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Understanding Why Accident Benefit Claims Get Denied—And How We Can Help!

Here’s what you should know about why accident benefit claims get denied. Need help filing or disputing an accident benefits claim? Get in touch with Feifel Gualazzi.

closeup of notepad during discussion with lawyer regarding accident benefits claims

Ontario has a no-fault car insurance system. This means that regardless of whether or not you’re legally at fault for an accident, you’re entitled to coverage from your insurance provider. Here’s what you should know about accident benefit claims, including what to do if your claim gets denied.

WHAT ARE ACCIDENT BENEFITS?


These benefits provide compensation for drivers, passengers and pedestrians who’ve been hurt or killed in a car accident. Some of the expenses covered include:

  • Ambulance fees

  • Hospital expenses

  • Medication not already covered by a private insurance plan

  • Assistive devices such as slings, crutches and braces

  • Items damaged in the car accident

  • Housekeeping expenses

  • Childcare expenses

  • Attendant care and case manager expenses

  • Funeral expenses

  • Income replacement benefits

  • Caregiver benefits

Since many insurance companies aren’t forthcoming about all the benefits available to you, it’s important to seek professional legal advice as soon as possible after a car accident to determine your rights and obligations.

WHY CLAIMS GET DENIED


The process of submitting a claim involves dealing with extensive documentation and time-sensitive paperwork. Unfortunately, a mistake can cause your claim to be rejected. An application may be denied for the following reasons:

  1. There’s insufficient evidence of the injury such as medical verification or proof of lost wages

  2. The required documents are incompletely or incorrectly filled out

  3. There’s missing documentation such as receipts or invoices for funeral and burial expenses

  4. The deadline to submit the claim was missed

HOW YOU CAN FIGHT THE INSURANCE COMPANY’S DECISION


If your claim is denied, you can either re-submit your application or request a dispute. Here’s what you should know about each option:

  • Re-submit the application. If failure to provide sufficient medical documentation is the reason your claim was denied, you have a limited amount of time in which to resubmit the application. Once you provide the required information, your claim has a good chance of being accepted.

  • Request a dispute. If your claim was denied for other reasons, you can request access to the dispute resolution process. Since this can be a difficult and time-consuming process, you should hire a lawyer. A legal professional will be able to represent you, answer your questions and help you complete the necessary forms.

HIRE A PERSONAL INJURY LAWYER SAULT STE. MARIE


If you need help filing or disputing an accident benefits claim, Feifel Gualazzi can help. Our team of personal injury lawyers will assist you in gaining the compensation you’re entitled to as quickly as possible. We’re one of the largest personal injury law firms in the Sault Ste. Marie and Wawa area, and we’re committed to providing you with affordable legal services. Contact us today to schedule a free consultation.

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