How To Proceed When Your Insurance Company Denies Your Claim?

Now, if you have been involved in an accident or you’ve been mistreated by the doctors in the hospital, you are entitled to claim your damages. There are usually a few options in front of you. The most preferred one and the one that could be more effective is to go directly to the insurance company and claim the damages from them. The entire insurance industry is thoroughly regulated by the Insurance Act as well as the FSCO (Financial Services Commission of Ontario). These two, in combination, set forth the rules as well as the regulations which all of the insurance companies are obligated to follow.

The statute for mediation

There is a section in the Insurance Act – section 280 which states that either the insurance company or the insured party could refer an actual disagreement regarding the entitlement to accident benefits or the actual amount of the benefits. If this happens, either party can receive a mediator. If mediation also fails, both parties have the right to go ahead and refer the matter to court. What is more, you should be aware that mediation doesn’t have any obligatory or binding significance – it’s the process of an independent party hearing you out and making a decision which is, under his impression, the best option. There is also arbitration, which is quite similar but the main difference is that in the case of arbitration the decision which is reached is binding and in force.

So, how to proceed?

If you get your claim denied from the insurance company you have the option to appeal it. Whether that’s going to yield a result or not is a completely different story. That’s why it’s better to prepare the necessary documentation and go for a lawsuit directly. It’s going to be more expensive but you should consider that the majority of the lawyers in Ontario work on contingency fees, rendering your risk in the entire situation reasonably low. Furthermore, if you win, the expenses for legal services and court fees will be handled and covered by the other party.

So, basically, if you believe that you claim has enough merit to win, you should absolutely aim for a trial. However, keep in mind that this is going to prolong the entire process significantly. Furthermore, it is highly likely that as soon as you file the claim in court, the insurance adjuster will approach you in an attempt to get you to settle the case upfront. This is because if you have a legitimate claim, the insurance company will lose much more if it took it all the way to a ruling. Take this to your advantage and negotiate a fair amount.

Your lawyer will be able to negotiate a better settlement amount than if you try to do it on your own. Thus, hiring a good lawyer is first step towards getting the right compensation amount.