What If the Insurance Company Denies Your Claim?

Written & reviewed by Olga Kanevsky, LL.B, LL.M
Personal injury lawyer · Law Society of Ontario #51731A · 20+ years serving the GTA · About the author

Few things are as discouraging as opening a letter from an insurance company that says your claim has been denied. After an accident, when you are hurt and worried about money, a denial can feel like the door has closed. Here is what every injured Ontarian should know: a denial is rarely the final word, and insurers count on people giving up. In Ontario, you have real, well-established ways to fight back.

Why insurers deny claims

Insurance companies are businesses, and every dollar they do not pay is a dollar they keep. Denials and delays are a routine part of that model. Common reasons a claim is denied or cut off include:

• “Not medically necessary.” The insurer’s assessor disagrees that your treatment is needed — often after a brief examination.
• The “minor injury” cap. The insurer classifies your injury as minor, limiting benefits to $3,500, when it is in fact more serious.
• Gaps or “pre-existing conditions.” The insurer blames your symptoms on something other than the accident.
• Missed deadlines or paperwork. A technical reason — a form filed late, information missing.
• Surveillance or statements. Something you posted or said is used to argue you are not as injured as claimed.

None of these is necessarily correct. They are the insurer’s position, and positions can be challenged with evidence.

Denied accident benefits: the LAT

If your accident-benefits claim (the no-fault benefits from your own insurer) is denied, you can dispute it at the Licence Appeal Tribunal (LAT), the body that resolves these disputes in Ontario. The process involves filing an application, exchanging evidence, a case conference to try to resolve it, and, if needed, a hearing. Crucially, the strength of a LAT dispute usually comes down to medical evidence — the right assessments, properly presented, often reverse a denial. This is highly technical, which is why representation matters. Learn how benefits work in our guide to accident benefits versus a tort claim and the minor injury guideline.

Denied by the at-fault party: the courts

If the at-fault party’s insurer denies liability or lowballs your tort claim (your lawsuit for pain and suffering and income loss), the forum is the civil court system. A denial of liability is extremely common as an opening move; it does not mean the case is lost. It means the claim proceeds — through pleadings, examinations for discovery, and usually mediation — where the evidence is tested and the vast majority of cases resolve.

The deadlines you cannot miss

This is the most important part. A denial starts clocks running, and missing a deadline can permanently end a valid claim. In general terms, there is a two-year limitation period to start a lawsuit, and accident-benefits disputes and appeals have their own strict timelines that can be much shorter. Because the specific deadline depends on your situation and what was denied, the safest thing to do after any denial is to get legal advice immediately — not after you have tried to argue with the adjuster for a few months.

What to do when you get a denial

• Keep the denial letter and note the date you received it.
• Don’t accept it at face value, and don’t sign anything the insurer sends in response without advice.
• Keep treating and keep documenting your injuries — the medical record is what wins the dispute.
• Get a free legal review right away, while there is still time to act.

Denial, delay, and “lowball” — three versions of the same tactic

An outright denial is only the most obvious way an insurer limits what it pays. Two quieter tactics do the same work. Delay — repeated requests for more forms, more assessments, more information — wears people down and pressures them to give up or accept less, especially when bills are piling up. The lowball offer arrives early, before your injuries have fully declared themselves, and is designed to look like relief when you are stressed and short of income. All three — denial, delay and lowball — rely on the same thing: that an injured person, alone and under financial pressure, will accept less than the claim is worth. Recognizing the tactic is the first step to not falling for it.

Keep treating — even after a denial

One of the most important and counter-intuitive things to understand is that a denial is not a reason to stop your medical treatment. If anything, continuing to treat and to document your injuries is what wins the dispute, because the medical record is the evidence that overturns the denial. Stopping treatment after a denial hands the insurer exactly what it wants: a gap it can point to as proof you recovered. If the denial has cut off funding for your treatment, tell a lawyer — there are often ways to keep care going while the dispute is resolved. The goal is to keep building the record that proves your claim, no matter what the insurer’s letter says.

You don’t have to fight the insurer alone

Insurers have teams of adjusters and lawyers whose job is to limit what they pay. An injured person arguing alone is badly outmatched — but with experienced representation, the odds change completely. At Kanevsky Law we have spent more than 20 years overturning denials and holding insurers accountable, and we do it on a no-win, no-fee basis, so challenging a denial costs you nothing up front. If your claim has been denied, delayed or cut off, a free consultation — in English, Russian or Ukrainian — will tell you honestly whether the denial can be beaten.