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Dispute Resolution Services

New Dispute Resolution Forms

 

 

Who we are

 

Dispute Resolution Services (DRS) is the branch of the Financial Services Commission of Ontario (FSCO) that helps claimants and insurance companies (the parties) resolve accident benefits disputes. Our mandate is to provide timely, cost-effective and fair dispute resolution services for claimants and insurance companies. Our services include mediation, arbitration, neutral evaluation, appeal, and variation and revocation.

 

 

How FSCO helps resolve accident benefits disputes

 

A claimant or an insurance company can apply for mediation if they disagree about the claimant’s entitlement to accident benefits or the amount of benefits that should be paid. An impartial FSCO mediator will help the parties reach a mutually agreeable resolution of their dispute. Mediation at FSCO is a mandatory first step in dispute resolution.

 

If mediation fails to settle the dispute, there are three ways to have the dispute decided:

 

  • The claimant can apply for arbitration with a FSCO arbitrator. Insurance companies are not allowed to apply for arbitration, but can raise new issues if the claimant applies for arbitration.
  • Either party (the claimant or the insurance company) can start a civil proceeding (law suit) in the courts.
  • If both parties agree, the dispute can be decided by a private arbitrator who is not employed by FSCO.

DRS does not make rules for private arbitrations or law suits.

The rules for dispute resolution at FSCO are set out in sections 279-288 of the Insurance Act and in the Dispute Resolution Practice Code.

 

 

Time Limits

 

You must apply for mediation within TWO YEARS after the insurance company refuses to pay the accident benefits claimed.

 

If mediation fails and you decide to apply for arbitration, you must apply within TWO YEARS after the insurance company refuses to pay the accident benefits claimed, or within 90 DAYS after the mediator issues the Report of Mediator, whichever is later.

 

The same rules apply if you start a private arbitration or a law suit. There are different rules if you participate in neutral evaluation.

 

The time limit is important.

 

You may not be able to proceed through dispute resolution if you do not apply for mediation or arbitration on time.

 

 

Accident Benefits

 

You can claim accident benefits (also known as statutory accident benefits or no-fault benefits) from the insurance company if you have been injured in an automobile accident.

 

Accident benefits are provided according to the Statutory Accident Benefits Schedule (SABS), which is a regulation made under the Insurance Act. You should be aware that the benefits and the rules differ depending on when you had your accident.

 

If you qualify, you may receive several kinds of accident benefits. The rules are complicated, but the following list will give you an idea about what may be available:

 

  • Income replacement benefits help replace lost income if an employed or self-employed claimant is disabled.
  • Caregiver benefits pay certain childcare or other caregiver expenses if a stay-at-home parent or other caregiver is unable to care for a child or other person in need of care.
  • Non-earner benefits are paid if a claimant who is not employed or self-employed is unable to carry on with normal life.
  • Medical and rehabilitation benefits pay for treatment and rehabilitation assistance that is not covered by OHIP or another disability insurance plan.
  • Attendant care benefits pay for someone to look after a seriously injured claimant.
  • Funeral expenses and death benefits are paid if an insured person dies as a result of the accident.
  • Depending on your circumstances, you may also be entitled to other benefits, such as payments for lost education expenses, housekeeping assistance, visitors’ expenses, repair or replacement of eyeglasses or clothing damaged in the accident, or case management services.

 

Other disputes

 

DRS only provides dispute resolution services to help resolve statutory accident benefits (SABS) disputes.

 

DRS is not able to assist with disputes about :

 

 

How do I apply?

 

If the insurance company refuses or stops paying benefits, they must give you written notice, including reasons for their decision.

 

If you decide to apply for mediation, you must complete and send us an Application for Mediation - Form A(PDF) within two years after you receive the insurer’s refusal. You can find more information about mediation on the Mediation page and in the Instructions for completing Form A (PDF).

 

After the mediation, the mediator will send you a Report of Mediator listing the issues the parties agreed on and the issues that remain in dispute.

 

If the dispute is not resolved in mediation, and you decide to apply for arbitration, you must complete and send us an Application for Arbitration - Form C (PDF) within two years after you receive the insurer’s refusal or within ninety days of the date of the Report of Mediator, whichever is later. You can find more information about the arbitration process on the arbitration page and in the instructions for completing Form C (PDF).


You cannot apply for arbitration unless you first complete mediation at FSCO and mediation fails.


If you proceed to an arbitration hearing, an arbitrator will be appointed to decide your case.

 

Either party to an arbitration may appeal the arbitrator’s order within 30 days on a question of law. If you decide to appeal, you must complete a Notice of Appeal - Form I (PDF) and send it to FSCO and the other party. You can find more information about the appeal process on the appeal page and in the instructions for completing Form I (PDF).

 

You may also wish to consider applying for neutral evaluation or variation/revocation.

 

 

Official languages and other language services

 

DRS provides dispute resolution services in English and French.

 

In mediation, claimants who require interpretation services in languages other than English or French must arrange and pay the cost of any interpretation services that are required.

 

In arbitration, appeal and variation/revocation hearings, DRS arranges and pays for interpretation services in languages other than the two official languages, on request.

 

 

Where can I get help?                

 

The Dispute Resolution Practice Code and Practice Notes describe the rules for participating in DRS proceedings.

 

Guidelines for accident benefits and the claims process are given in the Superintendent’s Guidelines.

 

FSCO’s Consumer Brochures provide information about auto insurance and auto accident claims.

 

All arbitration and appeal decisions are posted on this site.

 

 

Do I need a lawyer?

 

You do not need a lawyer for dispute resolution at FSCO.

 

You can choose to represent yourself. However, as disputes can become complicated and most insurance companies have lawyers representing them at arbitration and appeal, you should consider consulting a lawyer or licensed paralegal. 


If you need help finding a representative, the Law Society of Upper Canada offers a referral service. For more information, visit their website at www.lsuc.on.ca, or call 1-900-565-4577. (There is a small fee for this referral service).

 

You are entitled to have a friend or family member help you in an informal and unpaid manner, but only if the person receives no compensation directly or indirectly.

 

 

What will dispute resolution cost?

 

FSCO does not charge claimants for participating in mediation. If mediation does not resolve the dispute, a claimant must pay $100 to apply for arbitration, and $250 to start an appeal. There are different charges for insurers. FSCO’s fees and assessments are explained in more detail on the Fees and Assessments page.

 

At arbitration, most claimants and insurance companies will  incur certain arbitration expenses, including legal fees, fees charged by doctors and other experts for preparing reports, witness,  and other fees.

FSCO arbitrators have authority to:

 

  • order the claimant to pay all or part of the insurance company’s arbitration expenses,
  • order the insurance company to pay all or part of the claimant’s arbitration expenses, or
  • order no expenses, leaving it to each party to pay their own expenses.

The expenses decision is based on each party’s degree of success in the outcome of the arbitration, any written offers to settle, whether novel issues were raised, the conduct of the parties and their representatives, and whether any aspect of the proceeding was improper, vexatious or unnecessary.

 

The rules about ordering expenses are explained in the expenses regulation. If the arbitrator decides to order one of the parties to pay all or part of the other party’s arbitration expenses, the amount that can be ordered is based on the expenses regulation.

        

The same rules apply in appeals.

 

 

Settlements

 

Even if you are unable to resolve your dispute in mediation and you apply for arbitration, you may be able to settle your dispute without an arbitration or appeal hearing and decision. The settlement regulation describes the obligations of claimants and insurers in settling claims. If you and the insurance company reach an agreement, the settlement regulation requires the insurance company to give you a written disclosure notice confirming the details of the settlement. You can change your mind about the settlement if the insurance company does not give you the required disclosure notice.

 

The insurance company will probably ask you to sign a written release that gives up your right to renew your claim, apply for mediation, or start an arbitration or other legal proceeding about the same benefits.

Once you sign the disclosure notice or release, you can change your mind by giving the insurance company written notice of your decision within two business days. You must also return any money you received as part of the settlement.

 

You should consider seeking legal advice before agreeing to a settlement of your dispute.

 

 

Contact us

 

To make sure we are meeting our mandate, DRS consults regularly with two stakeholder groups. You may wish to read the minutes of DRS Counsel Forum and DRS Companies Forum to see if your concerns are discussed.

 

If you have a question about your mediation, arbitration or appeal, you may wish to contact the appropriate inquiries line or the contact person identified by DRS in our letters to you.

 

Other questions may be addressed through the DRS Inquiries lines:

 

  • Mediation Inquiries: 416 590-7210 (toll-free: 1 800-517-2332, extension 7210)
  • Arbitration Inquiries: 416 590-7202 (toll-free: 1 800-517-2332, extension 7202)
  • Appeal Inquiries: 416 590-7222 (toll-free: 1 800-517-2332, extension 7222)

Insurance companies can track the status of the mediation, arbitration and appeal proceedings in which they are participating through the DRS Case Directory. To obtain access to the directory, an insurance company must sign up for the service and agree to comply with certain rules for the use of the information.