When dealing with legal matters, it’s normal to feel overwhelmed and unsure about what to do next. You may have questions about your rights, the legal process, or what to expect. At Gowland, Boriss, we’re here to help.

These Frequently Asked Questions and Answers sections address some of the most common questions we hear from individuals.

If you need more personalized guidance, our team is just a phone call or email away. We are committed to helping you move forward with clarity and confidence.

 

705.743.7252 | 1.800.808.0189 | info@gowlandboriss.ca

Accident Benefits Disputes FAQs

1. What are accident benefits?

Accident benefits—also known as Statutory Accident Benefits Schedule (SABS)—are mandatory insurance benefits provided through your auto insurance policy. They may cover medical treatment, income replacement, attendant care, and other expenses, regardless of who was at fault for the accident. 

2. Why would my accident benefits be denied or disputed?

Insurance companies may dispute or deny benefits for several reasons:

  • They claim your injury doesn’t meet the definition required for the benefit.

  • They rely on an independent medical exam (IME) or Insurer’s Examination (IE) that contradicts your doctor’s opinion.

  • They allege the treatment is not reasonable or necessary.

  • They believe you didn’t provide proper documentation or missed a deadline.

An experienced lawyer or paralegal can help challenge unfair denials and protect your rights.

3. What can I do if my insurer denies or stops my benefits?

You have the right to dispute the decision. Most accident benefit disputes in Ontario are resolved through the Licence Appeal Tribunal (LAT). Before that, you can:

  • Request a reconsideration or clarification from the insurer.

  • Work with a personal injury lawyer or paralegal to prepare a formal LAT application.

  • Gather medical evidence and expert reports to support your claim.

You typically have two (2) years from the denial or termination to bring a LAT application.

4. What types of benefits are commonly disputed?

Common areas of dispute include:

  • Income Replacement Benefits (IRBs): Denied due to insufficient evidence of disability.

  • Medical and Rehabilitation Benefits: Disagreements over whether treatment is “reasonable and necessary.”

  • Attendant Care Benefits: Disputes about eligibility or the amount of care required.

  • Catastrophic Impairment Designation: A high-stakes classification that drastically increases benefit limits.

5. What is the Licence Appeal Tribunal (LAT)?

The LAT is an Ontario tribunal that handles disputes between accident victims and insurance companies over accident benefits. It replaced the courts and FSCO (Financial Services Commission of Ontario) for these disputes in 2016. LAT decisions are legally binding, and both parties can submit evidence, attend hearings, and make legal arguments.

6. How long does a LAT dispute take?

Timelines vary based on complexity. Some disputes particularly those involving catastrophic injuries or multiple benefits, may take 12–18 months or longer. Legal representation by a lawyer or paralegal can help streamline the process and avoid procedural delays.

7. Can I settle my accident benefits claim?

Yes. Many accident benefits claims are resolved through negotiated settlements before reaching a LAT hearing. Insurers may offer a lump sum payment to resolve all or part of your claim. However, settlements are final—so it’s crucial to understand what you’re giving up before accepting an offer. An experienced lawyer or paralegal can help assess whether a proposed settlement is fair.

8. Do I need a lawyer or paralegal for an accident benefits dispute?

You are not required to have a lawyer or paralegal, but insurers have teams of professionals working to limit payouts. A knowledgeable personal injury lawyer or paralegal can:

  • Help gather medical evidence

  • Represent you at LAT hearings

  • Communicate with the insurance company

  • Maximize your compensation

9. How much does it cost to hire an accident benefits lawyer or paralegal?

Most personal injury lawyers and paralegals in Ontario work on a contingency fee basis where the fee is a percentage of your settlement or award, and all terms are discussed in advance so there are no surprises. When your matter resolves our firm takes a percentage of the settlement or award for our fees and disbursements. Our lawyer or paralegal will fully explain our retainer and fee arrangements at your initial consultation before you retain us.

10. What are disbursements?

Disbursements are out-of-pocket expenses paid by a law firm to move your case forward. These can include costs for medical records, LAT filing fees, medical assessment reports, and other necessary documentation. At our firm, we typically cover these costs upfront and recover them upon settlement.

11. What happens if the insurer sends me to an Independent Medical Examination (IME) or Insurer Examination (IE)?

The insurer may request an IME, also called an IE to assess your condition. While it’s legal, the examiner/assessor is hired by the insurer and may not fully align with your treating doctor’s opinions. You still have the right to submit your own medical evidence, and a lawyer or paralegal can help ensure the process is fair.

12. What is the difference between “minor injury,” “non-catastrophic,” and “catastrophic” designations?

These categories affect the amount of accident benefits you’re eligible for:

  • Minor Injury Guideline (MIG): Up to $3,500 in medical/rehab benefits.

  • Non-Catastrophic Injury: Up to $65,000 for medical/rehab and attendant care.

  • Catastrophic Impairment: Up to $1 million (or more) in benefits.

Disputes often arise over whether an injury fits into a higher-benefit category. Legal and medical support is essential in these cases.

If you have a question that isn’t answered here, we invite you to contact us. The Gowland, Boriss team is here to listen, support, and guide you through the process—with clarity, compassion, and a strong commitment to your best interests.

705.743.7252 | 1.800.808.0189 | info@gowlandboriss.ca

Disclaimer:

Please note that nothing on this website should be considered legal advice and is being provided for general information purposes only. For legal advice, we encourage consultation with a lawyer to review your specific concerns and situation.