If you have been injured in a motor vehicle accident in Ontario, you may rely on accident benefits to cover medical treatment, rehabilitation, and income replacement while you recover. These benefits are meant to provide timely financial support, regardless of who was at fault for the accident. However, many injured individuals experience delays, reductions, or denials of accident benefits from their insurance companies.
When disputes arise, they are most often resolved through the Licence Appeal Tribunal (LAT). Understanding how the LAT works and what it means for your accident benefit claim is essential if you are facing an insurance dispute in Ontario.
What Is the Licence Appeal Tribunal (LAT)?
The Licence Appeal Tribunal (LAT) is an independent administrative tribunal in Ontario that adjudicates disputes between individuals and insurance companies, among other matters. Since April 2016, the LAT has been the primary forum for resolving disagreements related to Statutory Accident Benefits Schedule (SABS) claims.
Before this change, many accident benefit disputes were handled through the court system or the Financial Services Commission of Ontario (FSCO) processes. The LAT was introduced to create a system that is intended to be more efficient and cost-effective. While the tribunal process may be faster in theory, it has also introduced new procedural and evidentiary challenges for injured claimants.
Why Accident Benefit Disputes Go to the LAT
Accident benefits are paid by your own insurer and may include several types of financial and care-related support. These benefits can help cover:
- Medical and rehabilitation expenses
- Income replacement benefits if you are unable to work
- Non-earner benefits
- Attendant care benefits
- Caregiver and housekeeping benefits in certain cases
When an insurer denies, reduces, or terminates any of these benefits, the dispute generally proceeds to the LAT. These disagreements often centre on medical opinions, benefit eligibility, or whether treatment is considered reasonable and necessary under Ontario law.
Common Reasons Accident Benefit Claims Are Denied
Insurance companies deny or limit accident benefit claims for a variety of reasons. Some of the most common include:
- The insurer classifies the injury as minor, limiting available benefits
- Disagreements about whether the proposed treatment is medically necessary
- Claims that the injured person has recovered or no longer requires benefits
- Conflicting medical opinions from insurer-arranged examinations
- Administrative or documentation issues, including missed deadlines
For injured individuals, these denials can be both financially and emotionally stressful, particularly when ongoing treatment or income support is needed.
How the LAT Process Works in Ontario
The LAT process follows specific procedural steps, and strict deadlines apply. While each case is different, most accident benefit disputes progress through the following stages:
Filing an Application
Once internal insurer reviews or mediation attempts have failed, the injured person may file an application with the LAT to dispute the denial or reduction of benefits.
Case Conference
In some cases, a case conference is scheduled. This step allows the adjudicator to clarify the issues, explore possible resolutions, and set expectations for the hearing process.
Written or Oral Hearing
Many LAT cases proceed by way of written hearings, where decisions are made based solely on submitted documents. In some situations, an oral or electronic hearing may be granted, but this is not guaranteed.
Decision
After reviewing the evidence and submissions, the LAT adjudicator issues a written decision. The decision is binding unless appealed under limited circumstances.
The written-hearing model places significant importance on medical records, expert opinions, and properly prepared submissions.
LAT vs. Court: Key Differences Accident Victims Should Know
There are several important differences between LAT proceedings and traditional court cases:
- LAT hearings are generally more document-focused
- Opportunities for cross-examination are limited
- Strict procedural timelines must be followed
- Legal and medical evidence must be clearly presented in writing
These differences can make LAT disputes challenging for individuals who are unfamiliar with the process or unprepared for the evidentiary burden required.
Challenges Injured Claimants Face at the LAT
While the LAT was designed to be accessible, many injured claimants encounter difficulties navigating the system. Common challenges include:
- Understanding procedural rules and filing deadlines
- Responding to insurer-retained medical assessments
- Obtaining supportive medical opinions in a timely manner
- Meeting the burden of proof required to establish entitlement to benefits
Insurance companies are experienced in LAT litigation and often rely on detailed medical and legal arguments to support their position.
Why Legal Representation Matters in LAT Disputes
Accident benefit disputes before the LAT can have significant financial and long-term implications. Having an experienced personal injury lawyer can help injured individuals better understand their rights and navigate the process.
Legal representation may assist with:
- Evaluating whether benefits were unfairly denied or terminated
- Collecting and organizing medical and vocational evidence
- Preparing effective written submissions
- Ensuring compliance with LAT procedural requirements
- Advocating for fair access to entitled benefits
This support can be especially important in cases involving serious injuries, long-term treatment needs, or disputed income replacement benefits.
What to Do If Your Accident Benefits Are Denied
If your accident benefits have been denied or reduced, it is important to take proactive steps, including:
- Reviewing the insurer’s explanation for the denial
- Keeping detailed records of medical treatment and expenses
- Seeking clarification on appeal deadlines
- Understanding your options before the LAT
Early action can help preserve your rights and improve your ability to challenge an insurer’s decision effectively.
Final Thoughts
The Licence Appeal Tribunal plays a central role in resolving accident benefit disputes in Ontario. While it is intended to provide an efficient alternative to court, the process can be complex and demanding for injured individuals. Understanding how the LAT operates, the challenges involved, and the importance of proper evidence can help accident victims make informed decisions during a difficult time.
If your accident benefit claim has been denied or delayed, learning about your options early may help protect your access to the benefits you need for recovery.
