After an insurance claim is denied, first preserve the complete policy and claim file, identify exactly what the insurer denied, and calendar every possible deadline. Do not assume an internal complaint, ombuds review or continuing negotiation pauses a limitation period. The next step depends on whether the dispute concerns coverage, compliance with a policy condition, valuation, or only part of the claim.
Preserve the contract and evidence
Save the documents as they existed when the decision arrived:
- declarations, policy wording and every endorsement
- the application, renewal materials and any binder or certificate
- notice of loss and proof-of-loss documents
- photographs, video, estimates, invoices and inventories
- adjuster reports or expert material provided to you
- emails, letters, portal messages and call notes
- the denial or partial-payment letter, including its attachments
Keep originals and work from copies. If physical evidence may be repaired, discarded or altered, ask the insurer what inspection it requires and record the response. Continue reasonable steps to protect property and reduce further loss, without destroying evidence needed to establish the claim.
Classify the insurer’s position
A full coverage denial is different from a disagreement about value. The letter may instead be:
- a reservation of rights while investigation continues
- a denial of one coverage but acceptance of another
- an allegation that notice, proof or cooperation was late or incomplete
- reliance on an exclusion, definition or warranty
- a dispute over repair scope, depreciation, replacement cost or amount of loss
- a non-renewal or cancellation, which is not itself a claim decision
Write down the exact policy clause and factual finding relied on for each disputed item. If the letter is unclear, ask the insurer to identify both in writing and to confirm whether any part of the claim remains open.
Calendar limitation and contractual dates immediately
Canadian insurance deadlines are not uniform. The applicable date can depend on the province, type of policy, statutory conditions, policy wording, date of loss, proof of loss and the remedy pursued.
For example, Alberta’s Insurance Act contains a two-year statutory limitation for actions against an insurer under certain contracts, and Alberta’s Superintendent has warned that a complaint process does not replace starting an action or obtaining a written extension before the limitation date. Do not turn that example into a national calculation.
Record the earliest plausible deadline and get province-specific advice well before it. Ask for any extension in writing. Silence, continued adjustment and a complaint file should not be treated as an extension.
Separate coverage from amount-of-loss disputes
Appraisal or a statutory dispute-resolution process may determine the value of property, the amount of loss or the adequacy of repair. It ordinarily does not decide whether the policy covers the loss in the first place.
If the insurer accepts coverage but disputes quantum, identify the policy or statutory process, who appoints representatives, how costs are allocated and whether invoking it affects another deadline. If the insurer relies on an exclusion or says no insuring agreement responds, a valuation process may not resolve the real issue.
Build a focused reconsideration request
A useful request does more than say the outcome is unfair. It should:
- identify the claim and decision date
- quote the disputed clause accurately
- state the material fact the insurer has wrong or omitted
- attach the evidence that changes that fact
- ask for a written response and updated coverage position
- reserve rights and avoid agreeing to a deadline calculation you have not verified
If expert evidence is central, ask what qualification or methodology the insurer used before commissioning a competing report.
Use the insurer’s complaint process before an external review
Provincial regulators commonly direct policyholders to the insurer’s complaint officer first. In Ontario, for example, FSRA says the insurer should issue a final position letter after its complaint process. That letter supports a later request for independent review.
Depending on the product and insurer, an external option may include the General Insurance OmbudService, the OmbudService for Life and Health Insurance or another approved service. Eligibility and available outcomes vary. A regulator may investigate compliance or market conduct without deciding private coverage or ordering the insurer to settle. Alberta’s consumer guidance expressly says its complaint process cannot order settlement or provide a legal opinion on coverage.
Know when to obtain legal advice early
Prompt advice is especially important where:
- a limitation or appeal date may be close
- the loss is large or business interruption continues
- the insurer alleges misrepresentation, fraud or breach of condition
- examinations under oath or sworn proofs are requested
- defence of a lawsuit has been denied or reserved
- several insurers or policies may respond
- the dispute involves a release, settlement or subrogation right
A denial is the insurer’s position, not necessarily the final legal answer. The safe sequence is to preserve the file, classify the dispute, protect the earliest possible deadline, request a clause-specific explanation and use the review route that can actually decide the issue.