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Odds are stacked

Against All Odds

What can you do when your own insurance company won’t pay for the benefits you need and are entitled to?

I get asked this question often. The clients we work with are badly injured. They need treatment, income and other supports. Your car insurance has a system in place to help you immediately – Statutory Accident Benefits.

Accident benefits are paid by your own insurance company. You have access to these benefits regardless of who is at fault for an accident. However, your insurance company won’t always agree that you need, or are entitled to, the benefits that you paid for. If the insurance company doesn’t agree, they won’t pay.

When the insurance company won’t pay, there is only one place you can go – the Licence Appeal Tribunal (the “LAT”). An independent adjudicator (decision maker) at the LAT will hear both sides of the story and decide if the insurance company must pay you the disputed benefits.

Seems fair… right? Well, the stats show otherwise.

The first issue is the amount of time it takes for the LAT to make a decision. Last year, it took an average of 505 days to get a decision back from the LAT![1]

The insurance companies have no problem waiting – they are not required to pay any benefits while we wait.

However, for our clients, 505 days is an extremely long time to go without treatment or without income replacement. This wait time is inherently unfair to our clients who need the help now – not in 17 months.

Even if a client does persevere through the LAT process, in 2020, the LAT overwhelmingly decided against them. They overwhelmingly sided with insurance companies. Take a look at the Stats:

LAT win rate

[2]

No matter what benefit you are fighting for, the odds are heavily stacked against our clients.

That is why you need a good lawyer to represent you right from the beginning.

A good lawyer will make sure that the right information gets to your insurance company at the outset, which will give you the best chance of avoiding a denial in the first place.

If there is a dispute, a good lawyer will gather the evidence needed to give you the best chance at winning at the LAT, despite the odds being stacked against you.

One thing is clear… the Ontario Government needs to take a hard look at the Licence Appeal Tribunal and determine – is it really a fair system? It certainly doesn’t appear that way to me.

 

Greg Willson

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