Odds ‘stacked’ against car accident victims who take benefits disputes to Ontario tribunal, lawyers say

TORONTO — It took six years and a complicated legal battle for Ngoc My Ly to reach a settlement with her insurance company after a car crash that left her with chronic pain, depression, dizziness and memory loss.

After her treatment plan and benefit claims were initially denied by her insurer, Aviva, the Toronto-area woman turned to Ontario’s Licence Appeal Tribunal, a quasi-judicial body tasked in 2016 with handling accident benefits disputes in an effort to make the process faster and more user-friendly.

Then came the twist that propelled her case into the spotlight: the adjudicator assigned to her file had accepted a job with Aviva before rendering a decision in the insurer’s favour in the case and several others, raising concerns about a conflict of interest.

A new hearing was ordered, a victory that nonetheless prolonged the process and piled on the bills, as did the challenges that followed, her lawyer said in a recent interview, noting successful applicants can’t recoup legal costs through the tribunal.

“So now not only has she been denied benefits, she’s lost one hearing outright and now she has no choice but to go to a second hearing at her own cost,” Meghan Hull Jacquin said. Meanwhile, her client was paying for treatment out of pocket, unsure if she would get reimbursed for that or her lost income, Hull Jacquin said.

The decision in the second hearing sided with Ly on most issues. She then reached a confidential settlement with the insurer last year, after enduring an “extremely taxing” process even as she tried to recover from the 2019 crash, the personal injury lawyer said.

“Many, I think, would have just said, ‘I can’t do it’ and had to just walk away, which is, frankly, what happens in many of these cases,” she said.

Few people are aware of the Licence Appeal Tribunal or how it works until they end up in front of it, Hull Jacquin said. But the system deserves scrutiny, particularly in light of plummeting success rates for those challenging their insurers, she said.

A report commissioned by the Ontario Trial Lawyers’ Association and released last fall found the success rate for applicants at the tribunal dropped to eight per cent in 2024, down from 11 in 2023 and 33 in its inaugural year.

Those “skewed” outcomes could undermine public faith in the fairness of the system, Hull Jacquin said. “Why would somebody put themselves out there … when the odds are so clearly stacked against them?”

Advocates including the lawyers’ association have long called on the Ontario government to review and reform the tribunal, saying the downward trend reflects broader issues in the system.

The latest findings, the association said, raise “important questions about balance, transparency and whether the tribunal is fulfilling its legislative mandate to provide a fair, accessible dispute resolution process for injured Ontarians.”

The office of the attorney general declined to comment, referring questions to Tribunals Ontario.

A spokesperson for Tribunals Ontario said that as a neutral adjudicative body, the Licence Appeal Tribunal doesn’t measure or track outcomes by party.

The tribunal receives between 16,000 and 17,000 new files annually, and 96 per cent of those closed each year are resolved through dispute resolution mechanisms that don’t require a final adjudicated ruling, Veronica Spada wrote in an email to The Canadian Press.

Any analysis that doesn’t account for that is “working from an incomplete picture” of how the tribunal operates, she said.

“Drawing system-wide conclusions from that subset of outcomes alone would not accurately reflect the tribunal’s performance.”

Ontario has a two-tier compensation system for those hurt in vehicle collisions. Some can sue the driver deemed at fault for damages. People can also receive compensation regardless of who’s at fault under what’s known as statutory accident benefits.

This coverage is part of every auto insurance policy in Ontario and includes supplementary benefits for medical, rehabilitation and attendant care as well as income replacement, with caps set based on the severity of the injuries. This summer, benefits beyond medical, rehabilitation and attendant care will become optional add-ons.

Disputes can arise when insurance companies deny treatment plans or specific benefits, or contest the seriousness and impact of the injuries stemming from the collision.

Since 2016, the only recourse for those seeking to challenge those decisions has been the Licence Appeal Tribunal’s Automobile Accident Benefits Service tribunal. The accident benefits tribunal recovers its operating costs from the insurance industry rather than relying on provincial funding.

When the tribunal was given exclusive jurisdiction over these disputes, “the promises that were made … were clear,” said Nainesh Kotak, a disability and personal injury lawyer whose firm operates in Ontario and other provinces.

Those included faster rulings, typically within 60 to 90 days; a process simple enough for injured people to navigate without a lawyer; and greater efficiency and consistency, he said in a recent interview.

“But the reality is, nearly a decade later, the data is telling us a different story,” he said, and the consequences are “not abstract.”

People may end up going without necessary care for long stretches of time, or may go into debt and depend on family for financial support, Kotak said. Costs are also passed on to the public health-care system instead of being borne by insurers, he said.

Three years ago, the tribunal announced it had cleared its backlog of cases, but Kotak said some people are still waiting more than two years from the time they file their application to when they receive a final decision. Critics have also expressed concerns that the tribunal is prioritizing speed at the expense of fairness in making decisions.

When people challenge the outcome of their case, the file is typically sent to the same adjudicator for review, making it less likely an error will be found, some lawyers and advocates say. The fact that the tribunal doesn’t award costs also favours the insurance industry by adding a financial barrier for applicants, they say.

As well, adjudicators appointed to the tribunals come from a range of professions and may not have expertise in the subject matter, or a legal background, critics say.

The Divisional Court, which hears appeals and judicial reviews of tribunal rulings, has generally upheld the majority of decisions but recently cited unfairness in overturning several from the auto benefits tribunal, including more than one where the adjudicator relied on a report by an expert who was never cross-examined.

The court has also previously raised concerns about the tribunal’s decision-making process in a landmark case where the ruling was reviewed by a supervisor before it was delivered, even though the adjudicator had not requested a consultation or feedback. That raised a “reasonable apprehension of lack of independence,” the court found.

Spada, the Tribunals Ontario spokesperson, said the tribunal’s current operations are “not driven by any backlog‑related pressures to move files at an accelerated pace” given that its backlog of cases was eliminated in October 2023.

The tribunal’s record at the Divisional Court speaks to the quality of its final decisions, she added, noting roughly 74 per cent of the accident benefits tribunal’s decisions brought before the court over the last several years have been upheld.

“This is a consistent figure that reflects the rigour and soundness of the adjudicative process,” she wrote.

All adjudicators are “independent decision-makers with the exclusive authority to make decisions in accordance with the relevant legislation,” she said. It would be “absolutely inappropriate” for the tribunal or others to try to influence how an adjudicator rules on a case based on anything other than the facts of the case and the applicable law, she said.

Those appointed to the Licence Appeal Tribunal go through a comprehensive onboarding process that includes training on the relevant laws and rules of procedure, as well as the specific legal framework regarding automobile accident benefits, Spada said. Ongoing training is offered to ensure they stay up to date on the law and new rulings from the Divisional Court, she said.

All Tribunals Ontario adjudicators are also trained on their ethical obligations during onboarding and receive an annual reminder, she said.

Concerns regarding institutional bias and transparency at the tribunal remain, said Imtiaz Hosein, a Toronto-area lawyer who is asking Canada’s top court to weigh in on a case centred on these issues.

Lucia Derenzis, a pedestrian who was struck by a vehicle in 2015, sought to file an affidavit from a former adjudicator turned whistleblower three years ago as part of her request for a reconsideration after the tribunal rejected her claim for income replacement and a catastophic impairment designation.

That prompted the tribunal to order the document’s destruction, citing protections for the decision-making process as well as solicitor-client privilege, said Hosein, who is part of her legal team.

The Divisional Court sided with the tribunal but summarized the contents of the affidavit in its ruling.

According to the court, the affidavit described internal consultations among adjudicators on “legal and policy matters involving adjudicative directions,” information on mandatory instructions on decision making given to adjudicators by the tribunal’s legal team and vice chairs, and bulletins telling adjudicators to deny motions filed by parties considered “difficult” or “high conflict.”

The case comes at a time when public confidence in the tribunal is already being tested, Hosein said.

“When the public is denied the opportunity of having the types of concerns that Ms. Derenzis is raising about institutional bias appropriately tested in a way that’s transparent and open, it will leave a cloud about the integrity of the tribunal itself and of our general justice system,” he said.

“That’s why I think it’s so important.”

Cassandra Dall’ Agnese worked as a personal injury lawyer for years before a car crash in 2019 forced her to advocate for herself like she would for a client.

Her car was rear-ended by a truck at a red light, leaving her badly concussed and bruised, then grappling with chronic pain, tremors and complex post-traumatic stress disorder, she said. She couldn’t work or safely do household tasks, or bear to look at herself in the mirror, she said.

Dall’ Agnese’s experience and legal connections allowed her to successfully navigate the medical assessments required by her insurer, and she eventually obtained a settlement without taking her case to the tribunal, she said.

Still, “it was crazy making to become a literal victim of the industry that I had worked in,” she said.

In her view, the core of the problem is the legislation governing car accident benefits itself. For one thing, she said, some of the benefit amounts set out in the legislation haven’t increased in decades, despite skyrocketing inflation.

Arguing these cases was already an “uphill battle” but it became much harder after the tribunal was introduced, she said.

“Giving that piece of legislation an arena where things are not as strictly refereed was not a wise decision.”

This report by The Canadian Press was first published April 21, 2026.

Paola Loriggio, The Canadian Press