What to Do if Your Car Accident Claim is Denied
Apr 4 2022 | ZAYOUNA ADMIN
A car accident is every driver’s worst nightmare every time they get on the road. But unfortunately, even with stringent traffic regulations and good driving behaviours, accidents can still occur. And while some are minor, severe crashes can have devastating effects—on you, the other parties involved, your loved ones, and your productivity and ability to earn a living.
Because of a car accident’s potential to significantly alter anyone’s life, carrying auto insurance with the right amount of coverage is mandatory in Toronto and across Ontario. Under the province’s “no-fault” insurance policy, your insurance company would pay out coverage benefits for injuries, regardless of who was at fault.
But what happens when your insurance claim is denied? Find out how a car accident lawyer can help you claim the benefits you are legally entitled to.
Quick Review: How to File an Auto Insurance Claim
The first step to claiming accident benefits is understanding your auto insurance policy—how to file a claim and when you should file (and why deadlines are crucial) to effectively dispute a denied claim.
Understand Your Auto Insurance Coverage and Rights
To start, make sure you always have a copy of your auto insurance policy and know your coverage, rights, and responsibilities.
Car accident insurance is mandatory in Ontario, with at least $200,000 third-party coverage for third-party liability. It also includes coverage for statutory accident benefits, direct compensation for property damage, and coverage for uninsured automobiles.
File an Auto Insurance Claim
Following a car accident, you need to report the accident to your auto insurance provider within seven days. Failure to report the accident promptly can result in the denial of your claim. This means losing crucial coverage for injuries and medical treatment, lost wages and earning potential, and property damage, resulting in devastating life outcomes for you and your loved ones.
To file a car accident claim, you need the following information:
- Your auto insurance policy number
- The make, modem, year, registration, and license plate number of your vehicle
- Names, driver’s license numbers, and auto insurance information of all drivers involved
- Date, time, and location of the accident
- Injuries sustained
- Number and personal information of passengers involved
- Name and badge number of responding police officers.
Once your auto insurance claim is filed, a claims adjuster will contact you to complete a Proof of Loss form. Then, they will determine the coverage you will receive based on your claim. In order for benefits to be paid out, they will first determine who is at fault, accounting for your and the other driver’s actions and responses to traffic and weather conditions and other contributing factors to the accident.
Why Car Accident Insurance Claims are Denied
Auto insurance is designed to protect you in the event of an accident. It provides the coverage you need to recover from your injuries, deal with property damage, and maintain financial security.
Unfortunately, it doesn’t always do its job—claims can get denied, leaving you without this necessary financial cover. But, if it’s designed to protect you, why do claims still get denied?
Here are some reasons why insurers deny car accident claims:
- Coverage issues: The amount of the liability damage exceeds your policy coverage limit, in which case you would be liable for the balance.
- Questions about your injury: Insurance companies tend to not pay out accident benefits if there is insufficient proof of the extent or nature of your injuries, particularly if there is no medical documentation of fractures, contusions, whiplash, and other car accident injuries.
- Fraudulent claims: Insurance companies are on high alert for fraud, so claims with insufficient documentation on the details of the accident, injuries, and other damages are quickly denied.
Next Steps: What to do if Your Car Accident Claim is Denied
A denied car accident insurance claim should not doom you to the lifelong devastating impacts of a crash. If you believe that your claim was wrongly denied, you can dispute the insurance company’s decision with the help of a personal injury lawyer knowledgeable in car accident claims. Follow these steps:
1. Contact a car accident lawyer
Consult a personal injury lawyer skilled in car accident claims as soon as possible. The sooner you seek legal advice, the more informed you are of the insurance claims process, the benefits you are entitled to, and your rights under Ontario law. A car accident lawyer can review the details of your accident and insurance claim and determine if you have sufficient grounds for appeal and/or filing a car accident lawsuit.
2. Gather evidence in support of your claim
Collect all documents related to your car accident and insurance claim. These include information submitted in the accident report, medical records of your injuries and treatment, and the claim you filed.
Your car accident lawyer will examine all of these documents and find gaps or errors, if any, that may have resulted in the denial. These include incomplete or incorrect use of forms, missed filing deadlines, and lack of documents or evidence related to your injuries and lost wages. Your lawyer will gather these documents to correct errors and initiate the appeals process.
3.Resubmit your car accident claim
Under Ontario’s Insurance Act, you are legally entitled to resubmit an auto insurance claim previously denied on the basis of non-compliance. As such, your insurance provider is compelled to reconsider the resubmitted claim, now with complete documentation.
Your car accident lawyer can handle this process, ensuring that the benefits you are entitled to will be paid out, including the amount lost during the period of non-compliance. They will also assist you with providing an explanation for the initial non-compliance within 10 days of the notification to ensure that your claim is reconsidered.
4. File an appeal with the Licence Appeal Tribunal (LAT)
If your appeal is still denied, or if your insurer determines that you should not continue to receive accident benefits, a car accident lawyer can help you dispute this decision by filing an appeal with the Licence Appeal Tribunal (LAT). Your lawyer will advocate for your financial recovery, and seek compensation for medical bills, rehabilitation and therapy, attendant care, lost wages, and other losses as a result of a denied claim.