Response to an Application for Mediation (Form-B) – SABS

This form, “Response to an Application for Mediation – Form-B,” is issued by the Financial Services Commission of Ontario’s Dispute Resolution Services. It is used by respondents involved in a mediation process under the Statutory Accident Benefits Schedule (SABS) to formally address and respond to an application for mediation. The form requires detailed information about the respondent, including contact details, insurance company information, and the specific issues raised in the mediation application, such as weekly benefits, caregiver benefits, medical benefits, and other disputes. Respondents must also list key documents relevant to the mediation, and they are expected to have exchanged these documents with the other party before filing this form. Additionally, if the claimant is a minor or mentally incapable, a separate Form P must be completed. The form ensures that all parties have provided the necessary information and documents to facilitate the mediation process effectively.

Filling out this form requires careful attention to detail to ensure all necessary information is accurately provided. Below is a step-by-step guide on how to complete each section of the form:

Mediation File Number

• What to Enter: This is the unique file number associated with your mediation case. You should have received this number from the Financial Services Commission of Ontario (FSCO) when the application for mediation was filed.
• Where to Find It: This number is typically provided in the notification you received about the mediation application.

Claimant Information

• What to Enter: Provide the full legal name, address, contact details, and birth date of the claimant.
• Additional Considerations
  • Indicate the best way to reach the claimant (phone, mail, fax, or through a representative).
  • Specify the best location to reach the claimant (home, work, or other).
  • If the claimant is under 18 years old or mentally incapable, the person filing the response on behalf of the claimant must also complete and attach Form P.

Insurance Company Information

• What to Enter: Include the name of the insurance company, the claim representative’s name, the insurer’s claim number, the policyholder’s name, and the policy number.
• Why It is Important: This information ensures that the correct insurance company and policy are associated with the claim.

Respondent’s Representative

• What to Enter: If you have a representative (lawyer or licensed paralegal), provide their full name, title, firm name, and contact details.
• Additional Considerations:
  • If the representative is not required to be licensed, specify the type of exemption they fall under, as recognized in the Law Society’s by-laws.

Response to Issues

• What to Enter: In this section, respond to each issue raised in the Application for Mediation. This could include disputes over weekly benefits, caregiver benefits, medical benefits, rehabilitation benefits, other expenses, and more.
• Tips for Completion
  • Clearly outline your position on each issue.
  • If there are new issues you wish to raise, include them here as well.
  • Attach extra sheets if necessary to fully explain your responses.

Document List

• What to Enter: This section requires you to list the key documents that you have in your possession and plan to refer to during the mediation.
• Two Subsections
  • Documents in Possession: List documents you currently have.
  • Documents to Obtain: List documents you do not have yet but intend to obtain from other sources.
• Important Note: Ensure both parties have exchanged key documents before filing this response form.

Signature and Date

• What to Enter: The respondent (or their representative) must sign and date the form. This confirms that the information provided is accurate and complete.
• Why It’s Important: The signature is a legal acknowledgment of the contents of the form.

Distribution of Copies

• What to Do:
  • Make two copies of the completed form.
  • Keep one copy for your records.
  • Send one copy to the other party involved in the dispute.
  • Send the original form to the Mediation Services at the Financial Services Commission of Ontario.

Additional Information and Inquiries

• What to Do: If you have any questions or need further information about completing the form, you can contact Mediation Inquiries at the provided phone numbers or visit the FSCO website.

By following these steps, you can ensure that the “Response to an Application for Mediation (Form-B) – SABS” is completed accurately and comprehensively, facilitating a smoother mediation process.