Receiving a denial letter from your insurance company can feel like the end of the road. In Ontario, it isn't. The accident benefits system comes with a formal dispute resolution process administered by the Financial Services Regulatory Authority of Ontario (FSRA) — but it's only available to those who understand it exists and act before the deadline.
Why Insurers Deny Claims
- The insurer disputes whether your injuries meet the threshold for a particular benefit
- An independent medical examination (IME) arranged by the insurer concluded your injuries are less severe than claimed
- The insurer alleges a procedural issue — missed forms, late notice, or missing documentation
- The insurer argues the treatment is not "reasonable and necessary" under SABS
- The insurer believes your injuries pre-dated the accident
The 2-Year Deadline to Apply for Dispute Resolution
Critical Deadline: You must apply to FSRA for dispute resolution within 2 years of the date the insurer refused, suspended, or terminated a benefit. Missing this deadline eliminates your right to formally dispute the denial.
This is not a soft deadline. Once 2 years have passed from the insurer's refusal, your right to challenge is gone. Many claimants assume they can dispute a denial whenever it's convenient — this is incorrect.
Step 1: Internal Review Request
Before going to FSRA, you have the option to request an internal review from your insurer within 10 business days of receiving a denial. The insurer must provide a written decision on the internal review. While this step is not mandatory, it can sometimes resolve straightforward disputes without formal proceedings.
However, an internal review does not pause the 2-year FSRA deadline. If you request an internal review and the insurer upholds the denial, you still must apply to FSRA within 2 years of the original denial.
Step 2: FSRA Dispute Resolution
The Financial Services Regulatory Authority of Ontario administers the accident benefits dispute resolution process. There are two main dispute resolution streams: Mediation: A neutral mediator helps both parties reach an agreement. This is non-binding — either party can reject the outcome. Arbitration: If mediation fails or is waived, an arbitrator makes a binding decision. The arbitrator has full authority to award the disputed benefit, plus interest and costs.
What to Do if Your Claim Was Denied
- Note the date of the denial letter — your 2-year deadline starts from that date
- Read the denial carefully and identify the stated reason
- Gather any medical or other evidence that contradicts the insurer's position
- Consider whether an internal review is appropriate, but don't let it distract from the FSRA deadline