Disputing denied accident benefits at the Licence Appeal Tribunal

Disputing denied accident benefits at the Licence Appeal Tribunal

From application to decision, about 9 to 17 months

When an insurer refuses or stops an accident benefit, the dispute goes to the Automobile Accident Benefits Service of the Licence Appeal Tribunal (LAT). Section 280 of the Insurance Act sends these disputes there and bars a court action over them, apart from an appeal or judicial review. The application has to start within two years after the insurer's refusal to pay.

Karb Law prepares the application or the response and represents the insured person at the case conference and the hearing. Angelina Shuster is a paralegal licensed by the Law Society of Ontario. This page is general information about the process. It is not legal advice, and reading it does not create a paralegal-client relationship.

What By-Law 4 lets a paralegal do on an accident benefits claim

A Class P1 licensee may advise a party and represent them in a proceeding before a tribunal set up under an Ontario statute. Section 6 of By-Law 4 also defines the accident benefit claims it covers, and those words sit inside that definition.

The firm's accident benefits work is on claims outside that wording. The term catastrophic impairment has its own definition in the Statutory Accident Benefits Schedule, and the medical records are read against it when a file first comes in.

Three things that can stop the application before it starts

Section 55 of the Statutory Accident Benefits Schedule lists the situations where an insured person cannot apply to the Tribunal. They are checked before anything is filed, because the insurer can raise each one.

  1. The insurer was not told about the claim, or the application for the benefit was not made, within the prescribed time. Notice is due by the seventh day or as soon as practicable after it.

    Section 34 helps here: a missed time limit in that Part does not end the entitlement when there is a reasonable explanation.

  2. The insurer gave proper notice of an examination under section 44, and the person did not comply with that section.

    The Tribunal may give permission to apply, and may attach terms and conditions.

  3. The insurer refused an invoice because a provider did not answer its request for information, leaving it unable to work out what it owes.

    The Tribunal may give permission here as well, on the same footing.

The benefits in dispute, and four questions that go elsewhere

Entitlement or amount of a benefit

  • Income replacement
  • Non-earner
  • Caregiver
  • Medical
  • Rehabilitation
  • Attendant care
  • Case manager services
  • Housekeeping and home maintenance
  • Death and funeral

Since July 1, 2026, section 2 of the Schedule has every policy entered into or renewed offer most of these as optional coverage, while medical, rehabilitation and attendant care stay in the policy. A policy renewed after that date keeps its earlier benefits unless the named insured and the insurer agreed in writing to change them. For that reason the policy itself is read together with the denial letter.

The paper a dispute needs at each stage

  • On filing

    Application by an Injured Person: the accident date and place, the disputed benefits and the documents relied on. A Certificate of Service and the filing fee go with it, by e-File or mail. Missing material is due within 10 business days.

  • 10 days before the conference

    Case Conference Summary, on the form revised for July 2026: preliminary issues, issues to add, documents, witnesses and the hearing format preferred. It is both filed and served. Settlement offers are exchanged but never filed.

  • 45 days before the hearing

    Unless an order sets an earlier date, each party exchanges all its evidence. For electronic and in-person hearings, that includes a witness list with a summary of what each witness will say.

  • 21 days before the hearing

    For electronic and in-person hearings, a brief of evidence and authorities goes to the Tribunal and the other side, indexed, tabbed and page numbered, with the witness list and the time each witness needs.

These dates come from Rules 9 and 20 of the Licence Appeal Tribunal Rules. The case conference runs two hours, usually by telephone, and the injured person and the insurer both attend even with a representative. An adjudicator asks questions and explains how the Schedule was applied in similar files. Without a settlement, that adjudicator gives directions, and a different adjudicator hears the case in writing, by videoconference or, in limited circumstances, in person. When a party or witness needs an interpreter and gives notice at least 14 days ahead, the Tribunal arranges one at its own expense.

After the decision, two short clocks

21 days

A request for reconsideration goes to the Tribunal, on its form, in submissions of no more than 10 double-spaced pages. It needs a jurisdiction or fairness problem, an error of law or fact that would likely change the result, or evidence that could not have been obtained before.

30 days

An appeal to the Divisional Court runs from the date the decision is released and is limited to a legal mistake. A transcript is the appealing party's job, so a court reporter is raised with the Tribunal ahead of the hearing.

A Tribunal order binds both sides. If it is not followed, it can be registered with the Superior Court of Justice and enforced as an order of that court.

Starting with the denial letter

The first reading covers the letter, the date on it and the policy, and fixes the two-year date. The firm then confirms the claim is within the licence, checks the three section 55 points and builds the document list the application and the summary will both use. The office at 10211 Yonge Street in Richmond Hill works in English and Russian.

A denial letter can be uploaded with the free assessment form. Questions about an insurer's notice can go to the office through the contact page.

FAQ

Frequently asked questions

How long is there to dispute denied accident benefits in Ontario?

Section 56 of the Statutory Accident Benefits Schedule requires the application to start within two years after the insurer's refusal to pay. The Tribunal can sometimes extend that time, and it may also refuse a late application.

Can a paralegal represent someone at the Licence Appeal Tribunal on accident benefits?

Yes, within By-Law 4 of the Law Society of Ontario. It lets a licensed paralegal appear before a tribunal under Ontario law, and its definition of accident benefit claims excludes a person who has or appears to have a catastrophic impairment.

Can a denied accident benefit be taken to court instead?

No. Section 280 of the Insurance Act bars a court proceeding about entitlement to these benefits or their amount, other than an appeal from a Tribunal decision or an application for judicial review.

Does the injured person have to attend the case conference with a representative?

Yes. The Tribunal requires both the injured person and the insurance company to take part in the case conference even when a representative is acting. It lasts two hours and is usually held by telephone.

Can an insurer start a Licence Appeal Tribunal application?

Yes. An insurer that believes it paid too much can apply to have the money returned. The injured person then files the Response by an Injured Person within 14 days of receiving the Tribunal's request.

Request a Consultation

Fill out the form below and our legal team will get back to you shortly.

Contact us

Google Google Rating
4.7★★★★★Based on 35 reviews
Google
Google Rating
4.7★★★★★
Based on 35 reviews