Short answer: If your insurer denies or stops an accident benefit, ask for the written reasons, gather medical evidence that answers them and, if the insurer will not change its decision, apply to the Licence Appeal Tribunal. You generally have two years from the denial to start that dispute.
What accident benefits are
Statutory accident benefits are paid by your own auto insurer after a collision, whoever was at fault. Since July 1, 2026, medical, rehabilitation and attendant care benefits are automatic in every policy, while income replacement, non-earner, caregiver, housekeeping and several others are optional coverage. Before challenging a denial, confirm which benefits your policy, or a household member's policy, actually includes.
Common reasons for a denial
- The Minor Injury Guideline. The insurer says your injuries are minor, which caps medical and rehabilitation benefits at $3,500.
- Insurer examinations. An assessor hired by the insurer concludes treatment is not reasonable or necessary, or that you can return to work.
- Missing paperwork or deadlines. Forms not completed, late notice or missed examinations.
- Optional benefits not purchased. A benefit is denied because the policy did not include it.
- Disputes about catastrophic impairment, which affects the limits available.
What to do first
- Read the denial letter carefully. The insurer must give its reasons in writing.
- Ask for copies of any insurer examination reports and the file the decision relies on.
- Take the reasons to your treating doctors and therapists. A clear report that answers the insurer's concerns is often the most important evidence.
- Keep attending treatment you can afford and keep records of your symptoms, work and daily limits.
- Calendar the two year deadline from the date of the denial.
The Licence Appeal Tribunal
Disputes about Ontario accident benefits are decided by the Licence Appeal Tribunal, not by the courts. The usual steps are:
- Application. You file an application identifying the benefits in dispute.
- Case conference. A tribunal member meets with both sides to narrow the issues, explore settlement and set the hearing schedule.
- Hearing. Often in writing or by video, sometimes in person. Both sides file documents and medical reports.
- Decision. The tribunal decides whether the benefit is payable and can order interest on overdue amounts.
Insurers often settle disputes once the medical evidence is clear, either before or after the case conference.
Accident benefits and a lawsuit are different
A tribunal dispute about accident benefits is separate from a lawsuit against an at-fault driver for pain and suffering and income loss. You may have both, and how they interact affects the amounts you recover. Read what to do after a car accident in Toronto for the other deadlines.
Frequently asked questions
How long do I have to dispute denied accident benefits in Ontario?
Generally two years from the date of the insurer's written denial.
Where do I appeal denied accident benefits in Ontario?
To the Licence Appeal Tribunal, which decides statutory accident benefits disputes.
What is the Minor Injury Guideline?
A framework that limits medical and rehabilitation benefits to $3,500 for injuries such as sprains, strains and whiplash, unless there is evidence that a pre-existing condition or the injuries take you outside it.
Can I get income replacement benefits after July 1, 2026?
Only if the policy includes that optional coverage. Check your policy and any household member's policy.
Do I need a lawyer to go to the Licence Appeal Tribunal?
It is not required, but tribunal disputes depend heavily on medical evidence and procedure, and advice early often makes a difference.
Talk to our team
This guide is general information, not legal advice. For advice on your situation, see our personal injury lawyer in Toronto page. For personal injury matters, book a free 10-minute case review with the lawyer or call (647) 271-1646; the phone is answered 24 hours a day, 7 days a week. Civitas Law is a team of legal professionals under the leadership of lawyer Nasibeh Mehrpouyan, serving clients in English, French, Farsi, Russian and Serbian.