Accident Benefits Denial: A Step-by-step Guide for Collingwood Drivers

Being involved in a motor vehicle accident can turn your life upside down. Beyond the physical injuries and emotional stress, you may face mounting medical bills and lost income. In Ontario, accident benefits are designed to provide financial relief and support for recovery, regardless of who was at fault. These benefits can cover medical treatment, rehabilitation, income replacement, and attendant care.

What happens when your insurance company denies your accident benefits claim? For many Collingwood accident victims, this denial feels like a second blow. Fortunately, a denial does not close the door on your benefits. You have options to challenge the decision and secure the benefits you deserve.

Top Causes of Accident Benefits Claim Denials in Ontario

The following are some of the top reasons insurance companies deny claims:

• Insufficient medical evidence: If your documentation does not clearly show the severity of your injuries or the need for treatment.

• Missed deadlines: Ontario’s accident benefits system has strict timelines for reporting accidents and submitting forms.

• Disputed injury severity: The insurer may argue your injuries are minor or unrelated to the accident.

• Pre-existing conditions: They might claim your symptoms stem from a prior health issue.

• Incomplete documentation: Missing forms or medical reports can weaken your claim.

Understanding the reason for denial is the first step toward resolving the issue. Review the denial letter carefully and make a note of the insurer’s stated reasons.

Steps to Take After a Denial

1. Review the Denial Letter

Your insurance company is required to give you a written explanation for the denial. This document outlines why your claim was refused and what evidence is lacking. Use this information to guide your next steps.

2. Gather Additional Evidence

If the denial is based on insufficient proof, strengthen your case with:

• detailed medical reports from your doctor or specialist.

• police reports confirming accident details.

• witness statements supporting your version of events.

• photos of the accident scene and injuries.

• receipts for medical and rehabilitation expenses. 

Providing thorough documentation greatly improves your chances of reversing the denial.

3. Communicate with Your Adjuster

Before filing an appeal, consider contacting your insurance adjuster. Ask for clarification and whether additional information could resolve the issue. Sometimes, providing missing documents can lead to a quick resolution.

4. Consult a Personal Injury Lawyer in Collingwood

Navigating Ontario’s accident benefits system can be complex. A personal injury lawyer in Collingwood understands the Statutory Accident Benefits Schedule (SABS) and can help you build a strong case. Legal representation is not mandatory, but it significantly improves your chances of success.

Appealing Through the Licence Appeal Tribunal (LAT)

If discussions with your insurer fail, the next step is to file an application with the Licence Appeal Tribunal (LAT). This independent body handles disputes between accident victims and insurance companies under Ontario’s SABS.

Here’s what the process looks like:

• File an application: Complete the LAT form, identify the denied benefits, and explain why the decision should be overturned. A $106 filing fee applies.

• Insurer’s response: The insurance company submits its position to the LAT.

• Case conference: You, your insurer, and an adjudicator meet to discuss the case. This is an opportunity to settle before a formal hearing.

• Hearing: If no settlement occurs, the case proceeds to a hearing, which may be written, virtual, or by phone.

• Decision: The adjudicator reviews the evidence and issues a written decision.

Deadlines are strict, so act quickly. Missing a timeline can jeopardize your appeal.

Why Professional Legal Guidance Can Make the Difference

Here’s what a car accident lawyer in Collingwood can do for you:

• Ensure all deadlines are met.

  
  

• Gather and present compelling medical evidence.

  
  

• Represent you during LAT proceedings.

  
  

• Negotiate with insurers to maximize your benefits.

In some cases, if the insurer acted unreasonably, the LAT could award additional compensation beyond the denied benefits. 

Your Path Forward

A denied accident benefits claim can feel overwhelming, but you are not powerless. By understanding the reasons for denial, gathering strong evidence, and seeking legal guidance, you can challenge the decision and secure the support you need for recovery.

If you are a Collingwood accident victim facing a denial, Littlejohn Barristers is here to help. Our team focuses on personal injury law and has extensive experience handling accident benefit disputes. Contact us today for a free consultation and let us fight for the benefits you deserve.