When Ontarians purchase auto insurance, they expect that if they are injured in a motor vehicle accident, essential benefits will be there when they need them most. These benefits — income replacement, medical and rehabilitation care, attendant care, and other supports — are meant to help injured people recover and regain stability.
Yet new independent data suggests that for many injured and disabled Ontarians, access to those benefits is becoming increasingly difficult.
According to a recent statistical analysis by inHealth Inc., success rates for injured people disputing accident benefit denials have fallen dramatically. In 2024, only 8% of applicants were fully successful at Ontario’s accident benefits tribunal. This represents a steep decline from 33% in 2017, the tribunal’s first full year of operation.
This trend raises serious concerns about access to justice — and whether Ontario’s accident benefits system is functioning as intended.
Accident Benefits Are Consumer Protection — At Least in Theory
Ontario’s no-fault accident benefits system is governed by the Statutory Accident Benefits Schedule (SABS). The SABS is intended to operate as consumer-protection legislation, ensuring that people injured in car accidents can access care and income support without needing to prove fault.
Disputes inevitably arise. Insurance companies may deny treatment plans, income replacement benefits, or catastrophic impairment designations. When that happens, injured people must challenge those denials through Ontario’s dispute-resolution system.
Since 2016, that system has been centralized at the Licence Appeal Tribunal (LAT). When the LAT was given exclusive jurisdiction over accident benefit disputes, the promise was clear:
- Faster decisions — typically within 60 to 90 days
- A process simple enough for injured people to navigate without lawyers
- Greater efficiency and consistency
Nearly a decade later, the data tells a very different story.
The Numbers Tell a Troubling Story
The inHealth analysis reviewed 5,670 substantive LAT decisions released up to the end of 2024. The findings are striking:
- In 2017, injured applicants were fully successful 33% of the time
- By 2023, that number fell to 11%
- In 2024, full success dropped further to just 8%
At the same time, insurer success rates have steadily increased. By 2024, insurance companies were fully successful in approximately 74% of all cases.
Importantly, this decline is not offset by an increase in partial or “split” outcomes. Mixed results have remained relatively stable over time, meaning the shift is overwhelmingly toward complete insurer victories.
The pattern is also consistent across benefit types — including income replacement benefits, medical and rehabilitation benefits, and catastrophic impairment determinations — suggesting a systemic issue rather than isolated anomalies.
Delays Undermine Access to Justice
The LAT was designed to provide quick resolutions. In practice, delays have become severe.
Today, injured people often wait more than two years from the time they apply to the LAT to receive a final decision. For individuals who are unable to work, require ongoing treatment, or depend on benefits to meet basic living expenses, these delays can be devastating.
Justice delayed, particularly in a benefits system, often amounts to justice denied.
A System That Is Unrealistic for Self-Represented Claimants
One of the original justifications for moving accident benefit disputes to the LAT was that injured people would not need legal representation. However, the data strongly contradicts that assumption.
The inHealth report shows that self-represented applicants experience extremely poor outcomes, with success rates far below those of represented claimants — and near-zero success on certain types of claims.
At the same time, the LAT does not award legal costs, even when an injured person succeeds and the insurer was wrong. This creates a system where:
- Injured people struggle to obtain legal help
- Lawyers are forced to turn away many deserving cases
- Insurance companies face little financial consequence for denying benefits
The result is an imbalance that discourages meaningful challenges to insurer decisions.
Reconsiderations Offer Limited Correction
The report also highlights concerns with the reconsideration process. In many cases, a request for reconsideration may be decided by the same adjudicator who issued the original decision.
While the report does not assign motive, this structure places a very high bar on meaningful review and limits the system’s ability to correct potential errors. From the perspective of injured Ontarians, this further erodes confidence in the fairness of the process.
Real Consequences for Real People
These trends are not abstract. When injured people lose accident benefit disputes:
- They may go without necessary treatment
- They may be forced back to work before they are medically able
- They may accumulate debt or rely on family members
- Costs are shifted from private insurers to public systems and taxpayers
For many injured Ontarians, the LAT represents the only avenue to challenge an insurer’s denial. When success rates fall to single digits and delays stretch into years, access to justice becomes illusory.
A Call for Review and Reform
This is not about attacking adjudicators or questioning individual integrity. The concern is structural.
The data raises legitimate questions about whether Ontario’s accident benefits dispute-resolution system is:
- Interpreting consumer-protection legislation as intended
- Providing timely and meaningful access to justice
- Maintaining public confidence
At a minimum, the system warrants independent review, increased transparency, and reform aimed at restoring balance and fairness for injured and disabled Ontarians.
Insurance is only meaningful if it works when people need it most.
About the Author
Nainesh Kotak is a disability and injury lawyer and the founder of Kotak Law. He represents injured and disabled individuals in accident benefit, disability insurance, and related claims across Ontario and Alberta.
