Many people who are receiving accident benefits will be
surprised and disappointed when their benefits begin to be
denied. Many people believe that a single denial means they
have been "cut-off" entirely from receiving any further
benefits. In fact, this is not the case. Insurers are
required to assess each individual treatment plan or application
for benefits to determine whether they are reasonable and
necessary. Often, an insurer will request a medical examination to
help make this determination. Many people are disappointed
with the outcomes of their insurer medical examinations or feel the
results of the examinations do not accurately reflect the severity
and impact of their injuries.
If a person has been denied a particular benefit, they must
apply to the Financial Services Commission of Ontario
("FSCO") to mediate the denied benefit. FSCO is
required to schedule a mediation of the dispute within 60 days of
receiving the application for mediation. However, many injured
people find that the wait time for a mediation date is much
At a FSCO mediation, the insurer and the injured person (or his
or her lawyer) will attempt to negotiate a resolution of the
disputed benefit. If more than one year has passed since the
date of the accident, the insurer may attempt to pay a lump sum
amount to close the accident benefits file on a full and final
basis. When considering whether to accept a lump sum pay out
of an accident benefits file, an individual should consider, among
other things, what his or her long term needs might be and what
potential entitlement to accident benefits he or she may have under
the accident benefits legislation.
If mediation does not successfully resolve the dispute with
one's insurer, then an individual may choose to either file a
Statement of Claim with the Superior Court or apply for an
arbitration through the FSCO. Ultimately a judge or
arbitrator will be called upon to determine whether or not the
disputed benefit should be provided. There are specific
deadlines for filing a Statement of Claim or applying for
arbitration. If these deadlines are not met, the injured
person may be precluded from recovering the benefits he or she is
seeking, even if the claim for benefits had merit.
It's not often that our little blog intersects with such titanic struggles as the U.S. presidential race – and by using the term "titanic" I certainly don't mean to suggest that anything disastrous is in the future.
J.J. v. C.C., is an interesting case in which the court held that an automotive garage owes a duty to minor children to secure the vehicles on the premises by locking the cars and safely storing the car keys...
In Irwin v. Alberta Veterinary Medical Association, 2015 ABCA 396, the Alberta Court of Appeal found that the "ABVMA" failed to afford procedural fairness to a veterinarian undergoing an incapacity assessment.
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