Denied Accident Benefits: Can I Dispute this Decision?

The denial of Ontario’s statutory Accident Benefits can be a frustrating and financially stressful experience for a recent accident victim. The benefits are intended as a no-fault means of compensating injured motorists for damages such as lost income and medical bills. Unfortunately, the no-fault system does not guarantee all victims will receive fair compensation.

You have several options in the event your Accident Benefits are denied. They include the right to dispute a denial of your claim.

Our personal injury lawyers can meet with you for a free initial consultation. Call (416) 364-2000

Below are four steps you can take if any part of your Application for Accident Benefits has been denied.

Step One: Consult a Lawyer

The sooner you begin working with a lawyer, the better your chances for a successful accident claim. Schedule a free case consultation with a lawyer to discuss whether you have grounds to appeal the benefits denial. Use this meeting as an opportunity to determine whether a particular lawyer is the right fit for your case. Ask questions about his or her background and payment policy.

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Step Two: Gather Evidence and Documentation in Support of Your Claim

An Application for Accident Benefits may be denied for any number of reasons, including:

insufficient/lack of evidence (for instance, no medical verification of injury, no proof of lost wages, etc.);
incomplete forms;
incorrect use of forms;
lack of necessary documentation (for instance, no receipts or invoices for funeral and burial expenses, etc.); and
failure to meet filing deadlines.

Your lawyer can examine your Application and subsequent denial to determine any shortcomings. For instance, you may be approved for the Medical and Rehabilitation Benefit, but your application lacked the employment details or the necessary confirmation of employment form required to prove eligibility for the Income Replacement Benefit.

You can assist your lawyer with this task by providing all available evidence and documentation, such as medical bills or an accident report. However, your lawyer likely will assume this responsibility on your behalf so you can focus on physical recovery.

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Step Three: Promptly Resubmit Your Application

The Statutory Accident Benefits Schedule under Ontario’s Insurance Act provides you the right to resubmit an Application that is denied on the basis of non-compliance. Your insurance provider is required to reconsider such a resubmission.

A successful resubmission entitles you to the benefits that should have been paid during the period of non-compliance. This means you may be entitled to “back payment” of benefits.

You must provide an explanation of your initial non-compliance within 10 days of the notification of non-compliance in order to qualify for reconsideration. Your lawyer can help you process the resubmittal within the deadline.

Step Four: Requesting a Dispute Resolution

In some cases, your benefits may be denied after the completion of an insurer examination. This is true when the examiner’s report contradicts one or more crucial factors of your claim or does not agree that you should continue or receive benefits.

At this stage, you may request the Financial Services Commission of Ontario to provide you access to the dispute resolution process. Certain forms must be filed within the applicable time frame. Your lawyer can represent you for the duration of this process and file the requisite forms. Set up a consultation with Preszler Law Firm to review this and other options. Call 1-800-JUSTICE®.

Call or text (416) 364-2000 or complete a Free Case Evaluation form