Insurance disputes
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n the event of accident or property damage, you and your insurance company may disagree as to what benefits you are entitled to. If you cannot come a to an agreement with your insurance provider, your insurance dispute is handled by the Dispute Resolution Services branch of the Financial Services Commission of Ontario (FSCO).
The FSCO dispute resolution services include:
- Mediation
- Neutral Evaluation
- Arbitration
- Appeal
- Variation & Revocation
Mediation
Mediation uses a neutral mediator to assist you and your insurance provider to agree on a mutually beneficial outcome in your insurance dispute. These sessions usually take place in person or over the telephone.You must apply for mediation within two years of your dispute. If you do not apply in time you may not qualify for mediation. Mediation is available at no cost but you must pay your own lawyer fees and other personal costs. You must represent yourself in the mediation process. You may only have someone representing you in extreme circumstances.
If the mediation process does not resolve all of the issues then your next set of options are:
- Application for arbitration with an FSCO arbitrator
- Lawsuit against your insurance provider
- Neutral evaluation or private arbitration
Neutral Evaluation
A neutral evaluator that both you and your insurance provider agree upon can be hired to review the mediation process. They will then give you an opinion on what is most likely to happen if the insurance dispute is taken to court. This decision is non-binding. You and your insurance provider can decide to come to an agreement based on this evaluation or proceed with arbitration or a lawsuit.
Arbitration
If your dispute is not settled by mediation, then your next step is to apply for arbitration. You must apply for arbitration within two years of your dispute, or within 90 days after the Report of the Mediator is issued by the FSCO.
A pre-hearing conference in which you discuss your case with an arbitrator will be arranged. Here you will try to come to an agreement with your insurance provider before a formal hearing is required. If no agreement is reached, a formal hearing will be scheduled.
Arbitration has a fee of $100 and you are likely to incur costs in preparation of your case. After hearing your case the arbitrator will make a decision that is binding to both parties in the insurance dispute.
There are two possible processes after the arbitration process in complete. Appeal and Variation & Revocation.
Appeal
You or your insurance provider can appeal the arbitrator’s decision within 30 days. An appeal is heard through a short hearing and written submissions, in which no new evidence can be presented. The Director of Arbitrations or a Director’s Delegate makes a final decision, which cannot be appealed.
Variation and Revocation
There are three reasons for which you or your insurance provider may apply for a variation or revocation of the arbitration or appeal order.
- There has been a material change in your circumstances that affects the arbitration result.
- New evidence becomes available after the appeal or arbitration has occurred.
- There is an error in the appeal or arbitration ruling.
A variation or revocation application costs $250 and your insurance provider must respond to your request within 20 days.
Insurance dispute law can be overwhelming and difficult to comprehend. If you find yourself in a dispute, hiring a lawyer is the best way to ensure you are treated fairly, have a thorough understanding of the process, and receive a satisfactory outcome.
For a free consultation with an insurance dispute lawyer call us at:
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