Auto Insurance Claims

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Auto Insurance Claims

In Ontario, automobile insurance is regulated by the Financial Services Commission of Ontario (FSCO), a regulatory agency of the Ministry of Finance. When you are involved in an auto accident involving injury or property damage, you need to report it to your insurance agent, broker, or insurance company within seven days, regardless of who is at fault. If you are unable to report the accident within seven days, report it as soon as possible after that. If you don’t report your accident within a reasonable amount of time, your insurance company may not have to honour your claim. FSCO website: www.fsco.gov.on.ca

Have the Facts in Hand

Your insurance agent, broker, or company representative will likely ask you to supply some basic information. To help speed things up, try to have the following information with you when you call:

  • the name of the registered owner’s insurance company and his/her auto insurance policy number;
  • the make, model, year, registration and licence plate number of the vehicle; and
  • the driver’s name and driver’s licence number (if the driver is not the registered owner);
  • the date, time and location of the accident,
  • the extent of any injuries;
  • the number of passengers involved, if any;
  • the extent of damage to the vehicle;
  • your description of the accident;
  • the names and driver’s licence numbers of the other drivers, as well as the names of their insurance companies and their auto insurance policy numbers;
  • the licence plate and vehicle identification numbers of the other vehicles; and
  • the name and badge number of the investigating police officer, if the accident was reported to the police.

Read Your Policy

It’s a good idea to sit down and thoroughly read your Ontario Automobile Policy (OAP 1). It provides specific details about your insurance coverages, your rights and your responsibilities under the contract. The claims process will be easier to understand if you know the details of your coverage and your responsibilities.

What Happens After You File a Claim with Your Insurance Company?

Once your claim is reported, you will be contacted by the claims adjuster assigned to your file. In some cases the adjuster will want to meet with you in person; in other cases the entire claim will be handled over the telephone. To support your claim, you may also be required to complete a claim form, also known as a Proof of Loss form (a sworn statement in support of your claim). Your claims adjuster will determine the extent to which the claim is covered by your insurance policy, explain the coverages provided by your policy, and help guide you through the entire claims process. If you have any questions or if there is something about your policy or claim that you don’t understand, ask your claims adjuster for clarification.

How Your Insurance Company Assess Fault

Someone is always determined to be at-fault in an auto accident, whether partially or fully. Insurance companies must determine the degree of fault to be assigned to each driver for purposes of determining which property damage coverages apply to the accident, and to ensure that the premiums of the driver who was more than 25 per cent at-fault are adjusted appropriately. The Insurance Act and the Fault Determination Rules made under the Insurance Act determine fault for an auto accident. The Fault Determination Rules are regulations put in place to help insurance companies provide consumers with prompt claims handling and consistent treatment. After you report an accident to your insurer, the company will investigate the circumstances of the accident and then make a fault decision based on the Fault Determination Rules. These rules:

  • cover more than 40 accident situations, using diagrams to illustrate specific occurrences, can be applied to almost every possible road collision scenario; and
  • are applied regardless of road or weather conditions, visibility, point of impact on the vehicles, or the actions of pedestrians.

Fault is allocated to each driver based on which accident scenario most closely resembles the accident. If the accident is not described by any of the scenarios, then fault is allocated according to the ordinary rules of negligence law. Visit the ServiceOntario e-laws website to view or print a copy of the Fault Determination Rules:

http://www.e-laws.gov.on.ca/html/regs/english/elaws_regs_900668_e.htm

MAKING A CLAIM FOR PROPERTY DAMAGE

If you have sustained property damage as a result of a motor vehicle accident, you may make a claim to the Motor Vehicle Accident Claims Fund, provided the owner and driver of the at-fault vehicle are identified. You may not make a claim to the Motor Vehicle Accident Claims Fund for damages to a motor vehicle, uninsured or otherwise. Claims for property damage are subject to a $100 deductible. Any claim in which the amount recoverable from the Fund exceeds $3000.00 requires legal action.

To make a claim for property damage, you must complete an Application. The application must be sent to the Motor Vehicle Accident Claims Fund with the following substantiating documentation:

  • Police Officer Report
  • Damage estimates and/or repair invoice
  • Consent and Notification forms (property damage claims only). These forms need only be signed and returned if the Application is being made on behalf of a private individual

Ontario Automobile Policy of September 1, 2010

The Ontario Automobile Policy (effective September 1, 2010) sets out the rights and obligations of insured persons and insurance companies related to automobile insurance coverage, and the terms and conditions of that coverage. The mandatory coverage is liability, accident benefits, direct compensation – property damage, and uninsured automobile. Optional coverage includes increased liability as well as collision and comprehensive coverage for your automobile and its contents. The Ontario government introduced changes to the auto insurance system intended to provide greater price stability, and give drivers more control over the amount of coverage and price they pay for auto insurance. As a result, some coverage under the Ontario Auto Insurance policy has been altered. Drivers are now able to:

  • Choose the insurance coverage that best meets their protection needs and budgets.
  • Customize their level of income replacement, medical, rehabilitation, attendant care, caregiver, housekeeping, death benefits and home maintenance coverage; and
  • Better integrate their auto insurance with private disability insurance coverage, or individual or group health insurance coverage

In Ontario, automobile insurance is regulated by the Financial Services Commission of Ontario, a regulatory agency of the Ministry of Finance. Every person who owns a car is required to have insurance for the vehicle.

“No Fault” Auto Insurance

In Ontario, there are significant limits for financial compensation for injuries sustained as a result of a motor vehicle accident, even if you were not an “at fault” driver. At the same time, the system makes available a set of mandatory benefits that insurers must pay to injured parties, including “at fault” operators, passengers in vehicles and injured pedestrians.

THE MOTOR VEHICLE ACCIDENT CLAIMS FUND

The Motor Vehicle Accident Claims Fund is a branch of the Financial Services Commission of Ontario. The major functions of the Motor Vehicle Accident Claims Fund are:

  • to provide statutory accident benefits directly to persons involved in an automobile accident, who have no recourse to automobile insurance;
  • to provide compensation for personal injury or property damage to victims involved in an automobile accident with an uninsured or unidentified driver or a stolen vehicle when no liability insurance exists; and
  • to recover from the owners and drivers of uninsured vehicles monies paid out on their behalf, where legally permissible

The Motor Vehicle Accident Claims Fund is considered to be the “payer of last resort” as it provides compensation to people injured in automobile accidents when no automobile insurance exists to respond to the claim.

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Author: AllOntario Team

AllOntario.ca is an information resource for Ontario residents and a marketplace for Ontario businesses. It’s all about living and doing business in Ontario. All in one site.