Accident Benefits Denials 101

Accident benefits being denied? You can do something about it!

Denied DocumentIf you have been in a car accident you may apply for and receive accident benefits. Accident benefits can be in the form of income replacement benefits or a caregiver benefit, but accident benefits also can help with medical costs, treatments and attendant care costs. The insurance company will pay these accident benefits to the person injured in the car accident once the appropriate Auto Insurance Claim Forms are filled out.

However, accident benefits are not necessarily a long-lasting payment and it is important to understand what happens if you receive a letter denying your claims.  Take the following example: When you submit a form to the insurance company for a treatment plan, the insurer will often set up a medical examination to confirm the necessity and reasonableness of the proposed treatment plan. Depending on what the insurer’s medical examiner determines, you may be denied accident benefits for that treatment plan.

What happens next? It is important that you understand that this does not always mean accident benefits are no longer possible for you. You must apply to the Financial Services Commission of Ontario (FSCO). If your medical treatment benefit, or other benefit, has been denied  it is important you take action and contact FSCO for mediation. FSCO will then schedule a mediation, supposedly within 60 days of receiving the application for mediation, but this might take longer. At mediation, negotiations around your disputed accident benefits will take place. You can negotiate for yourself, or through your lawyer. These negotiations will ideally come to a resolution of the disputed accident benefit that pleases both parties.

If mediation fails, your plight is not necessarily over with. You may either file a Statement of Claim through the Courts, which will begin a court action, or you can apply for arbitration through FSCO. With both of these, a decision-maker will decide what, if anything, you receive. Like any court action, there are deadlines to submit a Statement of Claim or an application for arbitration. Make sure to educate yourself on these deadlines so you are not prevented from getting what you deserve! This is basic information regarding the process you can do if and when your accident benefits are denied. An important website you can check out for information/instructions and important forms is:

http://www.fsco.ca/en/forms/Pages/default.aspx

If you or a loved one has sustained personal injury from a car accident and wish to gain more information on accident benefits, accident benefit denials, and tort claims and legal options, do not hesitate to contact our personal injury law firm about your legal rights!

 

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