What to Do If the Insurance Company Refuses to Pay My Car Accident Claim - Diamond and Diamond Lawyers
  • Tuesday, 12 October 2021

What to Do If the Insurance Company Refuses to Pay My Car Accident Claim

Car accident insurance is mandatory in Canada if you drive or own a vehicle. The insurance types and minimum coverage will depend on your province or territory. The Financial Services Commission of Ontario, for example, requires a vehicle owner to have $200,000 in Third Party Liability as well as the following coverage:

  • Statutory Accident Benefits
  • Direct Compensation – Property Damage
  • Uninsured Automobile

Most people find the car accident insurance requirements burdensome, and it isn’t cheap. Ontario residents can expect to pay a minimum of $1,103 a year in premiums, more if they are in the high-risk category. 

However, you will appreciate your car accident insurance if you are ever involved in an accident. How much does your car insurance go up after an accident? Quite a bit, but at least you will not have to pay most of the property damage costs right now. You can also make a car accident insurance claim for personal injuries to you, your passengers, or a third party.

The problem is what to do if the insurance company refuses to pay? Find out more about the causes of insurance claims denial and how to avoid it.

Insurance Claims Denial

As you can probably imagine, car insurance claims denial is when the insurance company refuses to pay your car accident claim. A claims denial can be a devastating blow following the trauma of a car accident, especially if it involves bodily harm to you, a loved one, or a third party.

Car accidents are notorious for causing numerous types of personal injuries. The most common is whiplash injuries, where the neck suffers trauma from sudden deceleration associated with a rear-end collision.  The effects can be debilitating in serious cases, and they can last for years.

A concussion is similar to whiplash in cause, but it is much more severe because it is an injury to the brain. The victim appears to recover entirely in some cases but may have persistent headaches, dizziness, and cognitive impairment that can last for months. Learn more about the other types of personal injuries.

Possible Reasons Why Insurance Companies Don’t Pay Accident Claims

Insurance companies routinely deny claims in the hope that the claimant will not challenge them. There are different reasons insurance companies may put forward to deny personal injury accident claims.

There are liability and coverage issues present

Coverage issues are common reasons for car insurance claims denial. Perhaps the amount of your coverage exceeds the cap of your policy, in which case you would be liable for the balance.

Another scenario is the accident that happened that qualifies as an exception for your policy. For instance, some policies stipulate that off-road driving is not covered. If you want to avoid such issues, check your policy exceptions and limits to ensure you have the appropriate kind and amount of coverage for your lifestyle.

The insurance company questions your injury

People often make the mistake of not documenting their medical condition at the time of the accident when filing an insurance claim for an injury. The insurance companies willtake every chance to doubt the extent or nature of an injury if you do not have proof that you sustained it in the accident.

The best way to avoid this pitfall is to go to the hospital to have a doctor examine you even if you feel the injuries are minor. The symptoms of whiplash and concussion, for instance, may not be immediately apparent to you, but it will be to a doctor. Broken bones, contusions, and other obvious injuries should definitely go on the record.

The insurance company believes that the injury is fraudulent

Insurance companies are often the target of fraud, so it is not surprising that they may be skeptical of injury claims from accidents. Some people exaggerate their injuries to get a higher payout, which is unfortunate for real car accident victims. Your best move in this situation is to document the scene of the accident, take photos of your injuries, and get statements from witnesses to corroborate your claims. A report from first responders and a medical certificate from a doctor will also be indisputable evidence for your claim when you challenge a denial.

Handling the Refusal of Insurance Companies’ Car Accident Claim Payment Failure

Getting upset when you first hear about the refusal of the insurance company to pay a claim is understandable. However, avoid going with your instincts. You must handle the insurance claims process with finesse so you can get the most out of your claims. Here are the things you should do.

Avoid emotional responses

An emotional response to denial can lead you to do and say rash things that the insurance company representative might hold against you. Exercise restraint and count slowly to ten when you feel your temper start to rise.

Ask for an explanation

Instead of giving in to your feelings, give the insurance adjuster a chance to explain the denial by asking and listening. They might have a good reason for denying your claim of which you are not aware.

Review your policy

Before going off half-cocked, ensure that you are on the right side of the argument. See if the denial of the claim was reasonable based on the limits and caps of your insurance coverage.

Keep a record of every interaction that you have with your insurance company

Whether you believe that the insurance company is trying to short-change you or not by denying your claim, document all transactions you have with its representative. Keep all text messages, emails, letters, and forms. Record your phone conversations with or without their permission (Canada has a one-party consent rule), so you have proof of what was said and promised.

Complain to authorities

If you are not satisfied with the outcomes of conversations with your insurance company, you can file a case with the General Insurance OmbudService or GIO. The GIO is a non-government body that oversees the insurance companies in Canada and handles consumer complaints regarding their auto, home, and business insurance.

Be persistent in your cause

Insurance companies deny claims and make it difficult to dispute them,hoping that people will simply give up. Disputing the denial of a claim is often a complicated process and takes a long time, but keep fighting for your rights. Continue following up and exploring all avenues to reverse the denial and get the compensation you deserve.

Ask for your lawyer’s help

If you have tried everything and are not getting any relief, it might be time to bring in the big guns. Experienced car accident and personal injury lawyers have the resources, knowledge, and expertise to give you the best possible advice on your case. In most cases, insurance companies are more willing to compromise when you get lawyers involved.

File a lawsuit

Most people balk at the idea of filing a lawsuit for a car accident claim, but sometimes you have no other option to get insurance companies to come to the table. Insurance companies acting in bad faith deserve it. They might be motivated to offer a settlement to avoid going to court, which might be a good thing if it is a reasonable offer. In either case, your lawyer will be your champion all the way.

Preparing Your Case to Court

Step 1

Both parties will issue pleadings in which your lawyer will issue a statement of claim that includes the amount, facts, and allegations of the claim that makes the insurance company (defendant) liable for the specified amount. The statement of defence will provide facts that show the defendant is not liable for the amount claimed. Your lawyer may then reply to the defendant within ten days. At this point, the court may also file a jury notice. 

Step 2

Both parties must then exchange an affidavit of documents within 20 days after the pleadings. These are documents that set out the relevant issues in the lawsuit, divided into four schedules. After the submission of all documents, the discovery process begins. Either party may request mediation at this point to settle the case.

Step 3

If there is no settlement, the lawsuit goes to trial before a Superior Court Justice and a jury of six people if appropriate. Five jurors may render a decision.

If you’re unsure of where to start with your car accident insurance claims process, schedule an appointment with Diamond & Diamond Lawyers and they’ll be happy to assist you.

Pro Tip

Be careful what you say in front of your insurance provider because they might use your words against you.

Contact Diamond & Diamond Lawyers Today

It might seem that your insurance claims process for a  car accident has been dragging on forever and with no end in sight. You can put an end to the torture by contacting Diamond & Diamond Lawyers today.  Our personal injury lawyers have served clients in Toronto and across Ontario. We have successfully helped victims through car accidents and other insurance claims for 40 years.

Suffering a personal injury due to a car accident can be a devastating experience, and fighting to overturn a denial of a car insurance claim only makes it worse. Diamond and Diamond’s team of lawyers will take on the insurance companies and make sure you have the proper representation. Get a free case evaluation to  have a better idea of the merits of your claim.

 

FAQs on Car Accident Insurance Claims Process

Can an insurance company ignore a claim?

Yes, insurance companies can ignore or delay responding to a claim to reduce payouts. However, that will open them to a formal complaint to the relevant authorities at the provincial and territorial levels.

How long does an insurance company have to settle an auto accident claim?

Once an insurance company receives the completed Accidents Benefits Application Package from you, they have ten days to assess the claim and ask for additional information. The time limit to settle a claim will depend on the terms of your policy. You have two years to file a dispute if your claim meets with a denial.

What do you do when an insurance company won't respond to your claims?

You can first seek the assistance of the General Insurance OmbudService or GIO. The GIO is a non-government body that oversees the insurance companies in Canada and handles consumer complaints regarding auto, home, and business insurance. If that does not pan out, the next step is to consult a personal injury lawyer.

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