In my blog entry of
February 5, 2016, I talked about the upcoming changes to the
procedure for accident benefit disputes. And further updates are
now available. The License Appeal Tribunal (LAT) will be accepting
applications to its new Auto Accident Benefits Service
(AABS). In order to accommodate some of the unique aspects of
accident benefit dispute resolution, the LAT will adopt new rules
of practice and procedure, effective April 1, 2016. The mandate of
the AABS is to reach a final decision with respect to a benefit
disputes within six months. Such an aggressive mandate has
many file handling consequences for insurers, including cost
savings through Legal Process Management.
Once an application is filed, an insurer must respond to same.
After the response is filed, a case management officer is assigned
to the file and that CMO will schedule a one hour case conference
within 45 to 60 days of the response being received. Once
this case conference is scheduled, a case conference summary form
is sent to all parties for completion. This must be completed
and delivered to AABS and the other party at least 10 days before
the scheduled Case conference. The majority of these case
conferences will be over the phone. They will discuss evidentiary
issues, as well as opportunities for settlement. A decision about
the type of hearing to take place (written, oral, video conference)
will also be decided. The current mandate is to have a
hearing within 60 to 90 days of the case conference.
There are significant implications to insurers for this
aggressive timeline. First, there can be no delay in assembling the
proper responding evidence once an application is received.
Insurers and their legal counsel partners must develop a
streamlined arbitration plan as soon as possible so as to ensure
that proper and admissible responding evidence will be ready for
the hearing. This includes ensuring that any medical reports
and any surveillance/investigation are all done in a timely
Second, is the ability for cost savings. The new streamlined
rules were designed with the goal of streamlined process
management. Insurers and their legal counsel partners should also
adopt process management to maneuver these claims through the new
dispute resolution process. With a discreet and finite set of
processes in this new structure, insurers and their legal counsel
partners must act efficiently in managing the process.
Furthermore, the process lends itself well to alternative fee
structures which should act to reduce legal expenses for all
parties involved, but particularly insurers. The new dispute
resolution process can therefore be distilled into three distinct
phases: phase 1, the receipt of the application, response, and
establishment of a tactical and strategic plan for moving forward;
phase 2, the case conference which involves documentary
productions, settlement negotiations, and a determination of the
type of hearing; and phase 3, the hearing. Each phase should have a
standard process that can be managed by insurers and their legal
counsel partners. With any standardized process then, the ability
to more accurately gauge and estimate legal fees for the purpose of
alternative fee arrangements is made easier. In fact, with
our national resources including a dedicated legal project
management team, we have already instituted alternative fee
arrangements for some of our clients. We believe that this new
dispute resolution process allows us to provide more efficient,
cost effective service to our clients.
The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
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