Being denied accident benefits can be a frustrating and stressful experience. These benefits help compensate injured accident victims for damages such as medical bills and lost income, regardless of fault. However, Ontario’s no-fault car insurance system does not guarantee fair compensation for all accident victims.
Below, we discuss a few options available if you are denied accident benefits by your insurer. This includes the right to dispute the decision. A Windsor vehicle accident lawyer at our firm is ready to meet with you during a free initial consultation. It costs nothing up front to utilize our legal services. We are available 24/7 to take your call.
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Accident Benefits Claims in Ontario
Anyone injured in a crash in Ontario will likely be covered by their insurance and may be able to receive accident benefits. The amount you may be eligible for will depend on a number of factors:
- Your specific insurance policy
- Circumstances of the crash
- Extent of injuries sustained
Several forms must be filled out by you to apply for accident benefits. Be sure to include supporting evidence that shows the seriousness of your injuries and how they have affected your work and personal life. This includes your ability to perform housekeeping tasks and daily activities.
Once you have completed and submitted your accident benefits claim to your insurance company, they will review it and determine your eligibility.
If approved, you will be notified of which accident benefits you may be able to receive, such as medical and rehabilitation benefits, income replacement benefits and attendant care benefits.
If denied, you will be notified as to why you did not qualify for accident benefits. An insurance company may deny an accident benefits claim under the following circumstances:
- Insufficient or lack of evidence (i.e. medical records, proof of lost wages)
- Incomplete forms
- Incorrect use of forms
- Lack of required documentation (i.e. receipts or invoices for expenses)
- Missed filing deadline
Options If Insurer Denies Accident Benefits
If you have been denied accident benefits, you have the right to resubmit your application under certain conditions or dispute a denial of your claim.
This option also applies if you disagree with your insurer’s decision about the accident benefits you are eligible for. Perhaps your insurer has reduced a benefit and you feel that you should receive more or are eligible for accident benefits for injuries your insurer will not cover.
Insurance companies may use allegations of non-compliance while investigating claims as a way to deny compensation. For instance, your insurer may argue that you did not follow your doctor’s orders.
It may come as a surprise that accident victims are initially on the hook for the payment of medical bills. If you do not have the financial means to handle a costly medical treatment, you may be justified in deciding not to undergo a recommended surgery. However, the insurance company will do all they can to reduce or dismiss your accident benefits claim on the basis of non-compliance.
Fortunately, the Statutory Accident Benefits Schedule (SABS) under Ontario’s Insurance Act gives you the right to resubmit an application that has been denied due to non-compliance. You generally have 10 days from the date of your denial notification to submit an explanation of your non-compliance. Your insurer is obligated to review and reconsider this resubmission.
Dispute the Decision
In most cases, accident benefits may be denied after an insurance company completes its claims investigation. If you do not agree with your insurer about your eligibility for accident benefits or the amount of a benefit, you have the right to dispute the decision.
You will need to file an application with Automobile Accident Benefits Service (AABS). AABS is part of the Licence Appeal Tribunal (LAT), helping many injured accident victims settle disputes. Drivers, passengers, pedestrians or family members of victims denied accident benefits may use this service.
You have two years from the date of denial to apply to AABS or risk losing out on accident benefits.
How Could a Lawyer Help Me?
Working with a lawyer could increase your odds of being approved for accident benefits. During a free case evaluation, a lawyer can discuss whether you have grounds to resubmit your application or dispute a denial of your claim.
This initial meeting is also an opportunity for you to decide if a particular lawyer is right for you. Be sure to ask questions about his or her experience handling accident benefits claims. A lawyer at our firm is prepared to help:
- Examine your claim and denial to determine any shortcomings (i.e. insufficient employment details for income replacement benefits)
- Gather and submit all available evidence and documentation (i.e. medical bills, accident report)
- File the resubmittal within the designated deadline on your behalf
- Assist you with the dispute resolution process and represent your interests
Call Our Firm to Schedule a Free Consultation
If your insurer has denied your accident benefits claim, it is important to seek legal help as soon as possible. We are ready to discuss your rights and available options at no cost or obligation to you. We have helped many injured accident victims over the years resolve disputes with their insurance companies.
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