Personal Injury Lawyers Since 1999
Insurance disputes after an injury can involve more than whether a claim is simply approved or denied. Benefits may be reduced, treatment may not be approved, payments can be stopped, or an insurer may disagree about the severity of your injuries or your ability to work.
At Yegendorf Rashid, we help clients with injury, accident, and disability-related insurance claims, including:
Accident Benefits
If you are injured in a motor vehicle accident, you may have access to accident benefits through auto insurance. We can help when eligible benefits are denied, reduced, delayed, or terminated.
Long-Term Disability Benefits
An injury or medical condition can prevent you from returning to work for an extended period. We help clients challenge denied LTD claims, terminated benefits, and insurer decisions about their ability to return to work.
Income Replacement Benefits
If injuries from a motor vehicle accident prevent you from working, income replacement benefits may provide financial support. We can help when eligibility or the amount or continuation of these benefits is disputed.
Medical & Rehabilitation Benefits
Recovery may require physiotherapy, occupational therapy, psychological treatment, rehabilitation, assessments, and other care. We help clients challenge insurer decisions that deny or limit eligible treatment and rehabilitation benefits.
Attendant Care Benefits
Serious injuries can leave you needing assistance with personal care and everyday activities. We assist with disputes involving eligibility for attendant care and the level of support required.
Catastrophic Impairment Claims
Severe injuries may meet Ontario’s specific criteria for catastrophic impairment following a motor vehicle accident. We help clients navigate disputes over catastrophic impairment designation and the accident benefits associated with their claim.
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Need Help With a Personal Injury Insurance Claim?
If your benefits have been denied, reduced, or stopped after an injury or disability, talk to our personal injury lawyers about your options.
Why Are Personal Injury Insurance Claims Denied or Reduced?
A denied insurance claim does not always mean you are not entitled to benefits. Insurers may question the medical evidence, disagree with your treatment provider, dispute the severity of your injuries, or determine that you no longer meet the requirements for certain benefits.
Common reasons injury-related insurance benefits may be denied, reduced, or stopped include:
Insufficient Medical Evidence
The insurer says there is not enough evidence to support your injuries, limitations, or need for benefits.
Disagreement About Your Injuries
The insurer disagrees with your doctor or treatment provider about the severity or impact of your injuries.
Treatment Is Not Approved
Recommended treatment, rehabilitation, assessments, or other care is considered unnecessary.
The Insurer Says You Can Return to Work
Disability or income-related benefits may be stopped if the insurer determines that you can return to work.
You Do Not Meet the Definition of Disability
The insurer determines that your condition does not meet the definition of disability under your policy.
An Insurance Assessment Disputes Your Claim
An insurer-requested assessment concludes that certain benefits or treatments are no longer required.
Catastrophic Impairment Is Disputed
The insurer disagrees that your injuries meet Ontario’s criteria for catastrophic impairment following a motor vehicle accident.
Understanding why the insurer made its decision—and reviewing the medical evidence and policy terms behind it—is an important first step in determining whether the decision can be challenged.
What Should You Do If Your Personal Injury Insurance Claim Is Denied?
If your insurance benefits have been denied, reduced, or stopped, the decision does not necessarily mean your claim is over. Start by reviewing the insurer’s explanation and your policy so you understand why the decision was made and what coverage may apply. Keep copies of your medical records, treatment recommendations, employment information, and all correspondence with the insurer. You should also be cautious about signing documents or accepting a settlement before you understand how it could affect your claim. Because deadlines and procedures may apply when challenging an insurer’s decision, getting legal advice early can help you understand your options.
If your insurance claim is denied:
Review the Denial
Understand the specific reason the insurer has given for denying, reducing, or stopping your benefits.
Check Your Coverage
Review the relevant terms, definitions, limits, and exclusions in your insurance policy.
Keep Your Evidence
Save medical records, treatment recommendations, employment documents, receipts, and communications with the insurer.
Be Careful What You Sign
Understand the consequences before accepting a settlement or signing a release.
Get Legal Advice
A personal injury lawyer can review the insurer’s decision, your policy, and the evidence to determine what options may be available.
How Our Personal Injury Lawyers Can Help
Our personal injury lawyers can review your insurance policy, the insurer’s decision, and the medical evidence supporting your claim to understand what benefits may be available and why they have been denied or stopped. We can also deal directly with the insurance company on your behalf and help you navigate the process of challenging its decision.
We can help by:
Reviewing Your Policy and Coverage
Determine what benefits may be available and what requirements apply to your claim.
Examining the Insurer’s Decision
Identify why your benefits were denied, reduced, or terminated and whether there may be grounds to challenge the decision.
Gathering Supporting Evidence
Work with medical records, treatment recommendations, employment information, and other evidence relevant to your claim.
Dealing With the Insurance Company
Handle communications with the insurer so you do not have to navigate the dispute alone.
Challenging Denied or Terminated Benefits
Take the appropriate steps to dispute the insurer’s decision and pursue benefits that may be available under your policy.
Negotiating a Resolution
Work toward a fair resolution and, where necessary, pursue further legal action on your behalf.
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Get Help With Your Personal Injury Insurance Claim
If your insurance benefits have been denied, reduced, or stopped after an injury or disability, our personal injury lawyers can review your claim, explain your options, and help you take the next steps.
Hear From People We’ve Helped
Howard helped me get what I deserved from my insurance company.
They were professional, incredibly thorough and included me every step of the way.
They took care of everything so that I was able to focus on getting better.
