You paid to be covered. The insurer says no.
Sultan Avocat inc. represents policyholders in Laval and Montréal when a claim is denied, reduced or left unanswered. An insurance policy is a contract: it is interpreted, it is argued, and it is enforced.
A denied claim is not a final decision. It is a position the insurer will have to defend.
The policy, the correspondence and the adjuster’s report often say something other than the denial letter.
Enforcing the contract you paid for
The insurer drafts the policy, chooses the adjuster and sets the amount. A lawyer restores the balance.
Denied claim
Challenging a refusal and requiring the insurer to justify its position.
Alleged misrepresentation
Responding when you are accused of withholding information at application or during the policy.
Disputed amount
Questioning the valuation of the loss, the depreciation applied and the exclusions invoked.
Disability insurance
Establishing your incapacity when the insurer terminates benefits.
Life insurance
Representing beneficiaries when payment is delayed or refused.
Losses and damage
Fire, water damage, theft: building the evidence and following the claim through.
From the contract to the payment, one step at a time
Read the policy
Coverage, exclusions, definitions: this is where the case is decided.
Reconstruct
Gathering the notice of loss, the correspondence and the adjuster’s reports.
Respond
Formally requiring the insurer to justify its decision and perform the contract.
Quantify
Establishing the real value of the loss, with supporting evidence.
Litigate
Going to court when negotiation fails.
Rules apply to the insurer too
An insurance contract is not left to the discretion of the party who drafted it. The Civil Code imposes obligations on both sides.
- You must report the loss as soon as you become aware of it.
- The insurer must pay within sixty days of receiving your notice of loss or the information it requested.
- A misstatement made without intent to deceive does not necessarily void coverage: the indemnity may instead be reduced in proportion to the premiums paid.
- You have three years to sue, but the starting point of that period is open to argument.
- A complaint to the Autorité des marchés financiers can move a file forward, but the Autorité cannot order compensation.
Read the policy. Quantify the loss. Require performance.
We start with the policy and with your correspondence with the insurer, before sending any formal notice. Most denials rest on one specific clause; the question is which one, and what it actually requires of each party.
One useful clarification: bodily injury suffered in a road accident falls under the public compensation plan and cannot be litigated against the other driver. Damage to your vehicle and to your property, however, is a matter for your insurer.
A written denial is not the last word.
A consultation tells you which clause the insurer is relying on and what it will have to prove.
Book a consultation