AB Claim Lawyers
When a benefit is denied by an insurer, formal written notification is provided by the insurer to the claimant. The denial usually comes following an Insurer’s Examination – under Section 44 of the SABS. If the claimant then wishes to challenge the denial of benefit, he/she is subject to section 280 of the Insurance Act which provides that the parties must participate in a mandatory mediation with a mediator from the Financial Services Commission of Ontario (“FSCO”), in an attempt to resolve the dispute. Assuming the mediation is unsuccessful, a Report of Mediator is issued to the parties and then, an application for arbitration is submitted with FSCO Arbitration proceedings, which is subject to the Dispute Resolution Practice Code. The Insurer will typically not engage in Settlement negotiations within the first year of your claim.
The Insurer may subject a claimant to medical examinations for several reasons and subsequently may deny one or more benefits based on the opinion (s) of medical doctor(s) who assess the injured victims on behalf of the insurance companies.
These assessments are also known as insurer’s examinations. The insurance company has a right to have the car accident victim assessed and provide the insurer with a copy of the results and the decision that follows such an examination. If benefits are denied, a claimant can enter in a Dispute between the claimant and the insurance.
Examination Under Oath
Insurance companies are entitled to examine a claimant under oath. These examinations are done with the present of your legal reprehensive. The examinations are usually done if there are coverage disputes but can also be done so that the insurer can better evaluate a claimant’s injuries and the claim.
An Examination Under Oath could expedite the approval of benefits previously denied by the insurer. However, it could also be detrimental to a claim, if the claimant is not aware of the procedures and lacks knowledge of the law. We highly encourage you to seek legal advice prior to participating in a EUO.
Also known as Alternative Dispute Resolution (ADR), mediation takes place when a disputes arise as a result of a denial from the insurer. It is an informal process where a Mediator is appointed by the government and helps the parties involved resolve the issues in dispute. Many claims settle at this stage. If the Mediation fails the next step is Arbitration.
Once an application for Arbitration is submitted, a Pre-Arbitration hearing is scheduled. An Arbitrator is now appointed to guide all the parties to either reach a solution or to set orders for an Arbitration. The Pre-hearing requires all parties to attend with full authority to settle the issues in dispute. In many instances, the insurer will be looking to use this opportunity to negotiate a full and final settlement of the entire claim. Although it may be tempting to enter into a full and final settlement at this stage, sometimes the amount of information required is not available or the claim is not ready for settlement. However, a large portion of claims do settle at this stage.
Arbitration is a well-established and widely used means to end disputes. In this stage, an Arbitrator will be appointed and he or she will make the final decision.
As per the legislation, cash settlement discussion can only commence a year after your accident. Your legal representative will help negotiate on your behalf to ensure you receive the maximum amount of benefits you may be entitled to.