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Frequently Asked Questions About the Licence Appeal Tribunal (LAT)
- What is the Licence Appeal Tribunal (LAT)?
- What is the difference between a Licence Appeal Tribunal and a court?
- Who can file an appeal in the Auto Accidents Benefits Service (AABS) of the LAT?
- How do I know if I have the right to appeal a Decision/Proposal/Order to the LAT?
- What happens if I do not appear on the date set for the hearing and I do not notify the LAT?
- Who will hear my AABS LAT appeal?
- Is my appeal going to be heard in writing or in person?
- When does a LAT decision take effect?
- What if I disagree with a LAT decision?
- Are LAT hearings open to the public?
- Do I need a Lawyer?
- Why is it important to choose a law firm that can cover expert fees if you appear before the LAT?
- Should I always agree to a full and final settlement of my accident benefits claim at the LAT?
- Am I required to settle my entire accident benefits case with the insurance company when I have only appealed certain issues that are currently before the LAT?
- When can I go ahead with appealing an insurance company’s denial or stoppage of a benefit?
- How do I fill out a LAT form?
- How do I file an appeal with the AABS LAT?
What is the Licence Appeal Tribunal (LAT)?
The LAT is an autonomous, quasi-judicial agency. LAT reviews applications and resolves disputes regarding compensation claims and licensing activities regulated by the provincial government.
The LAT currently has two divisions: General Service (GS) and the Automobile Accident Benefits Service (AABS). GS oversees a wide range of legislation and case types, whereas AABS resolves disputes about an insured person’s entitlement to, or amount of, a statutory motor vehicle accident benefit.
What is the difference between a Licence Appeal Tribunal and a court?
The LAT is quasi-judicial agency, it is created by statute and it has many of the same powers and procedures that we see in a court of law, however, the biggest distinguishing factor is the rules of evidence appear to be less stringent and the parties in many instances represent themselves. The person who oversees a hearing in the LAT is not a judge but rather an adjudicator who derives his or her powers from the Insurance Act, Statutory Powers and Procedures Act, as well as the Common Rules of Practice specific to the LAT.
Who can file an appeal in the Auto Accidents Benefits Service (AABS) of the LAT?
An injured claimant, an insurance company, or their representatives, can appeal their disputes to the LAT. If you disagree with your insurance company’s decision to deny, reduce, or withhold your accident benefits, you can appeal to the LAT to argue your case. For example, if your healthcare provider submits a treatment plan (OCF-18) for a specific treatment and/or assessment, and your insurance company determines this request for treatment and/or assessment is unreasonable or necessary, you can file an appeal with the LAT. A second example could include the insurance company’s disagreement that your injuries are of a severity to be deemed catastrophic.
How do I know if I have the right to appeal a Decision/Proposal/Order to the LAT?
Your right to appeal to the LAT must be communicated by your auto insurer in writing to you or your legal representative each time they make a decision which affects your right to a benefit. You have two years from the date of the insurance company’s decision to appeal to the LAT. A failure to appeal within this two-year timeframe, will likely prohibit you from being able to overturn the insurance company’s decision.
What happens if I do not appear on the date set for the hearing and I do not notify the LAT?
It is vital that you attend any proceedings on their scheduled date. The LAT will attempt to reach you if you are not present. If they are not able to reach you, the hearing may proceed without you, and you would not be entitled to further notice in the proceedings. The LAT may also dismiss your appeal.
Who will hear my AABS LAT appeal?
Hearings are conducted by a LAT member who will either be an adjudicator or a vice-chair. LAT members are appointed by Order-in-Council. For more information about the appointment process, please visit the Public Appointment Secretariat website.
Is my appeal going to be heard in writing or in person?
The majority of appeals are in writing. Those issues tend to be issues of treatment or rehabilitation disputes. More complicated appeals regarding income replacement benefits, non-earner benefits, attendant care benefits, or catastrophic determination are heard orally (in person) via video conference.
The cost difference between these hearings is substantial, as expert witnesses need to be paid to testify in an oral hearing. The overall preparation time is also costly, and legislation no longer allows for the recovery of these costs even if you are successful in your appeal.
When does a LAT decision take effect?
Unless otherwise indicated, a decision takes effect on the day it is released. In addition to future benefits, a decision can order retroactive benefits and interest for various periods.
What if I disagree with a LAT decision?
A party can ask the Executive Chair of SLASTO to reconsider a decision. An appeal for reconsideration must be filed within 21 days of the date the Tribunal issues a decision. There is also a statutory right of appeal from a decision of a tribunal on a question of law only. This appeal must be filed before the Ontario Superior Court of Justice, Divisional Court within 30 days of the date the tribunal issues its decision (it is not 30 days from the date of the reconsideration).
Are LAT hearings open to the public?
Yes, LAT hearings are open to the public unless otherwise ordered by the adjudicator overseeing the hearing.
Do I need a Lawyer?
You do not need a lawyer to file an appeal with the LAT; however, it is strongly recommended to retain the services of a legal representative who is Licenced to appear before the LAT. This can be a licensed paralegal or a lawyer. It is important that you understand the advantages and disadvantages of each type of legal representation for your LAT appeal. For example, only lawyers can conduct LAT hearings for a dispute regarding the determination of catastrophic impairment. Therefore, the more serious your injuries, the more prudent it is to hire an experienced lawyer who can appear before the LAT to argue any dispute regarding catastrophic impairment.
For more information about the importance of legal representation, please read our blog on having the right legal representation.
Why is it important to choose a law firm that can cover expert fees if you appear before the LAT?
It can cost between $25,000-$35,000 to cover the expenses associated with expert fees if you have to appear before the LAT for more complex issues such as income replacement benefits, attendant care benefits, and/or the determination of catastrophic impairment.
You need to work with a firm that can handle the exorbitant expenses of obtaining third-party medical experts, especially in appeals relating to the determination of catastrophic impairment. Experts require payment for their reports as well as their testimony if they are to appear as an expert on your behalf in an oral hearing at the LAT.
For more information about the importance of working with a law firm that can cover expert fees, please read our blog on expert fees.
Should I always agree to a full and final settlement of my accident benefits claim at the LAT?
No. In cases where you are unsure of the prognosis of your injuries and how they may affect you in the future, signing a full and final settlement will put you at risk of not being able to claim any future benefits related to the injuries you sustained from the motor vehicle accident. Settling before the five-year mark in cases of non-catastrophic injuries (where medical rehab and attendant care benefits are available for 5 years or up to $65,000) can be problematic if your injuries worsen and can still be traced to their original cause.
There is currently no limitation preventing an accident victim from pursuing a catastrophic impairment determination for injuries that resulted from a motor vehicle accident, except in cases where they settled their entire accident benefits claim with their insurance company.
Am I required to settle my entire accident benefits case with the insurance company when I have only appealed certain issues that are currently before the LAT?
This is where clients or other legal representatives make mistakes when they settle out an entire accident benefits claim when the appeal was relating only to a simple medical rehab issue or even a more complicated income replacement issue. This mistake is particularly grave when there is uncertainty about the prognosis or future function of a person who has been involved in a serious motor vehicle accident. Unfortunately, our current legislation, your legal representative, or the adjudicator overseeing your case conference, can sometimes suggest that an early settlement of your entire accident benefits case with your insurer is favourable to you and can result in relieving the legal burden of continuing to fight for past and future accident benefits.
Settling without knowledge of what care you may require in the future could put you at risk, especially if your injuries become catastrophic.
When can I go ahead with appealing an insurance company’s denial or stoppage of a benefit?
If an insurance company denies or stops paying benefits to an insured person, the insurance company must provide written notice of this decision that includes the reason for its denial or stoppage. Once you receive this notice you can file an appeal by completing an AABS LAT application.
AABS LAT applications must be filed within two years of a denial or stoppage notice from an insurance company.
AABS LAT does not hear disputes about damages for pain and suffering, damages to cars or other property, determining who is at fault, or determining which insurer is responsible for a claim.
How do I fill out a LAT form?
The LAT has several different types of appeals and applications for different case types, each with its own appropriate forms and required details. Forms for each can be found on the Tribunals Ontario website. As each case type has its own specific requirements, timelines for filing with LAT are different dependent on the type, with timelines identified on the decision, proposal, or order issued by the Regulator or Registrar.
When you apply, you should provide reasons for the application and the result or action you are seeking.
How do I file an appeal with the AABS LAT?
To file an appeal you complete an Application by an Insured Person for Auto Insurance Dispute Resolution under the Insurance Act. You can either send it by mail or email. There is a filing fee, which must be paid before your application is submitted. Once the application has been submitted, a Case Management Officer will review the documents, and may reach out to you for more information if necessary.
Another method for initiating your appeal is by electronic filing, using the e-File. e-File is available to the public and provides a simple and fast option to file applications, responses and other documents. For more information, the LAT has also created a guide on how to submit documents with your application.
Within 5 days of filing your application, you must serve a copy of the application and all additional attached documents to the Insurance Company and the Insurance Company’s representative and serve the Tribunal with a completed Certificate of Service as proof of service of the documents.