Insurance Claim Disputes: What to Do When Your Claim is Denied

Receiving an insurance claim denial can feel like a second blow—especially after an accident, loss, or health crisis. You paid your premiums, trusted the policy, and counted on that coverage when you needed it most. When an insurance company fails to uphold its end of the bargain, it’s not just frustrating—it can be financially and emotionally devastating. As an Alberta-based lawyer, I regularly assist clients who are facing unfair insurance claim denials. In this blog, I’ll guide you through what steps to take if your claim has been rejected and how you can fight back.

1. Understand Why Your Claim Was Denied

The first step in challenging a denial is understanding the insurer’s reasoning. Insurance companies are legally required to provide a written explanation outlining the reasons behind the decision. Common reasons for denial include:

• Alleged misrepresentation on the application

• Lapse in coverage or non-payment of premiums

• The claim falling outside the scope of the policy

• Missed deadlines or incomplete documentation

Read the denial letter carefully and compare it with the terms of your insurance policy. In many cases, the language is vague or overly broad—designed to discourage you from pushing back. But denials are not always final or legally justified.

2. Review Your Insurance Policy in Detail

It’s crucial to understand the coverage you actually purchased. Policy documents are often dense and full of technical jargon, but reviewing the following sections can be helpful:

• Coverage Summary: What is and isn’t covered?

• Exclusions: Are the reasons for denial clearly listed?

• Claims Process Requirements: Were all deadlines and procedures followed?

If the denial appears inconsistent with the actual policy language—or if that language is ambiguous—you may have grounds to dispute it.

3. Collect Supporting Documentation

Like any legal dispute, evidence is key. Gather and preserve all relevant documents that support your version of events and demonstrate compliance with the policy, such as:

• Your full policy agreement and any addendums

• The denial letter from the insurer

• Photos, receipts, invoices, or repair estimates

• Medical reports (for health or disability claims)

• Witness statements, if applicable

• Any emails or letters exchanged with the insurance company

This documentation will strengthen your case and help demonstrate that the insurer’s decision was unjustified.

4. Submit a Formal Appeal

Most insurance companies have an internal appeals process. To begin:

• Write a clear, concise appeal letter outlining why the denial is wrong

• Include your supporting documentation

• Reference the exact policy provisions that support your claim

• Keep copies of everything you send

Insurers are legally obligated to handle appeals in good faith and respond within a reasonable time. If they continue to delay or deny without valid justification, you may be dealing with bad faith insurance practices—which opens the door to additional legal remedies.

5. File a Complaint with the Appropriate Regulatory Body

If your appeal is unsuccessful or you suspect the insurer is acting unfairly, you can escalate the matter by filing a complaint with a regulatory authority. In Alberta, options include:

• Alberta Superintendent of Insurance (part of Treasury Board and Finance)

• The OmbudService for Life & Health Insurance (OLHI)

• The General Insurance OmbudService (GIO)

These agencies can review the complaint, issue recommendations, or even launch an investigation into the insurer’s practices.

6. Consider Taking Legal Action

If your insurer continues to deny your claim without valid reason, pursuing legal action may be the best option. Legal remedies can include:

• Payment of the original claim amount

• Additional compensation for financial losses caused by the denial

• Punitive damages (in bad faith cases)

Smaller claims (under $100,000) may be handled in Alberta’s Court of Justice (Civil Division), while larger or more complex disputes may go before the Court of King’s Bench.

7. Consult a Lawyer Experienced in Insurance Disputes

Insurance law is complex, and insurers often count on claimants giving up out of frustration or confusion. An experienced lawyer can help you:

• Evaluate whether the denial was legally justified

• Navigate the appeals process or regulatory complaints

• Negotiate with the insurer for a fair settlement

• Litigate the matter in court if necessary

You don’t have to take an insurance denial at face value. There are legal tools available to ensure you get the coverage and compensation you’re entitled to.

Final Thoughts

When your insurance claim is denied, you may feel overwhelmed and powerless—but you have rights. Alberta’s legal system offers protections for policyholders against unfair treatment. By understanding your policy, gathering strong evidence, and seeking the right legal guidance, you can hold insurers accountable and pursue the compensation you deserve.

If you’re facing a denied insurance claim and don’t know what to do next, reach out to me, Joshua Williams, JW The Lawyer. I’m here to help you challenge wrongful denials and fight for what you’re owed.