Claims for accident benefits seldom go smoothly. Your insurance company has a right to dispute your injuries and the amounts and types of benefits that you claim are required. Often after several months of a claim, your insurer will have you examined by their medical experts14. At that time, and according to their medical expertÕs reports, they may decide that you no longer meet the 'substantial inability' or other tests necessary to claim benefits, and they will terminate your benefits. The claimant has a right to dispute this termination of benefits.
At that time and as required by the regulations, we will mediate your claim on your behalf at the Financial Services Commission of Ontario, which is the organization that will act as mediator between the claimant and the insurance company. If successful, the insurance company will reinstate your benefits. If not, the claimant has a choice of either taking the claim to arbitration, or issuing a legal proceeding in the Ontario Superior Court of Justice.15
- INTRODUCTION
- MEDICATION REHABILITATION BENEFIT
- INCOME REPLACEMENT BENEFIT
- CAREGIVER BENEFIT
- ATTENDANT CARE BENEFIT
- HOUSEKEEPING AND HOME MAINTENANCE BENEFITS
- ADDITIONAL BENEFITS
- DISPUTED CLAIMS
- LUMP SUM SETTLEMENTS OF ACCIDENT BENEFITS CLAIMS
