Insurance Denial Lawyers and the Policies and Insurers We Deal With

Insurance policies are not all the same. A denied long-term disability claim is different from a denied life insurance claim. A mortgage disability claim is different from a private disability policy. A residential fire loss is different from a commercial property loss with a business interruption claim. The wording of the policy matters, the type of claim matters, and the insurer you are dealing with can also matter.

At Taylor & Blair LLP, our insurance denial lawyers help people in British Columbia when an insurance company denies, delays, underpays, or cuts off benefits under an insurance policy. We act for policyholders, beneficiaries, homeowners, business owners, employees, professionals, and families who expected insurance to be there when they needed it and were told no.

We do not sell insurance. We do not act for insurance companies. We help people challenge insurance denials and recover the benefits they are entitled to under the policy.

Types of Insurance Policies and Claims We Deal With

Long-Term Disability and Short-Term Disability Claims

Long-term disability and short-term disability insurance policies provide income replacement when illness or injury prevents a person from working. These claims often turn on the definition of disability in the policy, the medical evidence, the nature of the claimant’s occupation, and whether the insurer is applying an “own occupation” or “any occupation” test.

We deal with denied disability claims, terminated disability benefits, change of definition denials, surveillance issues, independent medical examinations, return to work disputes, and disputes over whether a person can realistically perform their job or some other suitable work.

Professional, Self-Employed, and Individual Disability Policies

Some people have private or individual disability policies purchased through an insurance broker or agent. These policies are often used by professionals, business owners, doctors, dentists, lawyers, accountants, tradespeople, consultants, and self-employed workers.

Private disability policies can be very valuable, but they can also involve detailed policy wording, occupation-specific definitions, residual disability clauses, partial disability benefits, business overhead expense coverage, cost of living riders, and disputes over pre-existing conditions or misrepresentation. Where a claim is denied, the exact wording of the policy matters.

Life Insurance Claims

Life insurance is supposed to protect a family or beneficiary after a death. When a life insurance claim is denied, the consequences can be devastating. Life insurance disputes can involve alleged non-disclosure, misrepresentation, lapse for non-payment of premiums, exclusions, beneficiary disputes, contestability periods, accidental death issues, and disputes over whether coverage was actually in force at the time of death.

We assist beneficiaries and estates with denied life insurance claims, delayed payment of death benefits, disputes over policy ownership or beneficiaries, and claims where the insurer says the deceased did not properly answer medical, financial, or lifestyle questions when applying for coverage.

Accidental Death and Dismemberment Insurance Claims

Accidental Death and Dismemberment insurance, often called AD&D insurance, is different from ordinary life insurance. These policies usually require the death or loss to result from an accident as defined by the policy. Insurers may deny AD&D claims by arguing that the death or injury was caused by illness, intoxication, a medical event, a policy exclusion, or something other than an accident.

AD&D claims can involve difficult factual and medical issues. The insurer may focus on the mechanism of injury, the death certificate, toxicology, police records, medical history, or whether an exclusion applies. These claims require careful review of both the evidence and the policy wording.

Critical Illness Insurance Claims

Critical illness insurance usually pays a lump sum if the insured is diagnosed with a covered illness and meets the precise definition set out in the policy. Common critical illness claims involve cancer, heart attack, stroke, coronary artery bypass surgery, multiple sclerosis, Parkinson’s disease, organ transplant, kidney failure, blindness, paralysis, severe burns, or other listed conditions.

Critical illness claims are often denied because the insurer says the diagnosis does not meet the technical definition in the policy, the survival period was not met, the illness was excluded, or the medical evidence is not sufficient. These are not simply medical questions, they are policy interpretation questions.

Mortgage Disability and Mortgage Life Claims

Mortgage disability, mortgage life, line of credit, credit card, and loan insurance policies are often sold through banks, credit unions, lenders, or other financial institutions. Many people assume these policies work the same way as ordinary disability or life insurance, but they often do not.

Property Insurance Claims

We also deal with property insurance claims, including residential property loss, commercial property loss, fire loss, water loss, sewer backup, storm loss, theft, vandalism, strata-related losses, and business interruption claims. Property insurance disputes often arise after a major loss when the policyholder is trying to rebuild, replace contents, keep a business alive, or find somewhere else to live.

Property insurance claims can be denied, delayed, or underpaid for many reasons. Common disputes include vacancy exclusions, misrepresentation, late notice, proof of loss issues, arson allegations, wear and tear, faulty workmanship, flood or water exclusions, causation disputes, disagreements over repair scope, underpaid contents claims, additional living expense disputes, loss of rental income, business interruption losses, and disputes over replacement cost.

In large property loss claims, the insurer’s estimate is not always the final answer. The policyholder may need help dealing with adjusters, restoration companies, engineers, accountants, appraisers, mortgagees, brokers, and the insurer’s coverage position.

Long-Term Disability Denial Occupations

For disability claims, not only the medical condition matters. The type of work you did before becoming disabled, your education, your training, your work history, and the day-to-day realities of your job can all affect whether you meet the test for disability under your policy. This becomes especially important when the policy changes from an “own occupation” test to an “any occupation” test.

The experienced insurance denial lawyers at Taylor & Blair LLP have dealt with disability claims involving many different occupations, including:

Group Policies and Individual Policies

Group Insurance Policies

Many disability, life, critical illness, AD&D, and health-related insurance policies are group policies. These policies are commonly provided through an employer, union, association, professional group, or employee benefits plan. Group policies can be convenient because coverage is often obtained with less underwriting than a private policy. However, the benefits, exclusions, limitation periods, offsets, and appeal requirements are still governed by the wording of the policy and plan documents.

Group policy disputes may also raise issues about whether the claim should be handled in court, through a union grievance, or under another dispute process. That question depends on the policy, the employment setting, and the role of the employer, union, plan administrator, and insurer.

Individual or Private Insurance Policies

Individual or private policies are usually purchased directly from an insurer or through an insurance broker or agent. These policies may include disability insurance, life insurance, critical illness insurance, mortgage protection, business insurance, or other forms of personal insurance. They are often more customized than group policies and may include riders, exclusions, special definitions, or higher benefit amounts.

Because individual policies are usually underwritten before coverage is issued, disputes can arise over what was disclosed in the application, whether the insurer can rely on an exclusion, and whether the policyholder meets the exact definition required for payment.

Insurance Denial Claims with British Columbia Insurers

Not only does the language of the policy matter, but the insurance company you are dealing with can matter. Different insurers use different policy wordings, different claims processes, different internal medical consultants, different adjusters, and different approaches to settlement.

We assist clients in British Columbia with denied, delayed, underpaid, and terminated insurance claims involving many different insurers, benefit providers, banks, lenders, and broker-sold policies. This includes claims involving:

Disability, Life, Critical Illness, Mortgage Disability, and AD&D Insurers

Property, Fire, Water Loss, Commercial Property, and Business Interruption Insurers

Common Insurance Denial Issues We Review

When we review an insurance denial, we look at the policy, the application, the denial letter, the medical records or loss documents, the insurer’s file, the claim history, and the deadlines that may apply. Depending on the type of claim, the issues may include:

  • whether the insurer applied the correct test under the policy
  • whether the insurer relied on an exclusion that actually applies
  • whether the insurer ignored or misunderstood important medical evidence
  • whether the insurer unfairly treated a claim as not proven
  • whether the insurer delayed making a decision
  • whether the insurer underpaid the value of the claim
  • whether the insurer relied on alleged misrepresentation or non-disclosure
  • whether the insurer properly considered the claimant’s actual job duties or business losses
  • whether the insurer properly valued property damage, contents, additional living expenses, or business interruption losses
  • whether an insurance broker or agent failed to obtain the coverage that was requested or needed

At the end of the day, every claim depends on the specific policy and the specific facts. A denial letter is not always the final word. If an insurance company has denied, delayed, terminated, or underpaid your claim, an experienced insurance denial lawyer can review the policy and help determine whether the insurer’s position can be challenged.

Speak With an Experienced Insurance Denial Lawyer in BC

If your insurance claim has been denied, delayed, cut off, or underpaid, contact the experienced insurance denial lawyers at Taylor & Blair LLP. For more than 30 years, our firm has helped people in British Columbia deal with difficult insurance disputes and push back when insurers refuse to pay valid claims.

We understand how stressful it can be when an insurance company denies benefits you were counting on, stops paying after initially accepting a claim, delays making a decision, or offers far less than the claim is worth. These decisions can affect your income, your home, your health, your family, and your financial security.

Our lawyers can review the policy, the denial letter, and the key claim documents and give you a practical assessment of your options. We will look at what the policy actually says, the reason the insurer gave for its decision, what evidence may be missing, and whether the denial or underpayment can be challenged.

We proudly serve clients throughout the Lower Mainland, including Vancouver, Burnaby, North Vancouver, Port Coquitlam, Richmond, Surrey, and Langley, and we also offer remote and virtual intake where appropriate.

Contact Taylor & Blair LLP today for a free consultation.