You filed your accident benefits claim. You did what you were supposed to do. And then your insurer sent a letter telling you the claim is denied. It is a stressful, frustrating moment — and one that many people accept as final when it isn't.
A Denial Is Not the Final Word
Ontario law provides a formal dispute resolution process for accident benefit denials, administered by the Financial Services Regulatory Authority of Ontario (FSRA). You have the right to challenge your insurer's decision — but you must act before the deadline expires.
Step 1: Note the Date of the Denial Letter
Your right to apply for dispute resolution through FSRA expires 2 years from the date your insurer refused, suspended, or terminated the benefit. The clock starts from the denial letter, not from when you decide to do something about it. Write the date down now.
Step 2: Understand Why You Were Denied
- Read the denial letter carefully. The most common reasons include:
- Your injury was classified as a minor injury under the Minor Injury Guideline (MIG)
- The insurer argues the treatment is not reasonable and necessary
- An independent medical examination (IME) concluded your injuries are less severe than claimed
- You missed a procedural deadline (late notice, incomplete forms)
- The insurer disputes whether your condition pre-dates the accident
Step 3: Request an Internal Review (Optional)
Within 10 business days of a denial, you can request an internal review from your insurer. This is an informal process where the insurer reconsiders the decision. It can sometimes resolve clear-cut errors without formal proceedings. However, an internal review does not pause your 2-year FSRA deadline — the clock keeps running regardless.
Step 4: Apply to FSRA for Dispute Resolution
If the denial stands, you can apply to FSRA for formal dispute resolution. The two main processes are:
Mediation: A neutral mediator helps both sides reach an agreement. Non-binding — either party can reject the outcome. Arbitration: A binding decision by an arbitrator. The arbitrator can award the disputed benefit plus interest and costs.
You must apply within 2 years of the denial. Missing this deadline permanently eliminates your right to challenge.
If your claim has been denied or your benefits have been reduced, a free review can help you understand what your options are and whether the denial is likely worth challenging.