Can My Insurance Company Deny My Critical Illness Claim?

Posted on by Taylor & Blair LLP Posted in Insurance Denials, Critical Illness Claim Denials

Having a critical illness insurance policy in place offers a sense of security and financial protection in times of medical emergencies. Unfortunately, there are instances where insurance companies deny critical illness claims, leaving policyholders confused and frustrated. While critical illness insurance denials can be devastating, it is important to understand the common factors behind denials of critical illness claims by insurance companies.

Critical Illness Policy Exclusions

Insurance policies for critical illness coverage often have very specific exclusions and limitations regarding critical illnesses. It is important for policyholders to understand these exclusions and ensure that their claim falls within the covered conditions. For example, some policies may not cover certain types of cancer or pre-existing chronic conditions.  While multiple sclerosis may be covered, often systemic sclerosis is not.  An insurance company will not pay out benefits under a critical illness policy unless the specific illness you have is listed in the … Continue reading

What Happens in a Long-Term Disability Claim?

Posted on by Taylor & Blair LLP Posted in Insurance Denials, Long-Term Disability

A significant amount of Canadian long-term disability claims are denied.  When some people attempt to appeal the decision this almost never changes the opinion of the insurance company which has denied the claim. This leaves people with only one choice if they want to enforce their rights, start a legal action.

Starting a legal action to enforce your rights under your insurance policy can be intimidating, especially when you’re going up against an insurance company with almost limitless resources.  Most people with a claim don’t have any idea how a long-term disability claim works or what happens.

We’ve put this blog post together so our clients can get an idea of what happens in a long-term disability claim.

Gathering Evidence

The first step in a denied long-term disability claim is gathering the evidence you’ll need to ensure you have a good claim. There are only two big steps to … Continue reading

Tips for Dealing With Your Insurance Company

Posted on by Taylor & Blair LLP Posted in Insurance Denials

In one way or another, nearly everyone invests in some form of insurance, aiming to secure financial assistance in times of crisis. These insurance policies, whether they cover long-term disability insurance, life insurance, critical illness insurance, mortgage protection, or  accidental death & dismemberment, provide peace of mind, knowing they’ll be there to support us when we need it most. However, the unfortunate reality is many legitimate insurance claims are denied every year. 

This is why we’ve created the Tips for Dealing With Your Insurance Company guide. The goal of this book is to equip you with the necessary information to handle your insurance company independently, aiming to prevent you from becoming one of our clients in the first place. 

 

If your claim is denied, and you’re having trouble negotiating with your insurer, we are here to help.  Our dedicated insurance denial lawyers at Taylor … Continue reading

Long-Term Disability & Return to Work Programs

Posted on by Taylor & Blair LLP Posted in Insurance Denials, Long-Term Disability, Return-to-Work Program

As discussed many times in this blog, your relationship with your insurance company is one based on contract. Your insurance policy lays out the responsibilities and obligations of the insured and the insurer.  The basic provisions of all insurance policies are that you pay insurance premiums to your insurance company, and they agree to pay out insurance benefits should an agreed upon event occur triggering coverage under the policy. That’s the broad strokes. However, every type of insurance policy has fine print as well and more often than not it’s the fine print that is the most important part of the policy when a claim for benefits is made.

A common provision in long-term disability insurance policies is that the insured is obligated to participate in a program designed to get them back to work and that if the insured fails to participate in the program the insurance company can … Continue reading

Is Your Long-Term Disability Provider Watching You?

Posted on by Taylor & Blair LLP Posted in Insurance Denials, Long-Term Disability

While this usually comes to the surprise of most people who are currently receiving long-term disability benefits, your insurance company is not your friend. They are providing you with long-term disability benefits because they are contractually obliged to, not out of some sense of altruism.

Not only are they only doing what they are contractually obligated to do, they are also constantly reevaluating your entitlement to ongoing long-term benefits and actively seeking excuses to disentitle you to benefits or to void coverage under your insurance policy.

Your Medical Records and Independent Medical Examinations

Your insurance company will be continually looking through your medical records from the start of your claim until the claim ends to look for ways to deny paying further benefits and to confirm you still meet the definition of “disabled” under the terms of your long-term disability policy.

In the beginning of your claim for long-term disability … Continue reading