After An Accident insurance: Understanding Claims Process

By: GeraldOchoa

After An Accident insurance: Understanding Claims Process

If you have been involved in an accident, you need to file a claim. These steps will help you get the most out of the process. You can speak with your broker or Accident insurance agent to get more information about your situation.

Learn your policy

To fully understand your rights and responsibilities, it’s a good idea for you to take the time to read your Ontario Automobile Policy 1 (OAP 1).

How to file an accident report and when

You must report an accident to your broker, agent, or insurance company within seven working days. If you do not, it will be deemed as late as possible. Failure to file a report within a reasonable time frame could result in your claim being denied. When submitting your report, you will need to include the following:

Your policy number

  • Make, year, make, model, and license plate number
  • Details of accident – Driver’s name and license number (if not the registered owner).
  • Date, time, and exact location of the accident

The extent of injuries

  • Number of passengers involved
  • Vehicle damage
  • Please describe the accident
  • All drivers involved: Names and driver’s license numbers
  • Names of insurance companies and auto insurance policies for all drivers
  • If the accident was reported to the police, the name and badge number for the investigating officer.

What happens when you file a claim?

After your claim has been filed, a claims adjuster will contact you. You may be required to complete a Proof Of Loss form. The adjuster will help you navigate the claims process and determine how much your insurance will cover.

What is the fault?

Your insurance company will determine who is at fault after you report an accident. They will follow the Insurance Act and Fault Determination Rules. These rules are:

  • Diagrams can be used to cover over 40 different accident scenarios that can be applied to nearly every road collision scenario.
  • They can be applied regardless of road conditions, weather conditions, visibility, point-of-impact on vehicles or pedestrian actions
  • It is possible for fault to be shared by multiple people involved in an accident.

What does fault mean for you as a driver?

You can be found at-fault in an accident as a driver anywhere from zero to 100%. This will be noted on your insurance records if you are found to be at-fault. There is a chance that your premium could go up if you are found at fault for more than 50%.

You will be charged for any accident that occurs when you lend your vehicle to anyone.

What to do if your insurance company disagrees with you about fault?

If you feel your insurance company committed an error in settling your claims, inquire about the Fault Determination rules that were used in your case. If your insurance company refuses revising their decision, and you still disagree with it, contact the insurance company’s complaints officer.

Convictions, charges and at-fault determinations by the police

It does not mean that you will be charged with an offense. The same applies to if you’re not charged with an offense. It doesn’t mean that you won’t be found at-fault. Fault determination will be made by the Fault Determination Rules.

What to do if your vehicle is damaged?

The extent of damage you are responsible for and the type insurance you have will affect the amount you receive. Ask your claims adjuster for full details.

What to do if you have a mandatory coverage claim

In Ontario, your mandatory coverage includes Direct Compensation-Property Damage (DC-PD). You may be eligible for costs depending on how much you are found to be at fault.

Temporary rental vehicle

Personal property damaged inside the vehicle. Note that your company will pay 50% of any loss if you are found to be at fault for the accident and 50 percent or more if the other party is not.

What do you do if the other driver has no insurance?

You can file a claim under your mandatory Uninsured Driver Coverage if another vehicle involved in an accident was not insured. The coverage is limited to $25,000 and includes $300 for the first $300. To be eligible, you must be able identify the driver or owner of the vehicle.

What to do if you have a claim for mandatory and optional coverage

Protection for Specified Perils

You will be covered for the following:

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

Forced landing or falling of an airplane or part of it

Any stranding or sinking, burning or derailment of any type of transport in or on your vehicle, regardless of fault, less any deductible you selected at the time of purchase.

Comprehensive Coverage

Comprehensive Coverage will cover the cost of repair or replacement of your vehicle for a non-collision injury. This includes perils such as falling or flying objects, vandalism, and specified perils.

Collision and Upset Coverage

Your insurance company will cover the cost of fixing or replacing your vehicle if it is involved in an accident. This applies to any uninsured driver who damages your vehicle or cannot be identified.

All Perils Insurance

All Perils Coverage will cover all the losses you have mentioned above, less any deductible that you selected at the time of purchase.

  • How insurance companies decide whether or not to fix your vehicle
  • Your insurance company will pay you the lesser of these two options when you file a claim.
  • Repair costs
  • The vehicle’s “actual cash value” at the time of damage
  • Your insurance company will not pay more for your vehicle’s repair than the actual cash value.

How do deductibles work?

You may have to pay a deductible when you file a claim. If the accident is not your fault or you are partially responsible, you can expect to pay the full deductible.

What to do if you have been injured

Every auto policy in Ontario includes Statutory Accident Benefits coverage. These benefits offer compensation regardless of fault if you or your passengers are hurt or killed in an accident.

You may be eligible for the following benefits if you are involved in an auto accident.

  • Income Replacement: replaces the job income you can’t earn while you are recovering
  • Caregiver: offers compensation if you have to take time off work to care for an injured member of your household
  • Non-earner : compensates you if your life is disrupted and you don’t qualify for an income replacement benefit or caregiver benefit.
  • Medical: covers medical expenses incurred due to your injury
  • Rehabilitation: Pays for rehabilitation costs
  • Attendant Care – covers some of the attendant’s or aide costs
  • Compensation For Other Expenses: can pay for family visits during treatment, recovery, housekeeping, and home maintenance. It may also cover the cost of lost or damaged items or educational expenses.

What your family can do if you are killed in an accident

Your family members may be eligible for the following benefits if you are killed in an accident:

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


Your insurance company might deny income replacement, non-earner, and compensation for other expenses payments in certain cases.

  • Driving without valid insurance
  • Driving without a valid driver’s license
  • Driving under an insurance policy that excludes you from driving
  • Driving a vehicle without permission

Fraud cases

Driving a vehicle and committing a crime (regardless of whether or not the crime is connected to the operation).

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