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How Long Does an Insurance Company Have to Investigate a Claim in Ontario?

The amount of time an insurance company has to investigate a claim varies depending on several factors. However, Ontario insurers have a legal obligation to handle the cases in the most efficient manner possible.

Here, we’ll discuss the factors that affect the investigation timeline. We’ll also see how you can ensure the process goes seamlessly, and your insurer won’t have a reason to delay handling your claim. Let’s take a look!

Timeline of Insurance Claims Process in Ontario

Handling an insurance claim in Ontario takes several steps. After filing your claim, you must receive a notification that your insurance company has received the claim. This acknowledgment typically comes from the insurance agent (or your broker if you used one to file the claim) within 2 to 3 days.

Once your insurer receives your claim, they start investigating to decide whether they’ll accept or deny the claim. This is the longest period, influenced by many factors, including your cooperation.

There are no limitations for your insurer to complete the investigation. If the insurance agent/broker provides an approximate time frame (which they’re legally obligated to do), they might extend this if they need more time to investigate.

Claims filed based on another party’s liability policy typically take longer to investigate. Once the investigation is complete, then the claim will be settled or refused.

Factors Affecting Your Insurer’s Investigation Timeline

The duration of an insurance claim investigation may vary based on the following:

Information Availability – The insurer’s investigation process relies on gathering evidence of the damage or loss and the events that led to it. The insurance company may take longer to investigate if they have to obtain medical reports, police reports, or special expert opinions in the case.

The Claims Complexity – If your claim involves extensive damage, complex circumstances, and/or multiple parties and their own insurance companies, the investigation can be delayed.

Cooperation of All Involved Parties – Beyond your cooperation as a policyholder, the investigation process is also influenced by factors like the other parties refusing to be interviewed, witnesses delaying giving testimony or handing over evidence, etc.

Legal Compliance – Insurance companies in Ontario must adhere to legal and regulatory obligations governing insurance claims throughout the entire investigation process. For example, if there is an open police investigation in the case of losses or damages you’ve filed for, the insurer might need to comply with legal obligations like providing evidence or waiting before gathering evidence.

insurer's investigation timeline

Your Rights During the Insurer’s Investigation

It’s a bit of a common myth that getting paid for a claim is challenging, and it’s crucial to note that you have certain rights during the claim investigation process. For example, your insurer is required to inform you of each step of the investigation process. They must also conduct a fair and impartial assessment of your claim. And while they shouldn’t cause unjustified delays, they should take their time to consider all the evidence and other relevant facts in your claim.

You also have the right to access and review the information your insurer has gathered during the investigation. This will allow you to understand the basis for the insurance company’s final decision.

Additionally, you have a right to receive a detailed explanation of the insurer’s decision, especially if they have decided to deny your claim or even partially deny it. If you disagree with your insurer’s decision on your claim, you can dispute the outcome of the investigation.

If your claim investigation takes longer than expected, contact the insurance company directly and ask about the status of your claim. If your claim has been open for over 90 days, you can also contact Ontario’s Financial Services Commission (FSCO), the agency overseeing the insurance companies in the province. They can investigate if there are any issues or unreasonable delays in any claim.

Tips for Ensuring a Prompt Claims Process

While you can’t control how long your insurance company takes to investigate your claim, there are a few steps you can take to avoid any unnecessary delays. The first step is reporting the incident promptly. The sooner you make your claim afterward, the sooner your insurer can start its investigation process.

Providing complete and accurate information when filing your claim is another way to ensure a smooth beginning to the process. If you provide incomplete or inaccurate information, your insurer will take more time to gather evidence in the case.

Cooperate fully with your insurer’s investigation by responding promptly to requests for interviews, information, or evidence you receive from their agent/broker. Keep records of everything you provide to the insurance company and all communication you have with them.

If disputes arise later during the investigation or you wish to dispute their denial of your claim, you can reach into the records to find any information you need.

If you have any concerns or inquiries about the insurer’s investigation process, reach out to the agent/broker handling your claim for clarification. This will help you avoid any misunderstanding or other issues that may delay the investigation process.

prompt claims process

Final Thoughts

Insurance claim investigations in Ontario often vary in duration based on several factors. Still, insurance companies are expected to handle claims fairly and within a reasonable timeframe.

As we’ve seen above, there are many ways you can play your part to help the process go smoother and prevent unnecessary delays. If you’re looking for insurance or simply need more advice, contact Marathon Insurance today, and we’ll be more than happy to help.

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