If there is a dispute between a claimant and an insurer with respect to the amount of or entitlement to statutory accident benefits, the dispute must be resolved through the Dispute Resolution Group at the Financial Services Commission of Ontario. The first step is mediation. Mediation is mandatory for all disputes with respect to statutory accident benefits. The Commission appoints a mediator who will attempt to resolve the dispute between a claimant and an insurer. While a lawyer is not required by law, an unrepresented claimant is frequently outgunned by an insurance company representative who is better informed, better trained and who deals with the same mediators all the time. A claimant is well advised to hire a lawyer who specializes in these types of claims.
In the event that a dispute is not resolved at the mediation stage, the claimant may apply to the Commission for Arbitration, may agree with an insurer on private arbitration, or may sue the insurer in court. Again, while a lawyer is not required by law, Insurers almost invariably hire a lawyer and go to arbitration with the expectation of winning. A claimant is well advised to seek legal advise and to hire a lawyer for court or arbitration.