Failing to Disclose a Medical Condition in an Auto Insurance Claim: What Ontario Drivers Should Know
- 4 days ago
- 4 min read
Being truthful when applying for insurance is not just best practice. In Ontario, it is a legal obligation. Whether you are purchasing auto insurance or submitting insurance claims for an auto accident, the information you provide forms the foundation of your policy. If you fail to disclose a medical condition, your insurer may later deny coverage, reduce benefits, or even void your policy. For anyone injured in a collision, this can have serious financial and legal consequences.
Understanding the risks of non-disclosure and how Ontario courts approach these cases can help you protect your rights and make informed decisions after an accident.
Disclosure Obligations under Ontario Insurance Law
When you apply for auto insurance, insurers rely on the accuracy of the information you provide to assess risk and set premiums. This includes disclosing relevant pre-existing medical conditions, particularly those that could affect your ability to drive or your likelihood of making a future claim.
Ontario insurance contracts are governed by the Insurance Act, which places a duty on policyholders to disclose material facts. A material fact is information that would influence an insurer’s decision to issue a policy or determine the premium. Even if a medical condition seems minor or unrelated to your accident, failing to disclose it could still be considered material.
Being truthful on your insurance application is essential. Your policy is based on the details you provide, and if you fail to disclose a pre-existing condition, your insurer may have grounds to deny a future claim.
Consequences of Failing to Disclose a Medical Condition
The consequences of non-disclosure can be significant, especially after a serious collision. Depending on the circumstances, your insurer may take one or more of the following actions:
Deny accident benefits related to your injuries
Reduce the amount of compensation you receive
Void your insurance policy from the start
Refuse to defend or indemnify you in a liability claim
This can leave accident victims personally responsible for medical expenses, rehabilitation costs, and even legal damages. For individuals seeking guidance from a car accident compensation lawyer, non-disclosure issues often become a major obstacle in securing fair compensation.
Non-disclosure Vs. Misrepresentation in Ontario Insurance Claims
It is important to understand that failing to disclose a medical condition does not always mean intentional dishonesty. In Ontario law, insurers may still deny coverage even if the omission was unintentional.
Non-disclosure occurs when relevant medical information is left out of an application. Misrepresentation involves providing inaccurate or misleading information. Both can have similar legal consequences if the insurer can show the missing information was material to the policy.
That said, there may be room to challenge an insurer’s decision, especially if the condition had no connection to the accident or the claimed injuries. This is where legal advice becomes critical.
Ontario Case Law on Disclosure Obligations
Ontario courts have consistently emphasized that full and accurate disclosure is a cornerstone of insurance law. This principle has been confirmed in several decisions of the Ontario Court of Appeal. In Mohammad v. The Manufacturers Life Insurance Company, 2020 ONCA 57 (CanLII), the court affirmed that insurers are entitled to receive complete and truthful information about all material facts. The ruling confirmed that an insurer may void a policy where a failure to disclose would have affected the underwriting decision.
The court reinforced this approach more recently in Davies v. AIG Insurance Company of Canada 2024 ONCA 509 (CanLII). In that case, the court noted that a material misrepresentation, whether intentional or not, can relieve an insurer of its obligation to provide coverage under the policy. The decision illustrates how Ontario courts focus on the importance of materiality when assessing disclosure disputes.
Together, these cases are frequently relied upon in Ontario insurance disputes, including those arising from auto accidents. They demonstrate that when relevant medical history or risk-related information is not disclosed, insurers may have legal grounds to deny benefits or treat the policy as void. For accident victims, these decisions highlight why accurate disclosure plays a critical role in determining access to insurance coverage after a loss.
How Accident Benefits Claims Are Impacted by Non-disclosure
After a car accident, injured individuals often rely on Statutory Accident Benefits to cover medical treatment, income replacement, and rehabilitation. If an insurer believes a pre-existing medical condition was not disclosed, they may argue that the claimed injuries were not caused solely by the accident.
This can lead to benefits being delayed or denied outright. An experienced car accident compensation lawyer can assess whether the insurer’s position is legally justified and whether the denial can be challenged through mediation, arbitration, or litigation.
What to Do If Your Claim Is Denied
If your insurer denies your claim due to alleged non-disclosure, do not assume the decision is final. Here’s what you can do:
Request written reasons for the denial
Avoid communicating with the insurer without legal advice
Many disputes turn on whether the non-disclosed condition was truly material or relevant to the accident. Legal representation can make a significant difference in these cases.
Minimizing Risk Through Clear and Honest Disclosure
Honesty is always the best approach when dealing with insurers. If you are unsure whether a condition needs to be disclosed, it is safer to include it or seek professional advice before submitting an application or claim.
For Ontario residents navigating complex insurance claims for an auto accident, staying informed and proactive can help prevent costly disputes and protect your rights after a collision. Contact Kelly Greenway Bruce today to discuss your situation and learn how our team can help protect your rights and pursue the compensation you deserve.