After the accident – an insurance claims primer
If you’ve been in a car accident, you are obligated to file a report with your broker, agent or insurance company within seven days – or as quickly as possible after that. The consequences of not reporting the accident within a reasonable amount of time could mean your claim will not be honored.
When you contact your broker, here’s what they will need:
- Your insurance policy number
- Make, model, year, registration and licence plate number of the vehicle
- Driver’s name and licence number (if the driver was not the registered owner)
- Date, time and location of the accident
- Extent of any injuries
- Number of passengers involved
- Extent of damage to the vehicle
- Your description of the accident
- Names and driver’s licence numbers of all drivers involved
- Names of insurance companies, and auto insurance policies of all drivers involved
- The name and badge number of the investigating officer – if the accident was reported to police
What happens next
Once your initial report has been processed, you will be contacted by an adjuster, who may need you to complete a Proof of Loss form. The adjuster will determine how much of your claim your insurer will cover, and assist you through the process.
After you’ve reported an accident, your insurance company will determine fault by following the Insurance Act and Fault Determination Rules. These rules use diagrams that can be applied to almost every possible road collision scenario. The rules are applied regardless of road or weather conditions, visibility, point of impact on the vehicles, or the actions of pedestrians. In some cases, fault may be shared between multiple parties involved in an accident.
Why fault matters
As a driver you can be found anywhere from zero to 100 per cent at-fault for an accident. If you are found at-fault, this will be noted on your insurance record. If you are found to be at-fault, your premium will go up when you renew your policy. Even if you loaned your vehicle to another driver and they are found to be at-fault for an accident in your vehicle, their accident will go on your record.
If you are charged with an offence, it does not necessarily mean you will be found at-fault for insurance purposes. Similarly, if you are not charged with an offence, it doesn’t necessarily mean you will be found not at-fault. Fault will be determined through the Fault Determination Rules.
If you believe your insurance company made an error in settling your claim, ask your claims adjuster which Fault Determination rule was applied in your case. If your insurance company refuses to revise their decision and you still disagree, contact your insurance company’s complaint officer.
If your vehicle has been damaged
The amount of compensation you receive will depend on the extent to which you were found at-fault for the damage, as well as the type of insurance coverage you purchased.
Mandatory coverage only
In Ontario, your mandatory coverage includes Direct Compensation – Property Damage (DC-PD). Depending on the extent to which you were found at fault, you may be eligible to receive costs for a temporary rental vehicle as well as damaged personal contents inside the vehicle at the time of the accident. If you were found 50 per cent at-fault, and therefore 50 per cent not-at-fault, your company will pay 50 per cent of any loss, less the deductible.
What if the other driver has no insurance?
If any other vehicle in the accident was uninsured, you can make a claim under the mandatory Uninsured Motorist Coverage of your policy. Coverage is up to $25,000, less the first $300. You must be able to identify the owner or driver of the other vehicle in order to qualify.
What about additional coverage?
If you purchased Specified Perils Coverage you will be covered for: fire, theft or attempted theft, lightning, windstorm or hail, rising water, earthquake or explosion, riot or civil disturbance, falling or forced landing of an aircraft or parts of an aircraft, and the stranding, sinking, burning, derailment, or collision of any kind of transport in, or on which, your vehicle was being carried, regardless of fault, less the deductible you chose at the time you purchased the coverage.
If you purchased Comprehensive Coverage you will be covered for the repair or replacement of your vehicle due to a non-collision loss, including those perils listed under Specified Perils, falling or flying objects, missiles and vandalism, regardless of fault, less the deductible you chose at the time you purchased the coverage.
Collision or Upset Coverage:
If you purchased Collision or Upset Coverage, your insurance company will pay to fix or replace your vehicle if it is damaged in an accident, regardless of fault, less the deductible you chose at the time you purchased the coverage. This also includes cases where an uninsured driver cannot be identified, or damaged your vehicle.
All Perils Coverage
If you purchased All Perils Coverage, your insurance company will pay for all losses noted above, less the deductible you chose at the time you purchased the coverage.
Repair or writing off your vehicle
When you make a claim, your insurance company will pay the lower of the two options: the cost to repair the loss or damage; or, the “actual cash value” of your vehicle at the time it was damaged. Your insurance company will not pay more to repair your vehicle than its actual cash value.
How deductibles work
When you file a claim, you may be responsible for a deductible – the amount of the claim you will have to pay. You can expect to pay your full deductible unless the accident was not your fault, or was only partially your fault.
What if you’ve been injured?
In Ontario, Statutory Accident Benefits Coverages are provided by law under every auto insurance policy. These benefits provide compensation, regardless of fault, if you, your passengers, or pedestrians are injured, or die as the result of your accident.
If you are injured in an auto accident, you may be entitled to the following benefits (each up to your policy limits):
- Income replacement:replaces job income you cannot earn while recovering
- Caregiver: provides compensation if you are required to leave work to care for an injured member of your household
- Non-earner:provides compensation if you are completely unable to carry on a normal life, and do not qualify for an income replacement or caregiver benefit
- Medical:pays for medical expenses incurred through your injury
- Rehabilitation:pays costs incurred during rehabilitation
- Attendant Care:pays some of the costs of an aide or attendant
- Compensation for Other Expenses:may pay for the cost of family visits during treatment or recovery, some housekeeping and home maintenance, the repair or replacement of some items lost or damaged in the accident, or lost educational expenses.
What if you die as the result of an accident?
If you die as a result of the accident, members of your family may also be entitled to the following benefits: Death: pays money to members of your family; Funeral: pays for some funeral expenses
In some cases, your insurance company may deny payment of Income Replacement, Non-earner and Compensation for Other Expenses. Cases include: Driving without valid insurance; driving without a valid driver’s licence; driving while specifically excluded from driving under your insurance policy; driving a vehicle without the owner’s consent; cases of fraud; and, driving a vehicle while committing a crime.
At DPM Insurance Group, our brokers and CSRs will take the time to ensure you understand all the options available to you when purchasing automobile insurance. Every driver’s situation is unique to them, and not everyone wants or needs All Perils Coverage. If you’d like to review your current policy to make sure you’re properly covered, contact one of our six offices today and we will be glad to assist you.