Can You Dispute an Auto Insurance Claim?

• Many provinces have established a standard complaint-handling protocol that all licensed insurance companies must follow.
• If working with your insurance company to resolve the issue isn’t successful, you have the right to appeal their decision to an independent public insurance adjuster.
• While Canada’s General Insurance OmbudService (GIO) can help you and your insurance company reach an agreement, the GIO’s determination is non-binding.

If you have been in a collision and feel your car insurance company is not being fair, you have options. Here is what you need to know about disputing an auto insurance claim.

File a complaint with your insurance company

One of the first steps to dispute an auto insurance claim is to ask your car insurance company to reconsider. Many provinces, such as Ontario, have established a standard complaint-handling protocol that all licensed insurance companies must follow. The intricacies of the process vary from company to company.

In many cases, you’ll speak to an insurance adjuster—the individual who determines whether your insurance policy covers the repairs in question. Before disputing your claim, ask your insurance adjuster for a detailed explanation of your policy and the insurance company’s decision. Consider reaching out to organizations like the Insurance Bureau of Canada, which can help answer questions about insurance policy technicalities, factors that might affect your insurance company’s decision, and who to contact for additional assistance.

If speaking with the adjuster doesn’t work, consider contacting your insurance company’s Consumer Complaint Officer, an individual who runs the complaint process. In the event you and the Consumer Complaint Officer can’t reach an agreement on your insurance claim, they must provide you with a letter stating the insurance company’s final position on your complaint.

Call in a public adjuster

If working with your insurance company to resolve the issue isn’t successful, you have the right to appeal their decision to an independent public insurance adjuster. Public insurance adjusters are often former private insurance company employees, so they understand the adjustment process and the motivations behind the insurance company’s decision. If the public adjuster agrees, they can argue on your behalf.

Consider reaching out to Canada’s General Insurance OmbudService (GIO), an independent consumer dispute-resolution system. GIO’s impartial environment can help you and your insurance company reach an agreement on your claim. However, the GIO’s determination is non-binding, so your insurance company can refuse to follow the recommendation.

File a lawsuit

If speaking with your insurance company and submitting your claim to the GIO has been unable to help you resolve your complaint, you may want to consider filing a lawsuit. By claiming your insurance company breached your insurance contract by refusing to pay your claim, you may be able to recover damages in court.

If your legal claim is strong, your insurance company may wish to settle out of court, paying you a negotiated amount instead of dealing with a long and complicated lawsuit.

Picking the right insurance company

While disputes can sometimes happen, many car insurance claims are paid out without a hitch. Having the right coverage can help you repair your vehicle after a collision, theft, or severe weather. Search for the right auto insurance coverage that can help protect you from the unexpected.