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Dispute Resolution Services: Mediation

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Mediation

 
Mediation helps resolve disputes between insurance companies and claimants (people claiming accident benefits). A mediator in the Dispute Resolution Services (DRS) branch of the Financial Services Commission of Ontario (FSCO) helps the parties reach a mutually agreeable solution to their dispute.
 
Mediation is an informal and confidential process. The discussions are not recorded, and the mediator cannot be compelled to give evidence about the mediation. FSCO mediators are neutral, do not take sides and do not give legal advice. Mediators guide and support the parties in attempting to resolve the dispute.
 
Mediation of accident benefits disputes is mandatory in Ontario and must be conducted through FSCO before the dispute can proceed to arbitration or court.
 
The mediation process is explained in more detail in Part 2 of the Dispute Resolution Practice Code.
 
 

Who can apply?

 
A claimant or an insurance company can apply for mediation if they disagree about the claimant’s entitlement to accident benefits or the amount of benefits that should be paid.
 

Time Limits

 
You must apply for mediation within TWO YEARS after the insurance company refuses to pay the accident benefits claimed.
 
The time limit is important. You may not be able to have a mediation if you do not apply on time.
 
 

How do I apply for mediation?

 
  • The claimant and the insurance company first try to resolve their dispute informally.
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  • The claimant completes an Application for Mediation - Form A and sends the original and a copy to FSCO. (Insurance companies can also apply for mediation, but the claimant is the applicant in most cases.)
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  • The parties exchange and file all the relevant documents with the mediator. This may help resolve the dispute. Practice Note 4: Exchange of Documents explains the parties’ obligations.
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  • The insurance company (or the claimant, if the insurance company applied for mediation) files a Response to the Application for Mediation - Form B.
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  • DRS schedules a mediation. The mediation will take place in person or on the telephone (usually by conference call placed by the mediator). The claimant and insurance company representative are obliged to participate personally in the mediation process, even if they have a representative.
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  • The mediator issues a Report of Mediator describing what the parties agreed on and the issues that remain in dispute. The Report of Mediator completes the mediation process.
 
 

What does mediation cost?

 
There is no cost to an insured person for mediation. The Fees and Assessments document describes FSCO’s charges for insurance companies.
 
The claimant and insurance company must pay for their own expenses, for example, travelling expenses, accounting services, additional medical reports, and any legal fees.
 
 

 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 Law Society of Upper Canada website [New Window], 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 mediation?

 
If the Report of Mediator states there are issues that remain in dispute, there are three ways of having the dispute decided:
 
  1. The claimant can apply for arbitration by a FSCO arbitrator. Insurance companies are not allowed to apply for arbitration, but can raise new issues if the claimant applies for arbitration.
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  3. Either party (the claimant or the insurance company) can start a civil proceeding (law suit) in the courts.
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  5. If both parties agree, the dispute can be decided by a private arbitrator who is not employed by FSCO.
You must apply for arbitration within TWO YEARS after the insurance company refuses to pay the accident benefits claimed, or within a 90 DAY period after the mediator issues the Report of Mediator, whichever is later.
 
The same rules apply if you start a private arbitration or a law suit. There are different rules if you participate in neutral evaluation. The options are explained in Practice Note 5: Mediator Referral to Neutral Evaluation and Practice Note 6: Neutral Evaluation at the Financial Services Commission of Ontario.
 
 

Where can I get application forms?

 
 
Application requests or inquires about completing forms can made by calling Mediation Inquiries line at (416) 590-7210 or toll free 1-800-517-2332, extension 7210.
 

What is the status of my file?

 
To obtain information on the status of your application, call the contact person identified by DRS in our letters to you, or call the Mediation Inquiries line at (416) 590-7210 or
toll free 1-800-517-2332 extension 7210.
 
 

How long will the mediation process take?

 
Mediation must be concluded within 60 days of the registration of the completed Application for Mediation - Form A. This limit can be extended with the written consent of the parties.

 

Can I go straight to court or arbitration if I have already attended a private mediation?

 
No. Ontario Law requires accident benefits disputes to be mediated at FSCO before neutral evaluation, arbitration or civil proceedings.
 
 

How do I file a complaint about my adjuster, my lawyer, or my licensed paralegal?

 
If you have a complaint about the insurance company, see Resolving a Complaint about Insurance.
 
If you have a complaint about your lawyer, or your licensed paralegal contact the Law Society of Upper Canada. [New Window]
 

How much can my health practitioner charge me?

 
 

 How much can a health practitioner charge an insurance company for completing forms?