was denied years ago?
The two-year limit runs from the refusal, so an older refusal may be out of time. Ask whether a later denial or a new application opens a fresh period.
This guide is general information for people in Ontario, not legal advice. Rules, forms and deadlines change, and every situation is different. Check the current rule or speak to a licensed legal professional before you act.
Not sure where you stand? A licensed paralegal can look at your documents and tell you your options.
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