If mediation at the Financial Services Commission of Ontario (FSCO) fails to settle the dispute, the claimant can apply to have the disputes decided by an arbitrator in the Dispute Resolution Services (DRS) Branch of FSCO. Insurance companies are not allowed to apply for arbitration, but can raise new issues if the claimant applies for arbitration.
The arbitration process is explained in more detail in Part 3 of the Dispute Resolution Practice Code.
If mediation fails and you decide to apply for arbitration, you must apply within TWO YEARS after the insurance company refuses to pay the accident benefits claimed, or within 90 DAYS after the mediator gives the Report of Mediator, whichever is later.
The time limits are important. If you do not apply on time, you may not be allowed to have an arbitration hearing.
How do I apply for arbitration?
To apply for arbitration, you must send FSCO two completed copies of an Application for Arbitration - Form C
, the Report of Mediator or Report of Neutral Evaluator you received, and an application fee of $100. You can pay by cheque or money order payable to the Minister of Finance. Please visit Fees and Assessments
for more detail.
Arbitration pre-hearing conferences
Arbitration hearings take place at FSCO or at a location near the claimant’s home. They are similar to hearings in court, but they are shorter, less formal and cost less. The arbitrator hears evidence from you and the insurance company and gives a written decision, with reasons based on the evidence and the law.
An arbitrator’s decision is binding on the parties. It has the same authority as an order of a judge in the Ontario Superior Court of Justice, and can be enforced by the court.
What does arbitration cost?
FSCO charges claimants $100 to file an Application for Arbitration - Form C.
You will likely incur some costs in preparing and presenting your case at arbitration, for example, legal fees, fees charged by doctors and other experts for preparing reports, witness and other fees.
After deciding your case, the arbitrator has power to:
- order you to pay all or part of the insurance company’s arbitration expenses,
- order the insurance company to pay all or part of your arbitration expenses, or
- order no expenses, leaving it to each party to pay their own expenses.
The expenses decision is based on each party’s degree of success in the outcome of the arbitration, any written offers to settle, whether novel issues were raised, the conduct of the parties and their representatives, and whether any aspect of the proceeding was improper, vexatious or unnecessary.
The rules about ordering expenses, and the amount that can be ordered, are explained in the Section F Expenses regulation of the Dispute Resolution Practice Code.
Do I need a lawyer?
You do not need a lawyer for dispute resolution at FSCO. You can choose to represent yourself.
However, as disputes can become complicated and most insurance companies have lawyers representing them at arbitration and appeal, you should consider consulting a lawyer or licensed paralegal.
If you need help finding a representative, the Law Society of Upper Canada offers a referral service. For more information, visit the Law Society of Upper Canada website
, or call 1-900-565-4577
. (There is a fee for this referral service).
You are entitled to have a friend or family member help you in an informal and unpaid manner, but only if the person receives no compensation directly or indirectly.
What are my options after arbitration?
Either the claimant or insurance company can appeal
an arbitrator’s order on a question of law within 30 days of the arbitration decision.
Either the claimant or the insurance company can apply to the Director of Arbitrations for variation or revocation of the arbitration decision if there has been a material change in the circumstances of the insured person, evidence not available at the arbitration has become available, or there is an error in the arbitration or appeal order (for example, the order does not correspond to the reasons for the decision).