Suffering a bone injury due to an accident can be painful—both physically and emotionally. It becomes even more frustrating when your injury claim is denied, especially if you were counting on that compensation to cover medical bills, lost wages, or rehabilitation costs. If you’re in Toronto and facing a denied bone injury claim, don’t panic. You still have several options to pursue justice and fair compensation.
Here’s what you should do if your bone injury claim is denied in Toronto—and why it’s worth speaking with a Broken Bone Fracture Claims Lawyer.
1. Understand the Reason for the Denial
The first step is to carefully review the denial letter or communication from the insurance company. In Ontario, insurers are required to provide written reasons for denying a claim. Common reasons include:
- Incomplete documentation or missing medical evidence
- Delays in filing the claim
- Disputes over how the injury occurred
- Pre-existing conditions
- Coverage limitations or policy exclusions
Understanding why your claim was denied will help you determine the best course of action going forward.
2. Consult with a Personal Injury Lawyer
In Toronto, navigating a denied injury claim can be complex, especially if you’re unfamiliar with insurance laws or accident benefits under Ontario’s Statutory Accident Benefits Schedule (SABS). A skilled personal injury lawyer can help you:
- Review your case and denial letter
- Gather additional evidence
- File an internal appeal
- Represent you in negotiations or court if necessary
Many Toronto personal injury lawyers offer free consultations and work on a contingency basis, meaning they only get paid if you win your case.
3. File an Internal Appeal with the Insurance Company
Most insurance companies have internal appeal procedures. You typically have 30 to 90 days to submit an appeal, depending on the insurer’s policy. When appealing:
- Provide all necessary medical records, X-rays, MRI scans, or doctor’s notes
- Include a detailed narrative of your injury and recovery process
- Attach witness statements if relevant
- Correct any errors or omissions from the original claim
Even if you feel confident in your appeal, having legal guidance during this process can increase your chances of success.
4. Apply to the Licence Appeal Tribunal (LAT)
If the internal appeal doesn’t work or the insurance company refuses to negotiate, you have the right to escalate the matter to the Licence Appeal Tribunal (LAT) in Ontario. This body handles disputes related to accident benefits and denied insurance claims.
The LAT process includes mediation, case conferences, and possibly a hearing. While it’s possible to represent yourself, claimants often benefit from having a lawyer or paralegal assist them in presenting a strong case.
5. Gather Strong Medical Evidence
Your medical documentation is often the most critical part of your case. To build a compelling claim or appeal, make sure to:
- Get a clear diagnosis from a qualified medical professional
- Follow through with treatment plans, physiotherapy, or surgery
- Obtain written opinions from orthopedic specialists, if possible
- Track all related expenses and limitations in daily life
In Toronto, where wait times for specialists can be long, it’s essential to keep all records and maintain consistency in your treatment to avoid undermining your claim.
6. Avoid Social Media Pitfalls
Be cautious about what you post online while your claim is under dispute. Insurance companies in Ontario are known to monitor social media for evidence that could contradict your injury claims—such as photos of physical activities or vacations. A single post can be misinterpreted and used against you.
7. Know the Limitation Periods
Ontario law sets strict time limits for filing lawsuits or appeals related to denied claims. In general:
- You have two years from the date of the injury (or the date of denial) to file a civil lawsuit.
- LAT applications must be filed within two years of the denial as well.
- Missing a deadline can mean losing your right to compensation entirely, so act quickly.
- Stay Organized and Document Everything
Keep a file of all correspondence, medical reports, bills, and journal entries related to your injury. This will help you stay organized during appeals or legal proceedings and will strengthen your credibility.
Final Thoughts
Having your bone injury claim denied in Toronto isn’t the end of the road—it’s just a bump along the way. With the right strategy, proper legal support, and persistence, you may still recover the compensation you deserve. The key is to act quickly, gather solid evidence, and understand your rights under Ontario law. Whether you resolve the issue through appeal or litigation, don’t give up on your claim without a fight. You’ve already suffered the injury—you shouldn’t suffer financially too.