In Ontario, all drivers are required by law to have automobile insurance. If you drive a car without proper and valid insurance, you risk a very serious fine. If you drive a car without proper and valid insurance, you may not be able to recover some benefits if you are involved in an accident, even if the accident was not your fault. Statutory Accident Benefits (or SABs) are the benefits that motorists (or pedestrians, or cyclists) are entitled to if they are injured in a motor vehicle accident. The benefits available to injured accident victims, irrespective of fault, include Income Replacement and medical and rehabilitation benefits. Some accident victims receive these benefits from their insurance companies without any problems or disputes. In many other cases, however, the insurance company will deny certain benefits, including income replacement and medical benefits, without proper justification. In those cases, the injured accident victim will need an experienced personal injury lawyer or paralegal to assist them in getting access to the benefits that they have been denied. 

There are a number of factors that can affect the nature and amount of benefits an accident victim is eligible for. These include:

  • The nature and seriousness of the injuries or impairments
  • The employment of the accident victim before the accident
  • The availability of other insurance coverage 
  • The provisions of the relevant automobile insurance policy

Reasons Why Your Accident Claim May be Denied

Insurance claims for benefits may be denied when:

  • The insurance company does not accept that you have a serious injury
  • The insurance company does not accept that the injury was caused by the car accident
  • The insurance company does not accept that the injury prevents you from working
  • The insurance company does not accept the benefit is reasonable or necessary

Insurance companies are large, they have vast resources, and they will employ doctors or other health professionals, accountants, and sometimes investigators to find ways to deny claims they do not believe are valid.  The lawyers at McNally Gervan have years of experience in dealing with denied claims for accident benefits.  So if your insurance company has denied your claim for accident benefits, do not conclude that you are not entitled to the benefit: you may be entitled to the benefit and your insurance company may be denying the claim improperly. And the best way to find out is to consult with an experienced personal injury lawyer who knows the system and will fight on your behalf. 

Options for Denial of Accident Benefits

There are many reasons why your claim for accident benefits (or for a specific benefit) may have been denied.  Sometimes, people resubmit applications or try to organize more documents to persuade the insurance company they are entitled to the benefits.  Sometimes it works. But most of the time the insurer maintains its position, and many important weeks or months have been lost, while you have not been receiving income support, or the rehabilitation you need to recover. That is why we recommend that you consult with an experienced personal injury lawyer.