What is the Statutory Accident Benefits Schedule?

The Licence Appeal Tribunal – Automobile Accident Benefits Service (LAT-AABS) helps resolve claims under Ontario’s motor vehicle insurance regulation, known as the Statutory Accident Benefits Schedule (SABS).

If you or a family member have been hurt by a motor vehicle accident, you may be entitled to claim accident benefits (also known as statutory accident benefits or no-fault benefits).

The SABS is the framework that the LAT-AABS uses to help you and your motor vehicle insurance company reach a settlement. The SABS is a regulation under the Insurance Act that sets out the benefits and compensation that may be available to you as a driver, passenger, or pedestrian if you have been hurt in a motor vehicle accident.

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Who can apply to the LAT-AABS?

A person injured by a motor vehicle accident can apply to the LAT-AABS if there is a disagreement about their entitlement to accident benefits or the amount of benefits that should be paid, and this dispute cannot be settled.

If an insurance company believes an individual has been paid too much under their policy, the company can also file an application with the LAT-AABS to have the money returned.

The LAT-AABS does not hear disputes about:

• damages for pain and suffering
• damage to cars or other property
• who was at fault in the accident
• which insurer is responsible for your claim

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When can you file a LAT-AABS application?

If an insurance company denies or stops paying benefits to an insured person, they must provide written notice of this decision to you that includes the reason(s) for their decision. You can file an application with the LAT-AABS if you receive that denial notice.

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Steps to consider before filing

These steps are meant to help you settle your dispute quickly.

You are encouraged to talk to your insurance company and try to settle your dispute before starting the LAT-AABS process. Settling your dispute with your insurance company is the fastest and least costly way to resolve your claim.

Some steps you may want to take before filing an application with the LAT-AABS include:

1. Review your automobile insurance policy

Before making a claim, review your insurance policy to see what benefits you are eligible for. Every automobile insurance policy provides specific benefits that may include:

• income replacement if an employed or self-employed person can’t work because of the accident
• childcare or other caregiver expenses, if a stay-at-home parent or other caregiver can’t care for a child or other person because of the accident
• “non-earner” benefits, if a person who is not employed or self-employed can’t carry on with normal life because of the accident
• medical treatment and rehabilitation costs that are not covered by OHIP or other disability insurance plans
• “attendant care” costs to help you pay for someone to look after you if you were injured because of the accident
• funeral expenses and death benefits, if an insured person dies as a result of the accident
• payments for lost education expenses, housekeeping assistance, repair or replacement of eyeglasses or clothing damaged in an accident, and the expenses of visitors who come to see you because of the accident, or
• case management services, to coordinate services for people who are seriously hurt in the accident

Your insurance benefits, and the rules that apply to them, can be different depending on the date of the accident. You may also have additional benefits if you added those benefits to your insurance policy at the time you bought it.

2. Write a letter to the insurance company

When you write a letter to the insurance company, ensure you:

1. explain the reason you are making the claim
2. summarize the facts
3. list what you want, and, if this includes money, how you have calculated the amount

The insurance company should answer you in writing. The reply should include whether they accept or deny your claim and the reasons why.

3. Exchange important documents that explain why you made the claim

Exchanging important documents with the insurance company, such as a police accident/incident report or a hospital discharge summary, may help you and your insurance company understand your differences and may provide information that will allow you to settle.

4. Consider other ways to resolve your dispute

Before you apply to the LAT-AABS, you may want to consider negotiation or mediation services. Parties are encouraged to attempt to negotiate the claim at all times, including before filing at the LAT-AABS, and continuing negotiation discussions after a claim has been filed.

Filing an application

Follow the steps below to complete and file an application with the Licence Appeal Tribunal – Automobile Accident Benefits Service (LAT-AABS). You may also wish to get legal advice before filing.

1. Complete the application form

If you are an injured person applying to the LAT-AABS, complete the Application by an Injured Person .

If the insurance company is applying to the LAT-AABS, they complete the Application by an Insurance Company .

The injured person or the insurance company who completes and files an application with the LAT-AABS is known as the “Applicant”.

You will be asked to provide the following supporting materials as part of your application:

• contact information of the Applicant, the Applicant’s legal representative (if applicable), and the insurance company
• date and location of the motor vehicle accident
• details of the disputed benefit(s)
• a list of documents you intend to rely on during the dispute resolution process (e.g., medical reports, surveillance evidence, tax returns, etc.)

2. Send a copy of the completed application to the other party or their representative

Make sure to send the other party a copy of your application. You can deliver it by hand, send it by courier or mail, or by email it as described in Rule 6 of the Licence Appeal Tribunal Rules.

3. Confirm you sent a copy of your application to the other party by completing a Certificate of Service Form

When you file your application with the LAT-AABS, you must also submit the Certificate of Service form that confirms that you have “served” a copy of the application to the other party.

4. Pay the LAT-AABS application fee

The fee to file an application with LAT-AABS is $106.00. The $106.00 fee is non-refundable.

You can provide the application fee to the LAT-AABS:

• by using e-File to pay online with Visa Credit Card, Visa Debit, MasterCard Credit Card or Debit MasterCard
• by cheque (certified), money order or bank draft, payable to the Minister of Finance
• by providing your credit card information with your application

5. File the application

You can file your completed application and Certificate of Service with the LAT-AABS by mail or by e-File. Applications sent via email cannot be processed.

If the LAT-AABS requires more information, staff will contact you. On the application form, you can tell us the best way to contact you.

After the LAT-AABS receives the application

LAT-AABS staff will review the application to make sure it is complete and assign a file number. After a file number is assigned, a Case Management Officer (CMO) will be assigned to your file. If the application is not complete, CMO may contact you to request more information. If you do not provide the missing information by the specified time, the LAT-AABS will not go ahead with your claim. The Applicant has 10 business days to submit outstanding materials.

Once the LAT-AABS assigns a file number to the application, the LAT-AABS will contact the other party by sending them a Response Request Form and will ask them to respond to the claim.

LAT-AABS will also provide parties with available dates for an upcoming oral adjudicative event. Parties can then select three preferred dates for consideration.

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Filing a Response

Follow the steps below to complete and file a response with the LAT-AABS. You may also wish to get legal advice before filing.

Who Responds to an Application

You are a party who must respond to an application if you receive:

• a completed LAT-AABS application form; and
• a Response Request Form from the LAT-AABS directing you to file a response.

The party responding to a LAT-AABS application is known as the “Respondent”. The responding party will usually be the insurance company, but sometimes it is the injured person who must respond to an application that was started by the insurance company. The Response Request Form asks for the contact information of the Respondent and/or the Respondent’s legal representative (if applicable), and also asks that the Respondent to address the issues raised by the Applicant.

How to respond to an application

Follow the steps below to complete and file a response to an application with the LAT-AABS. You may also wish to get legal advice before responding.

1. Complete the Response Form

An insurance company must complete the Response by an Insurance Company .

If you are responding to an application made by your insurance company, you must complete the Response by an Injured Person . The response form must be completed within 14 days of receiving a Response Request from the LAT-AABS.

2. Send a copy of the completed response to the other party and their representative

Make sure the other party gets a copy of your response. You can deliver it by courier or mail, or email.

3. Confirm you sent a copy of the response to the other party on the Certificate of Service

You must complete a Certificate of Service form that confirms that you have “served” a copy of the response to the other party.

4. File your response with the LAT-AABS

You can submit your completed Response and Certificate of Service to the LAT-AABS by e-File, email, or by mail.

After LAT-AABS receives the Response Request Form

After the LAT-AABS receives your Response form, a LAT-AABS staff member called a Case Management Officer (CMO) will be assigned to the file. The CMO is your main contact at the LAT-AABS for your case.

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Filing and serving other documents

Filing documents

You can file forms with the LAT-AABS via e-File, mail or email. For more information on filing, see the Forms, Filing and Fees page.

Serving documents

All LAT-AABS documents, except for a request for an approved Summons to a Witness form, must be served by one party on the other parties. You must include a Certificate of Service form as proof that you have served the document on the other party. The person serving the documents should make careful, detailed notes regarding the name of the person served, the date, time, and how the service was completed.

For more information about the service and filing requirements for signed Summons to a Witness forms, please see Rule 8 of the LAT Rules .

Parties must arrange for service of their own documents. You can:

• have your representative arrange for service of your documents
• serve the documents yourself
• have someone else or a private process server serve the documents on your behalf

Please refer to Rule 6 of the LAT Rules , Service and Filing, for more information about different ways for you to send a document.

Scheduling

As per the Licence Appeal Tribunal – Automobile Accident Benefits Service (LAT-AABS)’s canvassing-based scheduling model, parties will receive an email that provides available dates for an upcoming oral adjudicative event (e.g., a case conference or oral hearing).

Parties can then select three preferred dates for consideration. Parties must respond within 9 business days. This process will be fully managed by the LAT-AABS Scheduling Unit. The tribunal will issue the Notice of Case Conference/Oral Hearing within 5-10 business days from the initial canvassing email sent to parties.

If parties do not respond to the canvassing email or do not provide mutually agreeable dates, the LAT-AABS will schedule the case conference/oral hearing based on earliest availability. Please note that adjournment requests will be granted sparingly.

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Case conferences

A case conference is an opportunity for parties to attempt to settle their cases and, if a settlement is not reached, an adjudicator from the LAT-AABS can direct how the hearing will proceed in a fair and timely manner.

The goals of the case conference are to:

• help the parties reach a settlement;
• help the parties exchange information so they have a clear understanding of what each party wants and what each party may wish to use as evidence at a hearing;
• help the parties understand what might happen if the case goes to a hearing; and
• plan the hearing, if it is still necessary.

Scheduling a case conference

The LAT-AABS will schedule a two-hour case conference for the parties to meet with an adjudicator. Case conferences will usually take place within 45-60 days of the response being received. The case conference will usually take place by telephone. The LAT-AABS will send a notice containing the case conference details to all parties.

Participants

Both parties must attend the case conference. The injured person and the insurance company must both participate in the case conference, even if they have a representative.

A case conference is led by an adjudicator whose role is to guide and support the parties in working to resolve the dispute. The adjudicator is trained to understand accident benefits disputes and will provide his or her view on what could happen if the case went to a hearing.

Disclosure

Once the case conference is scheduled, you must complete a Case Conference Summary Form , serve it on the other party and file with the LAT-AABS. This form asks for details about documents that may be relevant to your case, possible witnesses and what other evidence you may have.

You must send a copy of the completed Case Conference Summary Form, and any relevant documents you have, to the other party. Exchanging this information is called disclosure.

Disclosure helps you and the other side understand your differences and may provide information that is needed to settle the case.

For more information about disclosure of documents and witnesses, see Rule 9 of the LAT Rules . For more information about the Case Conference Summary Form, see Rule 20 of the LAT Rules .

What happens at a LAT-AABS case conference

Most case conferences will be held by phone. The case conference is informal, confidential and led by a LAT-AABS adjudicator. The adjudicator will have read the Case Conference Summary Form from each party. The adjudicator will try to narrow the differences between the parties by asking questions and explaining how the Statutory Accident Benefits Schedule (SABS) has been applied in other cases that were similar. If you and the insurance company cannot settle the case, the adjudicator may make decisions and give you instructions to prepare for a hearing. The adjudicator has the power to end the case at the case conference if the dispute does not fall within the legal authority of the LAT-AABS. The adjudicator can also order one or both parties to complete steps, exchange information or follow other orders as they deem necessary.

Settlement discussions are confidential and not recorded, and if parties are directed to a hearing, the adjudicator who leads the hearing will be different than the one who led the case conference. The adjudicator at the case conference will not tell the hearing adjudicator about your confidential discussions. The only documents that will be shared with the hearing adjudicator are documents that both parties may agree to send forward, and any orders made by the adjudicator with directions on how the hearing will be held or any preliminary issues that must be decided on. These orders are contained in the Case Conference Report and Order that will be sent to the parties shortly after the case conference.

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Hearings

A hearing will only be held if an agreement between the parties is not reached.

Schedule and Format

All parties will receive a ‘Notice of Hearing’ from the LAT-AABS Scheduling Unit which will include the date, time and hearing format. The date of the hearing will be within several months after the case conference.

LAT-AABS hearings can happen in writing, by videoconference, or, in limited circumstances, in-person. The hearing format is determined on a case-by-case basis by the LAT-AABS at the case conference with input from parties. The parties have an opportunity to make submissions about the hearing format they prefer at the case conference.

At the beginning of the hearing, the adjudicator will again see if the parties are able to settle the case. If they do not, the hearing will proceed. After the hearing, the adjudicator will make a final decision about the case, which will usually be sent to the parties as a written decision. LAT-AABS decisions are legally binding and must be followed by both the injured person and the insurance company.

Participants

The participants in a LAT-AABS hearing include:

• The adjudicator(s)
• The injured person (in most cases, this is the Applicant)
• A representative of the insurance company (in most cases, this is the Respondent)
• Any representatives of the participants (lawyer, paralegal or other representative)
• Witnesses
• Interpreters, if required for persons who require language interpretation or sign language interpretation
• Support persons, if needed

Hearings are open to the public, unless the adjudicator decides that all or part of the hearing should be closed for privacy reasons allowed by law.

What happens at a LAT-AABS hearing

A hearing is a legal proceeding led by a LAT-AABS adjudicator. The injured person and the insurance company each state their understanding of the case and the important issues. Each party will use evidence (documents, witnesses, etc.) to present their position.

The adjudicator controls the hearing. The adjudicator who leads the hearing will not be the same adjudicator as at the case conference and they will not know what happened at the case conference, unless it was noted in the Case Conference Report and Order. You will need to explain what has happened from the beginning.

During the hearing, the injured person and the insurance company, or their representatives, will explain their position to the adjudicator, question witnesses and introduce documents as evidence. The parties can make arguments about the facts and the law.

Parties must follow the directions of the adjudicator during the hearing. Adjudicators are neutral and independent. Adjudicators may provide assistance to a self-represented party about the hearing procedure, but then cannot act as an advocate on behalf of any party. Adjudicators cannot provide legal advice to either party. Adjudicators will often ask questions during the hearing, as the injured person and the insurance company present evidence to support their positions.

The adjudicator considers all of the evidence and everything the parties say, and then makes a decision based upon the evidence and the law. The decision is delivered later to the parties in writing, and it will include reasons to explain the result.

Everyone participating in the hearing is expected to be courteous and respectful of the adjudicator and of each other, which includes not interrupting anyone who is speaking. The person who filed the case presents their position first, and then the other party has their turn to present their position.

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Evidence

Evidence can include documents that the adjudicator considers in deciding the case, such as an invoice, estimate, letter, notice, photograph, video, advertisement, report, agreement, contract, etc. It could also include the police accident report, or a medical report from a doctor, physiotherapist or other type of medical professional. If the document is stored electronically, everyone involved in the case must have access to it, so you may have to provide a copy in electronic format.

In some cases, you may have to give an original document to the adjudicator to show that the document has not been changed or that everything on a photocopy shows up properly. If you are using a copy of a document, the parties can agree that a document is real without calling a witness to prove it, however, if the parties do not agree that the document is real, you may need to have a witness “prove” the document. The witness must testify and give details about when the witness prepared, received, sent, obtained or found the document. For example, in an accident case, if you have a physiotherapist’s report, and the insurance company does not believe it is real, you may have to submit a Summons to a Witness form to the LAT-AABS requesting for the physiotherapist to come to say they prepared the document and it is real.

Evidence can also be the testimony of witnesses – that is, what witnesses say at the hearing. Evidence from witnesses can also be contained in a written affidavit, where the witness swears or affirms that the information they state is the truth. A person who provides an affidavit may be required to be at the hearing to answer questions, known as cross-examination.

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Witnesses

A witness is someone with personal knowledge about the events. A person can be their own witness and testify at the hearing. The adjudicator will ask witnesses to make an affirmation or swear an oath that they will tell the truth. Persons who are called by one party to testify as a witness may be questioned by the other party – this is called cross-examination. The adjudicator may also ask questions to any witness.

Expert witnesses

An expert witness is a person who can provide technical information or an opinion at the hearing. The adjudicator can decide who is an expert witness, based on their experience. In accident cases, doctors who examined you after the accident are often expert witnesses. For more information about expert witnesses, please see Rule 10 of the LAT Rules .

Expert reports

Parties must exchange information about their expert evidence. This information is usually set out in written reports or witness statements and are called “expert reports”. These reports provide a summary of what the expert will say and explain briefly why they believe they are right. For more information about expert evidence, please see Rule 10 of the LAT Rules .

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If you cannot attend your case conference or hearing

You are expected to be prepared and ready to proceed on the date scheduled. If you cannot attend a scheduled case conference or hearing, you must notify the LAT-AABS and the other party as soon as possible that you are requesting an adjournment. The request must include:

• the reason for the request
• written agreement to the adjournment request from the other party or their representatives, if the parties have agreed to the request

There is no guarantee that an adjournment request will be granted. The adjudicator may order the case conference or hearing to proceed as originally scheduled.

For more information on adjournments, please see Rule 16 of the LAT Rules , the Practice Direction on Adjournments , and the Request for Adjournment form .

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French Language and Interpretation Services

If a party requires a case conference or hearing in French, a bilingual Case Management Officer and adjudicator will be assigned to the case. Parties may submit an application in French and request the proceeding to be conducted wholly or partly in French. Interpretation services are also available upon request. Parties should provide as much notice as possible, in advance of a proceeding to advise the LAT-AABS if they require interpretation services.

Decisions

After the hearing, the adjudicator who heard the application will issue a decision about the case, with written reasons that explain how they reached the decision. The Licence Appeal Tribunal –Automobile Accident Benefits Service (LAT-AABS) will send a copy of the decision to both parties.

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Orders

Adjudicators can make orders during the case conference, the hearing or as part of the decision.

The adjudicator’s orders are legally binding and must be followed.

If either party believes that the other party is not obeying an order or if a party is having trouble getting the remedy that the adjudicator has ordered, the order can be registered with the Superior Court of Justice. It is then enforceable as if it is an order of that Court.

The LAT-AABS cannot help with the enforcement of orders. Parties are encouraged to get legal advice.

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Requests for reconsideration

Under the LAT-AABS’s rules, a party can ask the LAT-AABS to reconsider its decision but must do so within 21 days of the date of decision. A request for reconsideration from a party must be served on all other parties and must include:

• reasons for the request, specifying applicable criteria under Rule 18.2
• notification if the party is seeking judicial review or pursuing an appeal in relation to the decision
• remedy or relief sought

Requests will be considered by the LAT-AABS. Requests will not be granted without first giving the other side an opportunity to respond. A request for reconsideration will not be granted unless the Tribunal is satisfied that one or more of the following criteria are met:

• the Tribunal acted outside its jurisdiction or committed a material breach of procedural fairness;
• the Tribunal made an error of law or fact such that the Tribunal would likely have reached a different result had the error not been made; or
• there is evidence that was not before the Tribunal when rendering its decision, could not have been obtained previously by the party now seeking to introduce it, and would likely have affected the result.

Reconsideration decisions are published on CanLII.

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When you can appeal a LAT-AABS decision

Decisions made by a LAT-AABS adjudicator can only be appealed if they contain a legal mistake. However, in limited circumstances, a party who is dissatisfied with a decision can request a “judicial review” by the Divisional Court.

Appeals must be filed with the Divisional Court within 30 days of the date the LAT-AABS releases its decision. You will find this date at the end of the decision document.

The Ministry of the Attorney General’s Guide to Appeals in Divisional Court explains how to apply for an appeal in Divisional Court.

The Divisional Court will ask if there is a transcript of the hearing. LAT-AABS hearings may be recorded, but the LAT-AABS does not guarantee the quality of any recording, nor is the LAT-AABS responsible for producing transcripts. Parties are strongly encouraged to seek the LAT-AABS‘s permission to bring their own court reporter and, if a party intends to use a transcript as part of their appeal, that party is responsible for ordering transcripts and providing copies to all other parties and the Tribunal.

You may want to get legal advice before you start your appeal.