canadaohipontarioappeal
OHIP Claim Denied Appeal Letter (Ontario Process)
March 29, 2026
5 min read
In Ontario, Canada, the Ontario Health Insurance Plan (OHIP) covers standard medical care. However, OHIP frequently denies coverage for out-of-country emergency care or specialized out-of-province surgeries. If you need an **OHIP claim denied appeal letter**, here is what you must do.
The Health Services Appeal and Review Board (HSARB)
If the General Manager of OHIP denies your claim, you have exactly **15 days** to request a hearing before the HSARB. This is a very strict legal deadline.
What to Include in Your OHIP Appeal
For out-of-country emergencies (the most common denial), your letter must prove three things:
1.The services were medically necessary.
2.The services were required immediately (an emergency).
3.It was necessary to receive the services outside of Canada because it was physically impossible to return to Ontario.
Our Free Appeal Letter Generator can help you draft a highly structured response to OHIP outlining these three critical legal pillars required for reimbursement.