After An Accident insurance: Understanding Claims Process

After An Accident insurance: Understanding Claims Process You have been injured in an Accident insurance and you want to file a claim. This guide will help you understand how the process works and get you …

After An Accident insurance: Understanding Claims Process

You have been injured in an Accident insurance and you want to file a claim. This guide will help you understand how the process works and get you the best outcome. For more information regarding your specific situation, contact your broker, accident insurance agent, or company representative.

Know your policy

It is a good idea that you take time to review your Ontario Automobile Policy (OAP1) to fully understand your rights, responsibilities, and coverages.

How to file an Accident Report and When

After an accident, you must notify your broker, agent, insurance company within seven days. Or as soon as possible thereafter. Your claim may not be honored if you fail to notify your broker, agent or insurance company within a reasonable period of time. To make your report, please provide the following information:

Your policy number

  • Make, model, year and registration number of the vehicle
  • Information about accidents – driver’s name, license number (if the driver wasn’t the registered owner)
  • Date, time and place of the accident

Injuries sustained

  • Number of passengers involved
  • The extent of the damage to the vehicle
  • Your description of the accident
  • Names and numbers of all drivers involved
  • Names and addresses of all insurance companies.
  • If an accident was reported to police, the name of the investigating officer and the badge number

What happens once you file a claim

A claims adjuster will contact your after you have filed your claim. The adjuster may ask you to fill out a Proof of Loss Form. An adjuster will assess the amount of your claim that your insurer will pay and will guide you through the claims process.

How is fault determined

After an accident is reported, your insurance company will assign fault according to the Insurance Act. These are the rules:

  • Diagrams are available to cover more than 40 possible accident situations. They can be applied for almost any road collision scenario.
  • These rules can be applied regardless if there are road or weather conditions, visibility or point of impact on vehicles.
  • You should note that fault can sometimes be shared among multiple victims of an accident.

Drivers: How does your fault affect you?

A driver can be found to be anywhere from zero up to 100 percent at-fault after an accident. Your insurance records will record if you are found at fault. Your premium may go up if your fault is found to be more than 50%.

If you lend your car to someone, and they are found to have been at fault for an accident in your car, your record will reflect this.

What to do when you disagree with the insurance company’s fault assessment

If you believe that your insurance company committed an error when settling your claim for you, contact your claims adjuster to find out which Fault Determination rule was used in your case. If your insurer refuses to reconsider their decision and you are still not satisfied, contact your complaint officer.

At-fault determinations, police charges, convictions

You are not automatically at-fault for insurance purposes if you are charged with an offence. Also, even if an offence is not brought against you, that doesn’t automatically mean you will not be found at fault. Fault will be determined by the Fault Determination Rules.

What to do when your vehicle is damaged

The amount of compensation you receive will depend on how much damage was caused by you and what type of insurance you have. Ask your claims adjuster for full details.

What to expect when you file a claim for mandatory coverage only

In Ontario, your mandatory coverage includes Direct Compensation-Property Damage (DC-PD). You could be eligible to get costs for, depending on the extent of your fault.

Temporary rental vehicle

Personal items damaged in the vehicle

What should you do if another driver doesn’t have insurance

If you were the uninsured driver of the vehicle involved in the accident, you may file a claim under the mandatory Uninsured motorist coverage. You can get coverage up to $25,000 less the first $300. In order to be eligible, you must identify the owner/driver of the other vehicle.

What to expect when you file a claim under mandatory plus optional coverage

Coverage for Specified Perils

Coverage for Specified Perils:

  • Fire
  • Theft or attempted theft
  • Lightning, windstorm and hail
  • Rising water
  • Earthquake or explosion
  • Riots and civil disturbance

Forced landing, or fall of an aircraft or its parts

You are responsible for the following: The stranding of sinking, burning and derailment of any transport in, on or about your vehicle while it was being transported on land or water.

Comprehensive Coverage

Comprehensive Coverage covers the cost of repairing or replacing your vehicle in the event of a noncollision loss.

Collision or upset coverage

Collision or upset coverage will pay your insurance company to repair or replace your vehicle in the event it is damaged or destroyed by an accident. This applies regardless of fault and less the deductible that you selected at the time you bought the coverage. This covers any cases in which an uninsured motorist damages or cannot be identified.

All Perils Protection

All Perils Coverage is a type of insurance that covers all types of losses. Your insurance company will pay the full amount, less the deductible, if you bought the coverage.

  • How insurance companies determine whether to write off or repair your vehicle
  • When you make a claim with your insurance company, the insurer will pay the less expensive option.
  • The cost of repairing the damage or loss
  • The “actual cash worth” of your vehicle as it stands at the time it was damaged
  • Your insurance company won’t pay more to fix your vehicle than it is worth in cash.

How deductibles work

A deductible is the amount you have to pay when you file a case. Unless the accident was your fault, you will be responsible for your full deductible.

What to do after being injured?

All auto insurance policies in Ontario include Statutory Accident Coverage. These benefits pay compensation for injuries or deaths caused by your accident to you, your passengers or pedestrians, regardless of your fault.

These benefits may apply to you if you are in an accident involving an automobile.

  • Replacement Income: replaces your job income while you’re recovering
  • Cargiver: compensates you if your household member is injured and you need to leave work.
  • Not-earner: offers compensation for those who are totally unable to live a normal lifestyle and are not eligible for income replacement or caregiver benefits.
  • Health: reimburses you for any medical costs resulting from your injury
  • Rehabilitation – Pays costs incurred during rehabilitation
  • Attendant care: helps to cover the cost of an attendant or aide.
  • Compensation for other Expenses. may cover family visits, homekeeping, repair, replacement, and/or cleaning costs for items that were damaged or lost in an accident.

What your family should expect in the event you die from an accident

Family members who are also affected by the accident may be eligible to receive the following benefits:

  • Death: sends money to family members
  • Funeral: pays for some funeral expenses


In certain instances, your insurance company may refuse to pay Income Replacement, Non-earner, or Compensation for Other Expenses.

  • Driving without valid insurance
  • Driving without a valid driver’s licence
  • Driving while your insurance excludes you
  • Driving a vehicle in an unregistered manner without consent from the owner

Fraud cases

Driving a car while committing crime (regardless if the crime is related or unrelated to the vehicle’s operation)