What should I do first when an insurance claim is denied?
Start by requesting a written explanation of the denial from your insurer. Insurers are required to explain their decision in writing. Read the explanation carefully alongside your actual policy wording — many disputes arise from misunderstandings about coverage terms, exclusions, or conditions. Identify the specific clause or reason the insurer relied on. Then file a formal written internal appeal stating clearly why you disagree, citing the policy language you believe supports your claim, and attaching any supporting documentation such as photos, repair estimates, or medical records.
How does the internal appeal process work at a Canadian insurance company?
Every federally or provincially regulated insurer in Canada must have a formal complaint handling process. After your initial claim is denied, write a formal complaint letter to the insurer's complaints department — not just your claims adjuster. Clearly state the facts, the policy provisions you rely on, and the resolution you are seeking. The insurer must acknowledge your complaint and provide a final position letter within a reasonable time, typically 30-90 days. Keep a record of every communication. The final position letter is what you take to an external ombudsman if you are not satisfied.
What does the Financial Services Regulatory Authority of Ontario handle?
The Financial Services Regulatory Authority of Ontario (FSRA) regulates insurance companies, credit unions, mortgage brokers, and pension plans in Ontario. For insurance disputes, FSRA handles complaints about insurer conduct — such as unreasonable delays, failure to investigate properly, or unfair claims practices — rather than adjudicating the specific dollar amount of your claim. File a complaint at fsrao.ca. FSRA can investigate and require insurers to explain their practices, but it does not order payment. For auto insurance dispute resolution in Ontario, FSRA administers the Dispute Resolution Services (DRS) for accident benefits claims.
What does the Ombudsman for Banking Services and Investments handle?
The Ombudsman for Banking Services and Investments (OBSI) handles disputes between consumers and federally regulated financial services firms — primarily banks and investment dealers. For insurance products sold through a bank (such as creditor life insurance, travel insurance sold at point of purchase, or group benefits), OBSI may have jurisdiction. OBSI provides free, impartial dispute resolution and can recommend compensation up to $350,000. Its decisions are not legally binding but are followed by most member firms.
What does the General Insurance OmbudService handle?
The General Insurance OmbudService (GIO) provides free, independent dispute resolution for home, auto, commercial, and travel insurance disputes involving participating insurers. If your insurer is a GIO member and your complaint falls within GIO's scope, you can escalate after receiving your insurer's final position letter. GIO reviews the dispute, may conduct an investigation, and issues a non-binding recommendation. Most major Canadian property and casualty insurers participate. Check the GIO website at olhi.ca to confirm your insurer is a member before filing.
How do auto insurance disputes work differently in no-fault provinces?
In no-fault provinces such as Ontario and BC, accident benefits (income replacement, medical and rehabilitation benefits, and attendant care) are paid by your own insurer regardless of who caused the accident. In Ontario, if your insurer denies or underpays accident benefits, the dispute goes to FSRA's Dispute Resolution Services (DRS), which offers mediation and then arbitration before the License Appeal Tribunal (LAT). In BC, ICBC handles both accident benefits and fault-based claims, and disputes are resolved through ICBC's internal review process or the Civil Resolution Tribunal (CRT) for claims under $50,000.
What should I do if the ombudsman cannot resolve my insurance dispute?
If the ombudsman process does not result in a satisfactory outcome, your remaining options include: filing a lawsuit in small claims court for amounts within the provincial limit (typically $35,000 in Ontario, $25,000 in BC), filing in superior court for larger amounts (usually involving a lawyer), or filing a complaint with your provincial insurance regulator for conduct violations. In Ontario, you can also apply to the LAT for accident benefit disputes. Time limitations apply — typically two years from the date of denial — so do not delay if the ombudsman process is exhausted.
What do independent medical exams and appraisals provide in an insurance dispute?
An independent medical examination (IME) provides an assessment by a doctor chosen by the insurer to evaluate your injuries or condition. You have the right to obtain your own IME or specialist report from a physician of your choosing to counter the insurer's opinion. For property disputes — such as disagreements about the value of a damaged home or vehicle — an independent appraisal by a licensed appraiser or public adjuster can document the true replacement cost. These independent reports are often the most persuasive evidence in an appeal or ombudsman complaint.
Do I need to notarize documents for an insurance dispute?
No. Insurance companies, ombudsman services, and provincial regulators do not require notarized documents for dispute processes. You will need to provide legible copies of your policy, all correspondence with your insurer, supporting evidence such as photos or repair estimates, and any medical or financial records relevant to your claim. Keep originals and provide good-quality copies. Some insurers may ask that you sign a sworn proof of loss for property claims — this is a specific legal document required under the Insurance Act, not a general notarization requirement.
How does uplaw.ai help draft your appeal letter and organize your claim documents?
uplaw.ai walks you through your provincial insurance complaint process step by step, drafts a clear and organized appeal letter citing the relevant policy provisions and supporting facts, helps you prepare a complaint submission for FSRA, GIO, or OBSI, and explains what evidence to gather. The AI identifies the correct escalation path for your type of insurance — auto accident benefits, home, life, or disability — and your province, so you can take the right steps in the right order without paying a lawyer.
What is a proof of loss and when is it required in a Canadian insurance claim?
A proof of loss is a formal sworn statement submitted to your insurer detailing the circumstances and value of your loss. Under provincial Insurance Acts, insurers can require you to submit a proof of loss — typically within 60 days of a request. Failing to submit one on time can void your claim. The proof of loss must be signed and sworn before a commissioner of oaths or notary. It lists every item lost or damaged, the value, and any other insurance you hold. Your insurer must provide a blank form on request.
What are the time limits for making an insurance claim in Canada?
Time limits vary by insurance type and province. For property and casualty claims, you must give notice of a loss to your insurer as soon as practicable — typically within a few days. To pursue legal action, provincial limitation periods apply: generally two years from the date you knew or ought to have known you had a claim. However, many insurance policies impose shorter contractual limitation periods — sometimes as short as one year from the date of loss. Read your policy carefully and do not delay filing your claim or initiating a dispute process.
Can a public adjuster help with my insurance dispute and is it worth it?
A public adjuster is a licensed professional who represents policyholders — not insurers — in the claims process. They assess the damage, document losses, prepare proof of loss statements, and negotiate with the insurer on your behalf. They charge a percentage of the final settlement, typically 10-15%. For large, complex property claims involving significant damage, a public adjuster can often recover enough additional settlement to justify their fee. For straightforward disputes involving clear policy language, handling the appeal yourself with uplaw.ai guidance and escalating to GIO if needed is a lower-cost approach.
Free to start
Ready to file? Tell uplaw.ai what's going on.
No account required. uplaw.ai drafts your appeal letter, organizes your claim documents, and identifies the right ombudsman for your insurance type and province.