When dealing with legal matters, it’s normal to feel overwhelmed and unsure about what to do next. You may have questions about your rights, the legal process, or what to expect. At Gowland, Boriss, we’re here to help.

These Frequently Asked Questions and Answers sections address some of the most common questions we hear from individuals.

If you need more personalized guidance, our team is just a phone call or email away. We are committed to helping you move forward with clarity and confidence.

 

705.743.7252 | 1.800.808.0189 | info@gowlandboriss.ca

Insurance Disputes FAQs

1. What types of insurance disputes do you handle?

We assist with a wide range of insurance disputes, including long-term disability (LTD), life insurance, critical illness, home and auto insurance claims, and more. Whether your claim was denied, delayed, or undervalued, our team can help assess your case and determine the best course of action.

2. Why would an insurance company deny my claim?

There are many reasons an insurance company might deny a claim, including alleged misrepresentation, missed deadlines, lack of medical evidence, or disputes over coverage. Sometimes, denials happen even when your claim is valid. That’s why it’s important to have a legal professional review the denial and explain your rights.

3. Can I dispute a denied or delayed claim?

Yes, you have the right to dispute a denied or delayed insurance claim in Ontario. In many cases, claims can be successfully challenged through negotiation or legal action. Speaking with a lawyer early can help you build a strong case and avoid missing critical deadlines.

4. Do I need a lawyer to handle an insurance dispute?

While it’s possible to communicate with the insurance company on your own, having a lawyer can significantly improve your chances of a fair outcome. We can help you understand your policy, gather the necessary documentation, and advocate on your behalf. Insurance companies often have teams of professionals working for them—you deserve someone in your corner, too.

5. How much does it cost to hire an insurance dispute?

Most personal injury lawyers in Ontario work on a contingency fee basis where the fee is a percentage of your settlement or award, and all terms are discussed in advance so there are no surprises. When your matter resolves our firm takes a percentage of the settlement or award for our fees and disbursements. Our lawyer or paralegal will fully explain our retainer and fee arrangements at your initial consultation before you retain us.

6. What are disbursements?

Disbursements are out-of-pocket expenses paid by a law firm to move your case forward. These can include costs for medical records, court filing fees, expert reports, and other necessary documentation. At our firm, we typically cover these costs upfront and recover them upon settlement.

7. How long do I have to dispute a claim?

Time limits (also known as limitation periods) vary depending on the type of insurance and the terms of your policy, but in many cases, you have two (2) years from the date of denial to take legal action. It’s important to act promptly to protect your rights.

8. If I have suffered a fire, flood or other event that has either destroyed or severely damaged my home or business property, what are the time limits in making a claim for compensation from my own insurance company? What about automobile property damage claims and life insurance claims?

Firstly, for property damage, you must deliver a form called a Proof of Loss, which is sworn to be true, and which sets out in detail your claims. The insurer is technically not obliged to pay anything until 60 days after you submit this form, but it often takes time to complete and ensure it is comprehensive. While some Proofs of Loss are short and relatively simple, a fire loss Proof of Loss may require lengthy schedules listing the value claimed for literally hundreds or thousands of individual items. There is a broad discretion to allow for late filing of a Proof of Loss. However, please appreciate it is important to be accurate. Claims can be successfully denied by insurers for willfully false or exaggerated claims in the Proof of Loss.

On the other hand, there is also a time limit for suing by starting a court action. While, in most cases, the limitation is two years from when you knew or ought to have known about your loss and the refusal to pay, in property loss situations, we recommend that you treat the limitation as one year, which is definitely the case for destruction or damage to an automobile, and may be the limitation period under some homeowners and business policies. Determining whether the limitation period is one year or two can be a complicated interpretation issue for which you will want a lawyer involved. We recommend to clients that, as a precaution, they always treat the limitation as one year from the date of loss unless the insurer agrees in writing it is two years.

As for life insurance, the limitation period to sue on a claim is usually two years, but, again, much depends on the wording of the whole policy and complicated interpretation issues, for which legal advice may be required.

9. If you feel that an insurer is not being responsive to your claims, either being slow or offering too little, will hiring a lawyer solve this problem?

The answer is usually simply hiring a lawyer will not solve problems of this nature, but a lawyer can provide you with guidance as to how to maximize your claims by, for example, hiring someone who is a public adjuster in a large enough claim to help you put a value on your losses and prepare the Proof of Loss. There are also various strategies for getting the insurance representative to be more responsive, such as reporting the problems to the Ombudsman of the insurance company. If the problems continue, that is the time to consider hiring a lawyer.

10. Can I get an award for the upset and inconvenience of dealing with a fire loss from my own insurance company?

The answer is usually no, unless there are some very rare provisions in the policy or very unusual circumstances. What you get is the value of your lost property. Policies may differ as to whether you will get the Actual Cash Value, which is usually the value of the property on the date it was destroyed (usually calculated as replacement cost less appropriate depreciation) or Replacement Cost, if your policy so provides, and your policy has adequate limits to cover that value. A lawyer should be consulted as to your prospects of obtaining any additional amounts to compensate you for the extreme inconvenience or mishandling of your loss or even punish an insurer who engages in outrageous conduct. Such additional awards are relatively rare.

11. What if I find I am seriously underinsured?

Lack of adequate insurance can come as an unpleasant shock. In those cases, you may want to consult a lawyer as to whether the agent selling you the policy was negligent, which may give rise to a lawsuit against the agent/broker.

12. What happens if I have a loss any my insurance company says I am not covered?

If you believe you are covered, the advice of a lawyer would be helpful in terms of assessing whether you have a claim worth pursuing. Because policies other than automobile insurance policies are not fully standardized, to provide you with an opinion a lawyer would need a detailed summary of the facts, copies of the correspondence between yourself and the insurance company, and a copy of the full text of your insurance policy to assess whether you are covered or not.

13. What happens if I have been sued by a third party? Does my homeowners or business policy respond? When does my automobile insurer respond?

Most homeowners’ policies and most Comprehensive General Liability (business) policies provide for liability coverage, which could require an insurer to defend you at their expense and pay any amounts ordered against you at either a trial or by way of settlement, up to the policy limits. However, policies are often full of exclusions and limitations on coverage, which require careful assessment as to whether you are covered or not. For example, almost all insurance policies exclude all coverage for intentional or criminal acts committed by you. Again, a full understanding of all the facts, the circumstances of the loss, the reasons for the refusal of your insurance company to defend you, and a copy of the full text of your insurance policy is essential in assessing whether there is coverage or not and whether there is a defence available to you. Most homeowners and business insurance policies do not defend or pay for claims arising from use or operation of a motor vehicle (motor vehicle accidents). In these cases, your automobile insurer should defend you at its own expense and pay any judgment or settlement up to the policy limits, again subject to the risk that coverage is excluded by the terms of the policy in the specific circumstances.

If you have a question that isn’t answered here, we invite you to contact us. The Gowland, Boriss team is here to listen, support, and guide you through the process—with clarity, compassion, and a strong commitment to your best interests.

705.743.7252 | 1.800.808.0189 | info@gowlandboriss.ca

Disclaimer:

Please note that nothing on this website should be considered legal advice and is being provided for general information purposes only. For legal advice, we encourage consultation with a lawyer to review your specific concerns and situation.