My insurer denied my claim after an accident in Ontario — what are my options?
A denial letter starts strict limitation clocks: accident benefit disputes go to the Licence Appeal Tribunal, while tort and coverage claims proceed in the Superior Court of Justice.
Ontario auto claims run on two tracks. Statutory accident benefits are paid by your own insurer under the Statutory Accident Benefits Schedule regardless of fault, and a dispute over a denied benefit is resolved at the Licence Appeal Tribunal. A tort claim against the at-fault driver for pain and suffering and income loss is brought in the Superior Court of Justice and is subject to statutory thresholds and deductibles.
Property, disability and commercial coverage denials are different again. There the fight is usually over policy interpretation, an exclusion clause, or an allegation of material misrepresentation at application.
The common thread is time. A denial letter typically triggers a short limitation period stated in the policy or the legislation, and it can be much shorter than the general two-year period. Bring the denial letter to a lawyer as soon as you receive it.
Source: Insurance Act, R.S.O. 1990, c. I.8 · O. Reg. 34/10 (SABS)
This work is handled by Arjun Vishwanth (Insurance / personal injury). Read more about insurance / personal injury at VK Law Group, or send us the facts and we will tell you where you stand.
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