Having an insurance claim denied after a car accident can be stressful, especially when you are dealing with injuries, vehicle damage, medical bills or lost income. A denial does not always mean that you have no legal options.
The first step is to determine what type of claim was denied. Ontario has different rules for accident benefits, vehicle damage and claims against another driver. The process for challenging an accident benefits decision is also different from a lawsuit for personal injury.
If your car accident insurance claim is denied, review the denial carefully, preserve your evidence and check the applicable deadlines before deciding what to do next.
What Should You Do If Your Car Accident Insurance Claim Is Denied?
Start by finding out exactly what the insurance company has refused to pay and why.
Your next steps should generally include:
- Read the denial letter carefully.
- Identify the benefit or claim that was denied.
- Check the reason given by the insurer.
- Gather medical, accident and insurance records.
- Keep copies of all communication with the insurer.
- Check the deadline for disputing the decision.
- Consider getting legal advice if the dispute involves significant injuries or losses.
For accident benefits, an insurer that denies or stops paying benefits must provide written notice explaining its decision. A dispute about entitlement to statutory accident benefits can be brought to Ontario’s Licence Appeal Tribunal – Automobile Accident Benefits Service (LAT-AABS).
A denial should therefore be treated as a decision that needs to be reviewed, not simply as the end of the matter.
Which Car Accident Claim Was Denied?
The answer depends on the type of insurance claim involved.
| Type of claim | What it may involve | Possible dispute route |
| Accident benefits | Medical treatment, rehabilitation, income replacement and other statutory benefits | LAT-AABS |
| Injury claim against another driver | Compensation for injuries and related losses | Civil claim |
| Vehicle or property damage | Repair or replacement costs and other property losses | Depends on the circumstances and coverage |
| Other insurance policies | Additional coverage purchased under a policy through your work, home or privately. | Depends on the policy and type of dispute |
Accident Benefits
Accident benefits are available to people injured in motor vehicle accidents who meet the applicable requirements. The Statutory Accident Benefits Schedule (SABS) sets out the benefits and rules that apply.
These benefits can include coverage related to medical and rehabilitation needs and, where eligibility requirements are met, income replacement and other benefits. The rules can depend on the date of the accident and the applicable insurance coverage. Ontario’s accident benefits framework was amended effective July 1, 2026, so the rules applicable to a particular accident should be checked carefully.
Claim Against the At-Fault Driver
An injury claim against another driver is different from an accident benefits claim.
If you suffered injuries because of another person’s negligence, a civil claim may be available. The issues can include fault, the nature of your injuries, your losses and the legal requirements for bringing the claim.
LAT-AABS does not decide who was at fault in an accident or award damages for pain and suffering.
Common Reasons for Car Accident Insurance Claim Denials
Insurance companies may deny or limit claims for different reasons. The reason should be stated in the insurer’s written decision.
Common issues can include:
- The insurer disputes whether you qualify for a benefit.
- The insurer says the medical treatment is not reasonable or necessary.
- The insurer disputes the severity or cause of an injury.
- Required forms or information were not provided.
- The insurer says a policy condition was not met.
- There is a disagreement about coverage.
- The insurer disputes the amount being claimed.
- The insurer relies on medical assessments or other evidence that conflicts with your claim.
- The insurer says you did not meet a particular eligibility requirement.
A denial does not tell you by itself whether the insurer’s position is legally correct. The policy, legislation, medical evidence and facts of the accident all need to be considered.
What Your Insurance Denial Letter Should Contain
If an insurer denies or stops paying accident benefits, the decision should be provided in writing with the reasons for the decision.
When reviewing a denial letter, look for:
- The specific benefit or coverage being denied
- The date the denial takes effect
- The reasons for the decision
- The evidence relied upon
- Any policy or legal provisions referred to
- Information about the dispute process
- Any deadline that applies
Keep the original letter and any attachments.
Do not rely only on a telephone conversation with the insurance company. Keep written records of important communications, including emails, letters and notes of telephone calls.
What to Do During the First 30 Days
The first few weeks after a denial can be important.
1. Read the Denial Carefully
Do not focus only on the word “denied.” Find out exactly what the insurer refused to pay and the reason given.
2. Gather Your Records
Collect:
- Insurance policy documents
- Denial letters
- Accident reports
- Medical records
- Treatment plans
- Medical assessment reports
- Receipts
- Income records
- Photos and videos
- Correspondence with the insurer
3. Ask Questions in Writing
If the reason for the denial is unclear, ask the insurer to explain the decision and identify the information or documents it relied on.
4. Keep Track of Treatment
Continue appropriate medical treatment and keep records of appointments, prescriptions, therapy and related expenses.
5. Record Your Financial Losses
Keep records of lost income, medical expenses, transportation costs and other accident-related expenses.
6. Check the Deadline
Do not assume that you have two years simply because the accident happened recently. Different claims can have different limitation periods.
7. Consider Legal Advice
A car accident lawyer in Ontario can review the denial, the evidence and the applicable process and help determine what options may be available.
Deadlines for Disputing an Insurance Claim Denial
Deadlines depend on the type of claim.
For accident benefits, Ontario’s LAT-AABS states that when an insurer denies or stops paying benefits, an injured person generally has two years from the insurer’s refusal to pay the amount claimed to file an application with LAT-AABS. The Tribunal notes that extensions can sometimes be available, but missing the deadline can result in an application being refused.
| Situation | Important point |
| Accident benefits denial | Generally 2 years from the insurer’s refusal to pay the amount claimed to apply to LAT-AABS |
| Personal injury claim | Limitation rules depend on the claim and circumstances. Generally, 2 years from the date that the cause of action arose. |
| Vehicle damage | Depends on the applicable coverage and dispute |
| Other insurance disputes | Deadline depends on the type of claim, policy and applicable law |
The date on the denial letter matters. Keep the letter and proof of when you received it.
Because limitation periods can affect your legal rights, getting advice early is safer than waiting until a deadline is close.
How Car Accident Insurance Disputes Are Resolved
The appropriate process depends on what the insurer denied.
Review the Decision With the Insurer
For accident benefits, you can first communicate with the insurance company and provide relevant documents or information.
Tribunals Ontario encourages parties to try to resolve accident benefits disputes before filing with LAT-AABS. Negotiation can also continue after a LAT-AABS application has been filed.
LAT-AABS
If the dispute concerns entitlement to or the amount of statutory accident benefits and cannot be resolved, an injured person can apply to LAT-AABS.
LAT-AABS handles disputes about statutory motor vehicle accident benefits. It does not decide vehicle damage claims, pain and suffering damages, fault for the accident or which insurer is responsible for the claim.
The process can involve:
- Filing an application
- Serving the other party
- Exchanging documents
- A case conference
- Settlement discussions
- A hearing if the dispute is not resolved
- A written decision
LAT-AABS requires supporting information such as details of the accident, disputed benefits and documents that may be relied upon.
Case Conference and Hearing
A case conference gives the parties an opportunity to discuss settlement and narrow the issues. If the dispute continues, the matter can proceed toward a hearing.
A final LAT-AABS decision is legally binding, subject to the available review or appeal processes.
Insurance Complaints
If your concern involves the insurer’s handling of your complaint rather than only entitlement to accident benefits, Ontario’s Financial Services Regulatory Authority (FSRA) advises consumers to first use the insurer’s internal complaint process.
For general insurance complaints, FSRA identifies the General Insurance OmbudService and the Mutual Insurance Companies OmbudService as possible independent review options, depending on the insurer and circumstances.
These complaint processes are not a substitute for checking a legal limitation period.
When Insurance Company Conduct May Require Further Action
Not every disagreement with an insurer means that the insurer has acted improperly. However, certain situations may require closer review.
Examples include:
- A claim is denied without a clear explanation.
- Important medical evidence appears to have been overlooked.
- The insurer relies on information that you believe is incorrect.
- Benefits are stopped and you disagree with the reason.
- The insurer does not properly explain what information is required.
- There is a significant dispute about your eligibility or coverage.
- You believe the insurer has not followed the applicable claims process.
Keep detailed records of communications with the insurer, including dates, names and what was discussed.
If the dispute involves serious injuries or substantial financial losses, speaking with a car accident injury lawyer can help you understand the available options before you make an important decision about your claim.
FAQ
Can an insurance company deny my accident benefits claim?
Yes. An insurer can deny a claim or refuse to pay a particular benefit when it believes the applicable legal, policy or eligibility requirements have not been met.
The important question is whether the denial is supported by the facts, the insurance policy and the law. For accident benefits, an insurer that denies or stops paying benefits must provide written notice of the decision and its reasons.
What should I do after my accident benefit claim is denied?
Read the denial letter carefully and identify exactly what was denied and why.
Then gather your accident, medical and insurance records, keep written communication with the insurer and check the applicable deadline. If the dispute involves significant injuries or losses, consider speaking with a car accident lawyer in Ontario before deciding how to proceed.
How long do I have to dispute a denied accident benefits claim in Ontario?
For an accident benefits dispute, LAT-AABS states that an injured person generally has two years from the insurer’s refusal to pay the amount claimed to file an application.
The exact circumstances matter, and the rules can change depending on the type of dispute. Do not wait until the deadline is approaching before getting legal advice.
Can I challenge an insurance company’s decision at the Licence Appeal Tribunal?
Yes, if the dispute falls within LAT-AABS’s jurisdiction.
LAT-AABS handles disputes about entitlement to, or the amount of, statutory automobile accident benefits. It does not handle disputes about vehicle damage, pain and suffering damages, who was at fault or which insurer is responsible for the claim.
Do I need a lawyer to dispute a denied car accident insurance claim?
You are not required to have a lawyer for every insurance dispute. However, legal advice can be useful when the denial involves serious injuries, significant financial losses, complex medical evidence, disputed eligibility or an approaching limitation deadline.
A lawyer can review the denial and explain which legal process may apply to your particular claim.
Speak With a Car Accident Lawyer in Ontario
If your insurance claim was denied after a car accident, do not assume that the denial ends your legal options.
Virk Personal Injury Law can review the circumstances of your accident, the insurer’s decision, the available evidence and the deadlines that may apply.
Contact Virk Personal Injury Law to discuss your denied insurance claim and understand your legal options.