A car accident is stressful enough, but having your accident benefits claim denied by your insurance company adds another layer of difficulty. If you’re in Ontario and facing this situation, you’re not alone. Here’s what you need to know:
Understanding Accident Benefits in Ontario
Ontario’s Statutory Accident Benefits Schedule (SABS) provides crucial financial and medical support to those injured in car accidents, regardless of fault. These benefits can cover:
- Medical and Rehabilitation Expenses: Costs for treatments, therapies, and assistive devices.
- Income Replacement: If your injuries prevent you from working.
- Attendant Care Benefits: For assistance with daily living activities.
- Other Expenses: Such as housekeeping or home modifications.
Why Do Insurance Companies Deny Claims?
Several reasons could lead to a denied claim:
- Disputes over the Severity of Injuries: The insurer might question the extent of your injuries or their connection to the accident.
- Pre-Existing Conditions: They may argue a pre-existing condition is responsible for your need for treatment.
- Late Reporting: Failing to report the accident or your injuries promptly can be problematic.
- Lack of Supporting Documentation: Insufficient medical records or other evidence can weaken your case.
What to Do if Your Claim is Denied
- Review the Denial Letter Carefully: Understand the specific reasons cited for the denial. This will guide your next steps.
- Gather Evidence: Collect all relevant medical records, police reports, witness statements, and any other documentation supporting your claim.
- Seek Legal Advice: An experienced personal injury lawyer specializing in car accidents can assess your case, explain your rights, and guide you through the process.
- Dispute the Denial: You can usually appeal the decision within a certain timeframe. Your lawyer can help you prepare a strong appeal with supporting evidence.
- The License Appeal Tribunal (LAT): If other options fail, the LAT is an adjudicative body that handles disputes related to accident benefits. Your lawyer can represent you before the LAT.
Important Considerations
- Statute of Limitations: In Ontario, there are strict deadlines for filing appeals or taking legal action. Don’t delay.
- Be Organized: Keep detailed records of all communications with your insurer, medical professionals, and legal counsel.
- Don’t Give Up: The process can be frustrating, but remember, you have rights.
Need Help?
If your accident benefits claim has been denied, contact a reputable personal injury lawyer who understands Ontario’s complex insurance laws. They can advocate on your behalf and help you get the compensation you deserve.
Remember: Don’t let a denied claim discourage you. With the right support, you can successfully navigate the process and secure the benefits you need to recover and move forward.