What Insurance Adjusters Don’t Tell You After an Accident 

After a car accident in Ontario, an insurance adjuster will likely contact you within days to ask questions, request a formal statement and sometimes offer a quick settlement. Adjusters are trained negotiators who work for the insurance company, not for you. Understanding how they operate, what documents to gather, and the difference between accident benefits and a tort claim can help protect an injured person’s right to fair compensation. 

Who Does an Insurance Adjuster Actually Work For? 

An adjuster’s paycheque comes from an insurance company, whether that is the at-fault driver’s insurer or the injured person’s own insurer. Their role is to investigate the claim, assess the damages and negotiate a settlement that is favourable to the company they represent. This does not mean every adjuster acts in bad faith. It does mean their goals and the goals of an injured person are not always the same. 

Why Do Adjusters Ask for a Statement Right Away? 

Adjusters often request a formal statement in the first few days after a collision, while the injured person is still shaken, in pain or unsure of the full extent of their injuries. Anything said in that statement can be used later to challenge the claim. A person who says they feel “okay” or “a bit sore” in the early days, before symptoms of a concussion or soft tissue injury fully surface, may find those words used against them months later. There is no legal requirement to give a statement to the at-fault driver’s insurer, and it is worth speaking with a lawyer before agreeing to one. 

Is the First Settlement Offer Usually Fair? 

Early settlement offers are often lower than what a claim may actually be worth. Adjusters know that a fast, modest payout can look appealing to someone facing medical bills, lost income or the stress of vehicle repairs. Once a tort settlement is agreed to, it is typically final, even if injuries turn out to be more serious or long-lasting than first thought. An accident benefits settlement will be binding two business days after signing the insurance company’s paperwork. Accepting an early offer without understanding the full scope of an injury can mean giving up the right to pursue fair compensation later. 

What Is the Difference Between Accident Benefits and a Tort Claim? 

This is one of the most misunderstood parts of an Ontario car accident claim: 

• Accident benefits (AB) are no-fault benefits available through a person’s own auto insurance policy, regardless of who caused the crash. These can include medical and rehabilitation benefits, attendant care and income replacement benefits, all subject to strict limits, deductibles and timelines set out in the Statutory Accident Benefits Schedule (SABS). 

• A tort claim is a separate legal action brought against the at-fault driver for damages not fully covered by accident benefits, such as pain and suffering, future income loss beyond AB limits and out-of-pocket expenses. A tort claim generally requires proving fault and, in the case of car accidents, meeting a threshold showing the injury is serious and permanent. 

Many injured people pursue only one of these claims when they may be entitled to both. Understanding how AB and tort claims work together, rather than assuming they are the same thing, is important to recovering full compensation. 

Why Might an Adjuster Downplay an Injury? 

Soft tissue injuries, concussions and psychological injuries, such as post-traumatic stress, do not always show up on an X-ray. Because they can be harder to prove, adjusters may determine these injuries are minor or unrelated to the accident. Thorough medical documentation from a family doctor and any specialists is one of the best ways to counter this. Keeping a record of missed work, medication, therapy appointments and how the injury affects daily life can also help support a claim. 

What Documents Should Be Kept After an Accident? 

Adjusters may not always volunteer a full list of records that will strengthen a claim. Useful documents include: 

• Medical records and imaging reports 

• Receipts for medication, mobility aids or home care 

• A record of time missed from work and any reduced hours 

• Pay stubs or income documents showing lost earnings 

This last point matters more than ever. It is worth noting that after July 1, 2026, the new SABS regulations no longer require insurers to include income replacement benefits as part of a standard automobile policy, making personal documentation of income loss even more important. For many, these losses will be recoverable only in tort, placing the onus on the victim to provide proof of their lost income. 

Do You Need a Lawyer to Deal With an Insurance Adjuster? 

There is no legal requirement to hire a lawyer before speaking with an adjuster, but it is strongly encouraged to speak with a lawyer before attempting to communicate with an adjuster on your own. A personal injury lawyer can handle communications with the adjuster, advise on whether a settlement offer is fair and help identify all the benefits and claims a person may be entitled to under both accident benefits and tort law. Most personal injury lawyers in Ontario, including those at Thomson Rogers LLP, offer a free initial consultation. 

Frequently Asked Questions 

Can I negotiate a settlement offer from an adjuster? Yes. Settlement offers are often a starting point for negotiation, not a final number. Accepting an offer usually ends the claim, so it is worth understanding the full extent of an injury first. 

What is the difference between accident benefits and a tort claim? Accident benefits are no-fault benefits paid through a person’s own auto insurer, regardless of fault. A tort claim is a lawsuit against the at-fault driver for damages not covered by accident benefits, such as pain and suffering. 

How long do I have to make a claim after a car accident in Ontario? Deadlines vary depending on the type of claim. The limitation period for tort claims is typically the second anniversary of the accident, but can sometimes vary. Several deadlines apply to applications for accident benefits, the earliest of which is seven days. It is best to speak with a lawyer as soon as possible after an accident to ensure your rights are protected. 

Does hiring a lawyer cost money upfront? Most personal injury lawyers, including Thomson Rogers LLP, work on a contingency fee basis, meaning there is no upfront cost and fees are only paid if the claim is successful. 

Lexicon 

Adjuster A representative of an insurance company who investigates a claim and negotiates a settlement on the insurer’s behalf. 

Accident benefits (AB) No-fault benefits available through a person’s own auto insurance policy after a car accident, regardless of who caused the crash. 

SABS The Statutory Accident Benefits Schedule, the Ontario regulation that sets out what accident benefits are available and the limits, deductibles and timelines that apply to them. 

Tort claim A lawsuit against the at-fault driver seeking compensation for damages not fully covered by accident benefits, such as pain and suffering and additional income loss. 

Threshold The legal standard a person must meet in a tort claim connected to a motor vehicle accident. The individual must show that their injury is serious and permanent to be compensated for pain and suffering and certain other kinds of damages. 

Contingency fee A payment arrangement where a lawyer’s fees are a percentage of the settlement or award, paid only if the claim succeeds, with no upfront cost to the client. 

What To Do If You’ve Been Injured in an Accident 

If you’ve been injured in an accident, speak with a Thomson Rogers lawyer. Thomson Rogers LLP is a Toronto-based law firm with nearly a century of experience representing plaintiffs in personal injury, medical malpractice and civil litigation matters across Ontario. The firm’s Personal Injury Group holds National and Toronto Tier 1 rankings for Personal Injury Litigation by Best Law Firms™, and is recognized as one of Ontario’s Top 10 Personal Injury Boutiques by Canadian Lawyer, known for handling complex, high-stakes cases with skilled and compassionate advocacy. 

Schedule a free consultation with the expert legal team at Thomson Rogers. Call us at 416-868-3100 or 1-888-223-0448, or contact us online to get the compensation you deserve. 

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Chris Lazaris is a Personal Injury Lawyer and a Partner at Thomson Rogers LLP and has been recognized by Best Lawyers™ Ones to Watch in Canada. Lucy can be reached at 416-868-3214 or by email.