Why would my Insurance Company deny my claim?  

Often people are surprised and betrayed that their insurance company would deny them for the very coverage that was paid for.  The unfortunate reality is this happens all too often and the reality is insurance companies care more about paying as little as possible on claims then they do taking care of their customers.

Who decides whether to accept or deny my claim?

An employee of the insurance company called an insurance adjuster or claims adjuster usually decides whether or not to accept or deny insurance claims.  While these adjusters act like they’re on your side, their main goal is to pay out as little as possible for insurance claims. 

What can I do to protect myself from insurance or claim adjusters?

Insurance or claim adjusters often only want to communicate by phone as there is no record of what is being said.  Always try to have them communicate in emails or writing what they tell you about your insurance coverage.  If they won’t, take your own notes with dates and times of your conversations with the insurance adjuster or claim adjuster.  

If I’m currently on Long Term Disability when should I be concerned?

If you’re currently on Long Term Disability or other ongoing disability benefits, beware when your claim adjuster starts asking specific updates, or for you to write a diary of your day to day life.  This is not information they need unless they’re evaluating whether or not you still qualify for disability payments.  

 

Do insurance companies use private eyes?

When insurance companies are trying to find ways to cut-off active insurance claims they will often hire private eye’s or individuals called Independent Adjusters, to follow people and record what they’re doing in hopes of using the surveillance footage to find an excuse to cut-off an active disability claim.

 

What if my Insurance Company sends me to a medical evaluation?

If you’re currently on Long Term Disability or other ongoing disability benefits and your insurance company wants you to be evaluated by a medical practitioner they hire, this is a good indication that they’re looking for a reason to cut-off your claim.  Insurance companies hire doctors to do Independent Medical Evaluations (IMEs) to find a way to deny legitimate disability claims.

What’s the difference between Private and Group Insurance Plans?

Private Insurance plans are taken out by an individual, while Group Insurance Plans are offered by employers.  Because Group Plans spread the insurance risk among many people, they are usually less expensive than Private Plans.

How long are disability benefits paid for?

Short-term disability benefits are paid for a specific amount of time which is set out in the insurance policy. Usually this time frame ranges from 15 weeks to up to a year, however each case is different.

Long-term disability benefits time lines are also governed by the wording of the insurance policy, with most policies continuing until the insured reaches 65 years of age. There are some policies however that have limits, which can be 2 to 5 years or any other amount agreed to, and others which allow you to pay a premium to continue coverage beyond 65 years of age.

As with most things involving your insurance coverage it will come down to the precise wording of your contract and how the Courts will interpret them. An experienced lawyer can help you understand your rights.

What’s the difference between being disabled from your own occupation vs. any occupation?

Almost all disability contracts have two different standards of disability that someone must suffer from to meet the terms of the policy.  Usually for the first 1 to 2 years of disability you have to be disabled from performing the duties of the job you have at the time you are disabled.  This is known as the own occupation period.  After this period most policies require you to be disabled from any occupation available to you within certain parameters.  This is a much higher standard and usually when insurance companies deny serious long term claims.  

Can I hire a lawyer if I’m part of a union?

Often you can hire a lawyer if you are unionized, but it will require a lawyer’s examination of the policy to ensure this is the case.

What can I do if my Insurance Claim is Denied?

The lawyers at Taylor & Blair can help denied insurance claims.  If your insurance claim is for long term disability, there are steps you can take that will also help.  These include applying for Canadian Pension Plan (CPP) disability or Provincial Persons With Disability (PWD) benefits. 

What am I entitled to legally if my insurance claim is unfairly denied?

If your claim proceeds to trial, the law states that all a Judge can do is order your insurance company to pay you any amounts owed to the date of the judgment and that it must continue to make payments pursuant to the terms of your insurance contract.

What if I don’t want to continue with my Insurance Company after they denied me coverage?

While a judge can only make your insurance company pay you the amounts owed to date and that the insurance company must continue to make payments pursuant to your insurance contract, many people want nothing to do with their insurance company after an unfair denial.  Due to this, many cases are settled out of court for a lump-sum settlement recognizing past payments owed as well as future payments. 

How much is my claim worth?

This will depend on the facts of your case and the specific wording of the insurance policy.  Insurance policies contain many terms and conditions that an experienced lawyer can help you understand.

How long will it take for my claim to settle?

While it may be shocking many claims can take up to a year if not longer to settle.  However each case is specific and some can resolve much quicker than this.  

What is an insurance broker?

An insurance broker represents someone who is or wants to be covered by an insurance policy and deals with the insurance company on that person or company’s behalf as their representative.  An insurance agent represents the insurance company and insurance brokers represent the insured/those seeking insurance.

What if an insurance broker gave me bad advice?

Insurance brokers have a professional obligation to their clients and if your insurance does not cover you because something your insurance broker did wrong or failed to do, you can sue them to recover what you should have received under your insurance.

Are there time frames that I need to be aware of?

Yes, insurance contacts can contain time limits you need to be aware of.  Experienced lawyers can help you understand these.