Orthopaedic Injury Claims in Ontario

Insurers may deny a claim for several reasons, including a belief that imaging or clinical findings don't fully support your reported symptoms, a conflicting independent medical examination, gaps in treatment, or a change in how your policy defines disability over time. A denial reflects the insurer's interpretation of your file, not necessarily the full picture of your recovery.

Not necessarily. Many policies distinguish between being unable to perform your own occupation and being unable to perform any occupation, and that definition can change after a set period. Whether you meet the definition depends on the specific language in your policy and the medical evidence in your file.

Read it carefully and act quickly. Denial letters often include appeal deadlines, and the steps you take next can affect your ability to challenge the decision. Speaking with a lawyer early can help you understand what the denial actually says and what your options are.

It's possible, though insurers may scrutinize whether your current injury is connected to the original incident or is an aggravation of a prior condition. This is often a key point of dispute and typically requires clear medical documentation linking the injury to the event.

Deadlines vary depending on your policy and the type of claim, and missing one can limit your options significantly. It's important to review your denial letter for specific timelines and speak with a lawyer as soon as possible after receiving it.

You are not required to have a lawyer, but the appeals process often involves navigating complex policy language, medical evidence, and insurer procedures. Speaking with a lawyer can help you understand your options and how to present your case.