Response by Insurer to an Application for Arbitration (Form E) – SABS

The “Response by Insurer to an Application for Arbitration (Form E)” is a document used by insurers to formally respond to an Application for Arbitration filed with the Dispute Resolution Services of the Financial Services Commission of Ontario (FSCO). This form is essential in the arbitration process, allowing the insurer to address the issues raised in the initial application. The form requires detailed information about the applicant, the insurance company, and any legal representatives involved. Insurers can dispute various benefits, including weekly, caregiver, medical, and rehabilitation benefits, as well as other expenses and claims related to the case. The form also requires insurers to list key documents that will be referred to during the arbitration and to provide certification of the accuracy of the information submitted. The response must be served to the applicant and the Commission within 20 days of receipt.

This form is used to respond to an arbitration application filed against your insurance company. Here’s a step-by-step guide to help you complete this form:

Basic Information

• Arbitration File Number: Enter the arbitration file number provided in the Application for Arbitration you received.
• Applicant Information: Provide the applicant’s details, including their full name and the date of the motor vehicle accident.
• Insurance Company Details: Fill in the name of your insurance company and provide contact details for the representative handling the case (name, title, address, phone number, email, etc.).
• Legal Representative Information (if applicable): If your company has a legal representative for this arbitration, enter their details, including their name, firm, contact information, and Law Society license number if they are a lawyer or licensed paralegal.

Type of Hearing

• Oral Hearing: Indicate whether your company requests an oral hearing by selecting “Yes” or “No.”
• Special Services: If you require any special services like audio-visual equipment or a court reporter, specify your needs in this section.

Issues in Dispute

• Check the Benefits: Identify and check the benefits that were not resolved during mediation and are now under dispute (e.g., income replacement, non-earner, caregiver, medical, rehabilitation benefits).
• Explain the Insurer’s Position: For each benefit checked, briefly explain your company’s position on why the benefit is being disputed. Include reasons for the refusal to pay and any other relevant details.
• Amount in Dispute: For each benefit, specify the amount in dispute, the date the insurer refused to pay, and the period during which any benefits were paid (if applicable).
• New Issues: You may also add new issues that were mediated but not settled. Provide details similar to those above.

Document List

• Documents in Possession: List the key documents in your possession that will be referred to in the arbitration (e.g., letters, medical reports, tax returns). Include the document type, author or issuing institution, and date.
• Documents Not in Possession: List the key documents you intend to obtain from other sources, including those requested from the applicant but not yet provided. Clearly identify the document type, author, and expected source.

Signature and Certification

• Certification: Certify that all the information provided in the response is true and complete.
• Signature: The person completing the form must sign and date it, providing their name and title.

Submission

• Copies: Send the original and one copy of the completed form to the Arbitration Services at the Financial Services Commission of Ontario. Keep an additional copy for your records.
• Proof of Service: Ensure you serve a copy of the completed response to the applicant and provide proof of service to the Commission within 20 days of receiving the arbitration notice.

Additional Note

• Attachments: Attach any necessary additional sheets or documents as required.

By following these steps, you can effectively complete the “Response by Insurer to an Application for Arbitration (Form E)” and ensure that your company’s position is clearly communicated in the arbitration process.