Ottawa Personal Injury Lawyers Blog

Has your accident benefits claim been denied ? You have options.

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Has your accident benefits claim been denied ? You have options.

You might be surprised to know that many insurance claims are denied benefits. I often meet with clients who have been told that their expenses will not be covered by their insurance company.  Inevitably, they are provided some sort of reason.  Other times, clients have been receiving accident benefits and are then notified by their insurance company that they their claim is being reviewed and reassessed and that they may be “cut-off”.  Sadly, some people accept this and end up continuing life injured , without access to benefits that are much-needed. Once their benefits are denied they think that they have no other options.

Insurance companies must assess every injury claim and the proposed treatment plan and from there determine what they believe to be necessary expenditures. Often times, the insurance company will conduct their own assessment by hiring their own medical professionals to perform an assessment. Sometimes the assessment from the insurance company are vastly different from our client’s initial assessments. Our Ottawa personal injury lawyers have seen this many times.  We understand how the system works and we make sure that our medical assessments are also taken into consideration and that our clients are treated fairly.  We know how important it is to show the severity of our clients’ injuries and that proper compensation is awarded.

If a person has been denied a particular benefit, they must apply to the Financial Services Commission of Ontario “FSCO” to mediate the denied benefit.  FSCO is required to schedule a mediation of the dispute within 60 days of receiving the application for mediation. However, many injured people find that the wait time for a mediation date is much longer.

Often times,  it begins with one benefit being denied. What then happens is that  a FSCO mediation is schedule to try to attempt a resolution. At a mediation, our Ottawa personal injury lawyers present the case and negotiate for what is right. Often times , at the mediation stage, the insurance company will offer a settlement amount, which is a sum of money to close out the file. This is where personal injury lawyers make all the difference because not only are they highly experienced in this negotiation process, they are armed with their own reports, prognosis  and medical examinations that can prove the long-term implications of the specific injuries and therefore what amount of compensation is truly needed long-term.

If the mediation is not successful and both parties do not agree, then typically the next step is for a personal injury lawyer to file a ” Statement of Claim” . At this stage, a judge or arbitrator is hired to access the benefits being denied and give a ruling as to whether or not they should be compensated.  Individuals who have been denied accident benefits are in a difficult spot.  They are injured and they need compensation and support.  Our Ottawa personal injury lawyers spend their days helping people get all the support and maximum compensation they are entitled to.

In every case, the facts will vary. Most personal injury lawyers offer free consultations and it is always best you sit down and discuss your situation. Experienced personal injury lawyers can walk you through the steps and give you an idea of what you might expect.  There are timelines that need to be met and forms that must be filled out and filed.  You don’t need to do this alone.


About the Author

David Hollingsworth has been a personal injury lawyer in Ottawa since 1999. David dedicates himself to helping people who have been injured in an accident, including car accidents, slip and fall accidents, motorcycle accidents, LTD claims, Accident Benefits claims and more. David and his team work closely with their clients and their families and help rebuild lives, following a traumatic accident. To learn more about David Hollingsworth, view his full profile.