Insurance Claim Denied in Canada: What to Review Next
A denial is easier to assess when the reason is in writing and tied to the policy. Separate a coverage or exclusion decision from a documentation, valuation or factual disagreement before choosing the next step.
Claim Denied
Request the written reason and the specific policy wording relied on. Compare that explanation with the facts and evidence, identify the exact outcome you want, use the insurer's internal complaint process, and obtain a final position letter before approaching GIO where the dispute is within its mandate.
Ask the insurer to identify the exact reason
Request a written explanation that points to the relevant coverage, exclusion, condition, definition or factual finding. A general statement that something is not covered is less useful than the clause and evidence supporting the decision.
Also ask whether the insurer considers the whole claim denied or only one item, cause, time period or amount.
Classify the disagreement before adding evidence
A dispute may concern whether the event is insured, whether an exclusion applies, whether a policy condition was met, what caused the damage, the value of property, the repair scope or missing documentation. Each category needs different evidence.
Create a short chronology and match every disputed point to a policy passage, document, photograph, estimate or expert opinion. Keep emotion out of the core submission even when the situation is stressful.
Use the insurer's internal complaint process
IBC's dispute-resolution guidance starts with the representative handling the file, then the insurer's internal complaint process or ombudsperson. State the decision being challenged, why it appears wrong and the specific remedy requested.
Ask for the insurer's final position letter if the internal process does not resolve the dispute. That letter is generally required before GIO considers an eligible complaint involving a subscriber insurer.
Know what external review can and cannot do
GIO provides a free service for eligible home, auto and business insurance disputes with subscriber companies, but its recommendations are non-binding and some matters are outside its scope. Provincial or territorial insurance regulators can explain complaint channels but do not necessarily decide private coverage facts.
In Québec, a consumer can ask the firm to transfer the complaint file to the AMF after receiving the firm's response. The AMF warns that using its complaint process does not pause court limitation periods. Obtain legal advice when rights may expire or the consequences are significant.