First: get it in writing
Before arguing anything, ask for the denial in writing stating the specific policy condition or exclusion relied on. Not "the claim is denied" — the actual wording.
Two things happen when you do. Some denials soften immediately, because writing down a reason forces it to be defensible. And when it does not soften, you now have the exact thing to challenge rather than a vague impression of what went wrong.
The grounds insurers actually use
- Misrepresentation on the application — an undeclared driver, the wrong garaging address, understated mileage. The most common serious ground, and it can void a policy entirely.
- An excluded driver was driving — where someone is excluded by endorsement, coverage may not respond at all.
- Undisclosed use of the vehicle — food or parcel delivery, rideshare, or business use on a personal policy.
- Impaired driving or a criminal act — a hard exclusion in every policy.
- Breach of a policy condition — most often late reporting. See reporting versus claiming.
- The loss is not a covered peril — mechanical failure, wear, or a cause your coverage does not include. If you carry Specified Perils rather than Comprehensive, check whether your cause is on the named list.
The escalation path, free, in order
- The adjusterAsk for the written reason and provide anything that contradicts it. Some denials rest on a fact that is simply wrong.
- A supervisor or team managerAsk for the file to be reviewed one level up. Routine, and not an escalation in tone.
- The insurer's complaints officerEvery Ontario insurer must have one. Ask for the complaint process in writing. FSRA publishes a list of these officers.
- The General Insurance OmbudServiceIndependent, free, and reviews disputes once the insurer's internal process is exhausted.
- FSRATakes complaints about insurer conduct. It does not adjudicate your individual claim, but conduct complaints matter.
The clock nobody mentions
It runs from when the claim was discovered, and it does not pause because you are appealing internally or waiting on the OmbudService. People lose otherwise winnable claims by spending twenty-six months being polite.
If your denial involves significant money or any injury, speak to a lawyer well before that horizon — most offer free consultations on exactly this. Use the internal process, but do not let it run the clock out.
If the denial is about injury benefits
Accident benefit denials have their own process and their own forms, and the deadlines are shorter and stricter than property claims. Disputes go to the Licence Appeal Tribunal rather than the ordinary courts. If medical or income replacement benefits have been cut off or refused, that is the point to get advice rather than keep writing letters yourself.
How most denials get avoided
- Declare every regular driver. An undisclosed household driver is the most common misrepresentation finding.
- Report promptly — within seven days or as soon as reasonably possible, whether or not you intend to claim.
- Tell your broker if your use changes — a new commute, delivery work, moving the car to a different address.
- Read your declarations page once a year. Most misrepresentation is accidental and would have been caught by five minutes of reading.
Common questions
Can an insurance company deny a claim in Ontario?
Yes, but only on defined grounds. The common ones are misrepresentation on the application such as an undeclared driver or wrong garaging address, an excluded driver being behind the wheel, undisclosed use of the vehicle such as delivery or rideshare work, impaired driving or a criminal act, breach of a policy condition such as failing to report promptly, or a loss that is simply not a covered peril under your coverage.
How do I appeal a denied insurance claim in Ontario?
Start by requesting the denial in writing with the specific policy condition or exclusion relied on, and provide any evidence that contradicts it. If that does not resolve it, ask for a supervisor review, then request the insurer's formal complaint process and its complaints officer, and after that the General Insurance OmbudService, which reviews disputes independently and free of charge. FSRA separately takes complaints about insurer conduct.
Is there a deadline to challenge a denied claim?
Yes, and this is the detail that costs people otherwise winnable claims. The general limitation period in Ontario is two years from discovery of the claim, and it keeps running while you are appealing internally or waiting on the OmbudService. If the amount is significant, get legal advice well before that two-year mark rather than relying on the internal process to finish in time.
Can a policy be voided entirely for misrepresentation?
Yes, and that is the most serious outcome. Where an insurer establishes material misrepresentation on the application, it may treat the policy as void rather than simply denying the single claim, which can leave you personally exposed for the loss. This is why declaring every regular driver and keeping your stated use and address accurate matters far more than the small premium difference involved.