Five Ways Insurance Adjusters Exploit Claimants Who Don’t Know the Law and How to Push Back

Insurance companies are meant to financially support injured victims when they need it the most. For individuals recovering from a car accident, workplace injury, or assault, seeking medical attention is often the immediate priority. It’s natural to assume insurance companies will always help them in those scenarios.

However, many injured claimants may not know that insurance adjusters are trained to minimize claim payouts to protect insurer profitability. For Ontarians unfamiliar with Ontario’s accident benefits system, they may be especially vulnerable.

Ontario’s Statutory Accident Benefits Schedule (SABS) is updating its policies in 2026, making it crucial to understand how those changes impact claimants to ensure fair compensation for injuries. Here are five ways insurance adjusters can exploit claimants, along with ways to push back.

1. Pressuring to Settle

Insurance adjusters often contact accident victims within days of a collision. Sometimes this happens before medical assessments are complete or the full extent of an injury is understood. Claimants should be careful about how they describe injuries in the initial stages following an accident.

Many injuries associated with Ontario motor vehicle accidents, including concussions, chronic pain, PTSD, and spinal injuries, can evolve gradually over weeks or months. Injured victims, believing initially they’re “fine,” may later develop symptoms that interfere with employment, education, or daily life.

Under upcoming SABS reforms, several benefits and supports will become optional, rather than automatically included in standard auto insurance policies. These include, but are not limited to:

• Income replacement
• Housekeeping and home maintenance
• Caregiver benefits

Eligibility for these optional benefits may depend on the injured person’s policy coverage, medical documentation, and the development of the claim over time. Early statements minimizing symptoms could later be used by insurers to question the severity or progression of injuries, potentially affecting compensation or benefit entitlement down the line.

For claimants navigating Ontario’s increasingly complex accident benefits system, understanding how SABS eligibility may change as injuries worsen is critical before agreeing to settlements or making detailed recorded statements.

How to Push Back

• Be cautious when describing injuries too soon: Symptoms from concussions, psychological injuries, and chronic pain conditions may not fully appear following an accident.
• Avoid signing releases prematurely: A settlement release may prevent you from pursuing additional compensation later if symptoms worsen or new diagnoses emerge.
• Request written communication: Keeping a documented record of insurer requests and responses can help reduce misunderstandings and preserve evidence.
• Track medical developments carefully: Maintain records of appointments, diagnoses, prescriptions, and changes to daily functioning as injuries evolve.
• Seek legal guidance before accepting settlement funds: An early offer may not account for long-term rehabilitation needs, income loss, or future care costs.

Keep in mind that statements minimizing symptoms early in the claim process could later complicate efforts to access those benefits or justify ongoing compensation needs.

2. Using Recorded Statements Against Claimants

After a motor vehicle accident, insurance adjusters may ask claimants to provide recorded statements to help process a claim. Recorded statements can become problematic when injured individuals are under stress or have not yet received a full medical assessment. Describing symptoms vaguely can later be referenced to challenge credibility or dispute the seriousness of an injury.

This can be particularly important in cases involving concussions, chronic pain, or psychological injuries, where symptoms may fluctuate or worsen over time. Statements made shortly after a collision may not accurately reflect an injured person’s long-term condition or recovery needs.

Claimants should also note that they don’t need to answer every question an insurer would ask of them. Although you must cooperate with them, you shouldn’t answer any questions about your symptoms or incidents if you’re not 100% sure.

How to Push Back

• Stick to factual information: Avoid speculating about injuries, recovery timelines, or fault before medical assessments are complete.
• Take time before providing detailed statements: Claimants dealing with pain, stress, medication, or trauma may unintentionally provide inaccurate information.
• Ask if a recorded statement is required: Some insurer requests may relate to voluntary investigative questioning rather than mandatory reporting obligations.
• Document communication: Keep copies of emails, letters, and notes from phone conversations in case disputes arise later in the claim.
• Avoid minimizing symptoms: Describing injuries as “minor” too early may later be used to challenge ongoing treatment needs or compensation claims.
• Seek legal guidance before interviews: Legal advice may help clarify what information insurers are entitled to request under Ontario accident benefits rules.

3. Misrepresenting or Downplaying Available SABS Benefits

Beginning July 1, 2026, medical, rehabilitation, and attendant care benefits are expected to remain mandatory under Ontario’s accident benefits system, while several other benefits may become optional coverage. These include income-replacement, non-earner, and caregiver benefits.

The reforms may also narrow who can access optional benefits. Under the new framework, eligibility may be limited to:

• Named insured individuals
• Listed drivers
• Certain family members under the policy

This could create coverage gaps for:

• Passengers
• Pedestrians
• Cyclists
• Individuals without their own automobile insurance

Adjusters may rely on that confusion when explaining benefit eligibility or claim limitations to injured individuals unfamiliar with the changing rules.

As a result, injured claimants who are unfamiliar with their policy terms may not realize certain benefits require optional coverage, or that failing to purchase that coverage before an accident could significantly limit compensation later.

How to Push Back

• Request written explanations for denied benefits: Insurers should clearly explain why a benefit is being refused or limited under the policy.
• Ask for complete policy documentation: Reviewing your coverage details can help clarify which optional and mandatory benefits may apply.
• Keep copies of all insurer communications: Emails, letters, forms, and adjuster notes may become important if disputes arise later.

With Ontario’s SABS reforms, claimants need to learn what coverage they may be missing and purchase it in advance to avoid unexpected compensation gaps later.

4. Surveillance and Social Media Monitoring

Insurance companies may monitor public social media activity or conduct surveillance during the course of an injury claim. Posts that appear harmless to a claimant can sometimes be used out of context to question the severity of injuries or the need for ongoing treatment.

A single image of someone attending a social event or participating in light physical activity may not reflect the pain or recovery challenges they continue to experience daily. This can become relevant in chronic pain, psychological injuries, or concussion claims, where symptoms are not always visible.

While surveillance does not always provide a complete picture of a person’s medical condition, inconsistencies between social media activity and reported symptoms may still complicate a dispute.

How to Push Back

• Avoid posting recovery details: Photos, videos, or comments about physical activity may later be reviewed during a claim investigation.
• Review privacy settings: Public profiles and shared content may be easier for insurers or investigators to access.
• Be truthful and consistent in medical reporting: Medical records, treatment notes, and public activity should accurately reflect your condition and limitations.
• Deleted content may not disappear permanently: Screenshots or archived posts may still be referenced later in a dispute.

5. Delaying Claims to Pressure Financially Vulnerable Victims

Insurance delays can create significant financial pressure on injured claimants, particularly those unable to work following an accident. In some situations, financial stress may pressure claimants into accepting lower settlements simply to access funds sooner.

Individuals without optional coverage in their policies may feel even more pressured under Ontario’s upcoming SABS reforms.

Ontario insurers are still required to process claims in accordance with legislated timelines and accident benefits rules. Claimants also have dispute-resolution options through the Licence Appeal Tribunal Automobile Accident Benefits Service (LAT-AABS) if benefits are denied or delayed unreasonably.

How to Push Back

• Maintain clean records: Save medical records, receipts, forms, insurer letters, and notes from conversations.
• Track deadlines and requests: Monitoring timelines may help identify unreasonable delays or repeated requests for the same information.
• Avoid accepting quick settlements: Financial stress can make early offers appear attractive even when long-term losses remain unclear.
• Understand available dispute-resolution options: Ontario claimants may have access to the LAT-AABS for accident benefits disputes.
• Seek legal guidance for excessive delays: Ongoing delays or denied benefits may require formal legal intervention.

Conclusion

Many claimants are unfamiliar with Ontario’s accident benefits system and may not realize how early statements, settlement decisions, or policy coverage issues can affect compensation.

This is becoming increasingly important as Ontario prepares for major SABS reforms in July 2026. With several benefits shifting from mandatory to optional coverage, understanding what protections are available under a policy may become more important than ever.

Accident victims should take time to document injuries carefully, understand their rights under Ontario law, and review available coverage before making significant claim decisions.

This article is for informational purposes only and does not constitute legal advice. Ontario insurance laws and accident benefits regulations may change over time.

About The Author

Warren WhiteKnight is a partner at Bergeron Clifford LLP. He is based in the firm’s Kingston office but travels throughout Eastern Ontario each week as clients’ needs require. Warren is an avid cyclist, rock climber, snowboarder, and soccer player, and is heavily involved in volunteer work. Warren understands that when you get injured, the impact runs deeper than the skin; the entire family is affected, and people lose their ability to work and play as they did before. Warren is a Queen’s Law graduate, achieving top 10% standing all three years and receiving numerous course prizes and scholarships. Warren regularly represents his clients in court and tribunal proceedings and has an excellent track record of achieving results both in court and in out-of-court settlements.