Denied, Delayed, Cut Off or Capped: What Happens Next
The person who wrote your letter works for the insurer. Our accident benefits lawyers work for you, and that is the whole difference. Whichever letter you are holding, there is a next step, and it is usually one you can take this week.
Denied
A refused treatment plan, benefit or accident benefits application often rests on a single report or a missing document. We get the reason in writing, put the medical evidence against it, and ask the insurer to reconsider. If it holds its position, we file at the LAT inside the 2-year window.
Delayed
Delay looks like silence past the timelines, a third request for the same document, or an approval that never quite arrives. We answer each request within its 10 business days or explain in writing what is still on its way. We keep a dated record of each one and treat delay as a decision the insurer has to answer for.
Cut Off
When a benefit ends after an insurer examination, it often ends on the strength of a single assessor's report. We challenge that report with a medical assessment of our own and press for the benefit to be reinstated.
Capped
A Minor Injury Guideline (MIG) letter puts your claim in the lowest tier, and that is not always where it belongs. We build the evidence to take you out of the MIG where your injuries warrant it. Where an injury may meet the catastrophic definition, as some brain injuries do, we pursue a catastrophic impairment designation.
Send us the letter. A free consultation with an accident benefits lawyer in Toronto tells you where the claim stands before you decide anything. Contact us or call (416) 238-7105.
What Our Accident Benefits Lawyers Claim and Defend
Since the July 1, 2026 changes, not every accident benefit comes standard on an Ontario auto policy. Three are mandatory under the Statutory Accident Benefits Schedule (SABS). The rest depend on the policy in force on the day of the crash. We read the policy first. Then we read the letter.
On every policy
Mandatory under the SABS, whatever your letter says
Medical Benefits
When the insurer refuses or trims a treatment plan for physiotherapy, medication or assistive devices, that does not have to be the end of the treatment. We put the clinical evidence behind the plan, press for approval, and defend it each time the insurer moves to cut it back.
Rehabilitation Benefits
Rehabilitation is the longer program after the acute phase: retraining, home changes, the help that gets you back to work. Funding for it is reviewed often, and each review is a chance for it to stop. We keep the medical case for it current, so the file answers before the insurer asks.
Attendant Care Benefits
Attendant care pays for the help with daily living that your injuries make necessary. The amount is based on an assessment of your care needs and on the care you actually receive. When the insurer's assessment counts fewer hours than your injuries call for, we contest it with an assessment of our own.
Depends on your policy
Optional for policies bought or renewed on or after July 1, 2026
Income Replacement Benefits
Where your policy includes it, income replacement pays 70% of gross earnings, up to $400 a week under the standard benefit, while you cannot work. We prove the earnings and challenge a cut-off that rests on a form rather than your recovery.
Non-Earner, Caregiver and Housekeeping Benefits
These cover the person who was not working, the person caring for a family member, and the housework you can no longer do. We check the policy for them before the insurer tells you they are not there.
Other Optional Benefits
Lost educational expenses, visitors' expenses, damage to personal items, and death and funeral benefits round out the optional group. If your loss is one of these and your policy carries it, we claim it.
For accidents since July 1, 2026, your auto insurer pays first for most medical and rehabilitation costs, ahead of workplace and private plans, so we start with your accident benefits claim, whatever other coverage you hold.
What Decides How Much You Receive
Six things shape what an insurer pays. Our accident benefits lawyers look at the same six, ideally before the insurer does, while the record is still being built.
Your Policy and Its Options
For policies bought or renewed since July 1, 2026, most benefits are optional, and optional benefits cover only the named insured, spouse, dependants and listed drivers. A policy without income replacement pays none, however serious the injury. We get a copy of your policy and check every endorsement, so no benefit you paid for goes unclaimed.
How the Injury Is Classified
The insurer decides which of three tiers your claim sits in: inside the MIG, outside it, or catastrophic. Each tier has its own ceiling. A claim placed in the wrong tier is capped at the wrong amount, so we challenge the placement with medical records that show where your injuries actually sit.
The Medical Evidence on File
Treatment plans, assessments and your family doctor's notes are what the insurer reads, and gaps in that record are what a denial often cites. We find the gaps and close them.
The Insurer's Examinations
What the insurer's own examiner writes carries weight in every decision that follows. We compare that report with your treating doctors' records and challenge it wherever it misreads your injuries.
The Deadlines
Every step has a clock, from the 7-day notice to the 2-year limit at the tribunal, and an unexplained late step gives the insurer a reason to refuse. We track the deadlines that apply to your claim and document the reason for any step that ran late.
Other Coverage
Income replacement, where your policy includes it, can overlap with a disability plan, and one can offset the other. We map every source of coverage and bring in a long-term disability lawyer where a plan is in play, so the benefits are claimed in the right order.
How It Works
What you do is small. What we do is the rest. Working with an accident benefits lawyer at HSK Law means the forms, the deadlines and the insurer's requests stop landing on your kitchen table and land on our desk instead.
Free Consultation
Bring the letter, the forms and anything the insurer has sent. We read the file and tell you plainly where it stands.
We Handle the Insurer
Once you retain us, the notice, the OCF-1 and every reply to an insurer request go out from our office. We track each treatment plan your providers submit until the insurer decides on it.
We Build the File
We gather the medical evidence, argue the right classification, and bring in our own medical opinion where the insurer's report got it wrong.
We Negotiate
Negotiation comes first. We put the evidence in front of the insurer and press for the benefits your policy provides.
We Dispute If Needed
If the insurer will not move, we take the refusal to the LAT within the 2-year limit. You pay no fee unless we win.
While we work on your claim, keep going to treatment, attend any insurer examination you are booked for, keep every receipt, and forward us anything new from the insurer. Step one costs nothing: book a free consultation or call (416) 238-7105.
Lawyers You Deal With Directly
Direct Lawyer Access
The lawyer who takes your file is the lawyer who calls you back. You are not explaining your case to someone new each time you call.
Multilingual Service
We serve clients in English, Russian, Punjabi, Vietnamese and Ukrainian, so you can talk through your claim in any of those languages.
Quality Over Quantity
Each file gets a lawyer's attention. Insurer requests arrive with 10-business-day clocks on them, and the person answering already knows what is in your file.
30+ Years of Collective Experience
Our team brings more than 30 years of collective personal injury experience to every accident benefits file.
1,000+ Clients Helped
We have helped more than 1,000 clients through injury claims. The consultation that starts yours is free.
No Win, No Fee
Our fee is a share of what we recover, and if we recover nothing, you owe us no fee. The written agreement you sign sets out the percentage and how disbursements and taxes are handled.
Kind Words From Our Clients
Accident Benefits Lawyer FAQ
Nothing to begin. The first consultation is free, with no obligation to go further. If you hire us, we work on a No Win, No Fee basis: our fee is a percentage of what we recover, and the written contingency fee agreement you sign sets it out, along with how disbursements and taxes are handled. There is no fee to find while you recover.