If your insurance claim is denied in Ontario, or you’re offered less than you think it’s worth, first ask the insurer to explain the decision in writing and send any new evidence. If that fails, use the insurer’s complaint process and ask for a final position letter. That letter opens the door to a free, independent review by the General Insurance OmbudService (GIO) for home, auto and business claims. Denied auto accident benefits go to the Licence Appeal Tribunal instead.
A denial isn’t always the last word. Ontario has a set route for disputes, and knowing it before you start saves time. Disputes are common: the GIO received 7,330 consumer contacts in the year to April 30, 2025, its busiest year on record. Of those, 4,701, about 64%, came from Ontario.
This guide picks up where our guides to filing a car insurance claim and filing a home insurance claim leave off: you’ve filed, and the answer wasn’t the one you expected.
Why was my insurance claim denied in Ontario?
Before you dispute anything, find out exactly why. Registered Insurance Brokers of Ontario (RIBO) states that if your claim is denied, “you also have the right to be informed why it was denied.”
Common reasons fall into a few groups:
- The loss isn’t covered. The policy excludes it, or you didn’t buy the optional coverage that would have applied.
- A policy condition wasn’t met. Late reporting is the classic one. For auto claims, FSRA says you must report an accident to your broker, agent or insurer within seven days.
- The insurer disagrees on the amount. It accepts the claim but values the loss lower than you do.
- Fault. For auto claims, the insurer applied Ontario’s Fault Determination Rules and found you wholly or partly at fault.
Each of these leads to a different fix, so pin down which one applies before you go further.
Step 1: Ask for the reason in writing and add evidence
Call your adjuster and ask which policy wording, exclusion or rule they relied on. For a fault decision, FSRA’s claims guidance says to ask which rule in the Fault Determination Rules was applied. It also says an insurer will reconsider fault “only if additional, relevant information is provided.”
So give them something new: repair estimates, photos, receipts, a contractor’s report, witness details or a police report. If the adjuster can’t help, ask for their claims supervisor.
Keep a log as you go. The Financial Consumer Agency of Canada (FCAC) recommends noting dates, the names of the people you spoke with and what was said.
Step 2: Use your insurer’s complaint process and get a final position letter
If the adjuster won’t change the decision, make a formal complaint. FSRA’s claims guidance says each insurer has a complaint officer responsible for making sure your complaint is addressed; some insurers call this role an ombudsman. FCAC suggests you prepare your policy number, your broker or agent’s name, the key facts, the outcome you want and copies of your documents.
The most important thing to ask for at this stage is a final position letter. FCAC advises asking for “a letter that clearly states your insurer’s final decision regarding your complaint.” Without it, the GIO can’t review your file and FSRA can’t review your complaint.
Step 3: Take a denied home, auto or business claim to the GIO
Once you have the final position letter and still disagree, you can bring the dispute to the GIO. It’s an independent, not-for-profit service for home, auto and business insurance disputes, and it’s free.
According to the GIO, the process runs in up to four stages:
| Stage | What happens | GIO’s target time |
|---|---|---|
| Consumer Assistance | An intake officer opens a file and explains your options | No target published |
| Informal Conciliation | An investigation officer checks the complaint is within mandate and has merit | 45 days |
| Mediation | A mediator works with you and the insurer toward a settlement | 60 days |
| Senior Adjudication | A senior officer investigates and issues a written report with recommendations | 90 days |
Know the limits before you start:
- Recommendations are non-binding. Neither you nor the insurer has to accept them. Using the GIO doesn’t affect your legal rights, so you can still pursue legal action afterwards.
- Some disputes are outside its mandate. These include the price of insurance, whether an insurer will offer you coverage, and matters already before a court.
- Your insurer must be a subscriber. The GIO’s member list covers many insurers, but not every Ontario insurer. FSRA’s claims guidance says the final position letter should identify the independent ombudsman organization that can review your complaint.
In the 2024–2025 year, the GIO’s average time to close a file fell to 38.25 days, from 48.3 days the year before.
Step 4: Disagree about the value of a property loss? Ask about appraisal
If your insurer agrees the damage is covered but you can’t agree on the amount, you may not need a complaint at all. FSRA’s claims guidance says a disagreement over the value of property damage “can be settled by an appraisal under the Insurance Act.” The request “must be made in writing, and your insurance company must participate.”
Appraisal settles the amount of the loss. It doesn’t decide whether the loss is covered. Ask your broker or a lawyer how appraisal works under your policy before you invoke it.
Step 5: Know who handles a denied insurance claim in Ontario
Ontario splits insurance disputes between several bodies, and choosing the wrong one costs time.
| Your problem | Where to go | Notes |
|---|---|---|
| Denied or underpaid home, auto or business claim | Insurer’s complaint process, then the GIO | Final position letter needed first |
| Dispute over the amount of a property loss | Appraisal under the Insurance Act | Request it in writing |
| Denied or stopped auto accident benefits | Licence Appeal Tribunal (LAT-AABS) | Apply within two years of the written denial; $106 fee |
| Insurer or agent not following the rules | FSRA | Regulatory review, not compensation |
| Your broker’s conduct or service | RIBO | Professional conduct complaints |
| Life, health or travel insurance | OmbudService for Life and Health Insurance (OLHI) | Separate from the GIO |
| Suing your insurer for up to $50,000 | Small Claims Court | Get legal advice first |
Accident benefits go to the LAT, not the GIO
If your insurer denies or stops statutory accident benefits after a car crash, the dispute goes to the Automobile Accident Benefits Service of the Licence Appeal Tribunal (LAT-AABS). Tribunals Ontario says you must apply within two years of receiving the insurer’s written denial with reasons. The application fee is $106 and isn’t refundable. The LAT-AABS doesn’t hear disputes about property damage, fault or which insurer is responsible.
Accident benefits rules changed on July 1, 2026. Our post on Ontario’s 2026 auto insurance changes explains which benefits are now optional.
FSRA regulates insurers but doesn’t settle your claim
FSRA’s complaint form says it reviews whether “regulatory requirements were not met” and decides whether action is needed. It’s also clear about what it can’t do: it can’t “force a company or individual to change a business decision or provide refunds,” and it can’t “seek compensation on your behalf or resolve individual disputes.” It also won’t review a complaint until you have the company’s final written response.
Complain to FSRA if you think an insurer isn’t following the rules. Don’t expect it to pay your claim.
RIBO handles complaints about brokers
If the problem is how your broker treated you, not your insurer, RIBO investigates conduct complaints. Examples include poor service, failing to follow your instructions or failing to explain your policy’s terms. RIBO says it can’t award compensation, and it refers claims disputes with insurers to the GIO.
Court is the last step
Ontario’s Small Claims Court hears claims of up to $50,000; the limit rose from $35,000 on October 1, 2025. Lawsuits have strict legal deadlines, so speak to a lawyer or licensed paralegal early if court is a possibility.
How a broker can help when your claim is denied
A broker can’t overrule your insurer. A broker can help you read the denial against your policy wording, gather the right evidence and press the insurer’s claims team for a clear answer. RIBO tells consumers they have “the right to be treated with fairness and integrity” by their broker.
[AAXEL to confirm or replace: one real, anonymised example of a disputed claim your brokers helped with. Delete this line if you have none.]
If your dispute came out of this fall’s storms, our storm damage claims guide covers sewer backup, flood and hail coverage. This guide covers what to do once you’ve been told no. For help with an existing claim, start at our claims page or request a call back.
Frequently asked questions about denied insurance claims
What should I do first if my insurance claim is denied in Ontario?
Ask your adjuster to explain the decision and name the policy wording or rule they relied on. RIBO says you have the right to be told why a claim was denied. Then send any new evidence, such as estimates, photos or a police report.
What is a final position letter?
It’s a letter from your insurer stating its final decision on your complaint. FCAC recommends asking for one at the end of the insurer’s internal complaint process. The GIO and FSRA both need it before they’ll review your case.
Is the General Insurance OmbudService free?
Yes. The GIO says all of its services are free for home, auto and business policyholders of its subscriber insurers. It works in English and French.
Does my insurer have to follow the GIO’s recommendation?
No. The GIO’s recommendations are non-binding for both you and the insurer. Using the GIO doesn’t affect your legal rights, so you can still pursue legal action or contact the regulator afterwards.
How long does a GIO review take?
The GIO sets targets of 45 days for Informal Conciliation, 60 days for Mediation and 90 days for Senior Adjudication, barring exceptional circumstances. In 2024–2025 its average time to close a file was 38.25 days.
Can the GIO help if I think my premium is too high?
No. The GIO lists the cost of insurance and rates as outside its mandate, along with whether an insurer will offer you coverage. Matters already before a court are also excluded.
What if my insurer and I disagree only on how much the damage is worth?
FSRA’s claims guidance says a dispute over the value of property damage can be settled by appraisal under the Insurance Act. The request must be made in writing, and the insurer must take part. Appraisal sets the amount; it doesn’t decide coverage.
Where do I appeal denied accident benefits in Ontario?
Apply to the Licence Appeal Tribunal’s Automobile Accident Benefits Service (LAT-AABS). Tribunals Ontario says to apply within two years of the insurer’s written denial with reasons. The fee is $106 and isn’t refundable.
Can FSRA make my insurer pay my claim?
No. FSRA says it can’t force a company to change a business decision, order refunds, seek compensation for you or resolve individual disputes. It reviews whether regulatory requirements were met and decides on regulatory action.
How do I complain about my insurance broker in Ontario?
RIBO handles complaints about a broker’s professional conduct, such as poor service or not explaining your policy. RIBO encourages you to contact the brokerage first. It can’t award compensation and refers claims disputes with insurers to the GIO.
Can I take my insurance company to Small Claims Court?
Ontario’s Small Claims Court hears claims of up to $50,000, a limit that took effect on October 1, 2025. Lawsuits have strict legal deadlines, so get advice from a lawyer or licensed paralegal early.
Sources
- General Insurance OmbudService – Annual Report 2024–2025
- General Insurance OmbudService – How the process works
- General Insurance OmbudService – FAQ
- General Insurance OmbudService – Member companies
- FSRA – Complaint Form GF-012E
- FSRA – Submit a complaint to FSRA
- FSRA – Auto insurance
- FSRA – After an Auto Accident: Understanding the Claims Process
- Financial Consumer Agency of Canada – How to file a complaint about your insurance company
- Tribunals Ontario – LAT-AABS application and hearing process
- RIBO – Making a complaint
- RIBO – Consumer rights and expectations
- Ontario.ca – Civil law information and resources
- Insurance Bureau of Canada – Dispute resolution
This article is general information about insurance disputes in Ontario as of October 30, 2026. It is not legal advice. Your rights depend on your policy wording and the facts of your claim, and legal deadlines apply. For advice on a specific dispute, speak to a lawyer or licensed paralegal. An insurance broker cannot overrule an insurer’s claims decision.
