Denied Insurance Claim Statistics… Where are they?

What is the CLHIA?

The Canadian Life and Health Insurance Association of Canada is a voluntary not-for-proftit association which has been in operation since 1984. Its mandate is to:

    1. To build consensus among members on issues and concerns of importance to the industry.
    2. To promote a legislative and regulatory environment favourable to the business of its members.
    3. To foster sound and equitable principles in the conduct of the business of its members.
    4. To inform and educate members about domestic developments and, where warranted, international developments of importance to them.
    5. To preserve and advance the industry’s reputation.
    6. To promote, on behalf of its members, public policies that contribute to the betterment of the Canadian economy and society.
    7. To deliver maximum value for money to its members.

The Facts

Canada has some of the largest financial databases to work with when dealing with injury. Based on a 2016 report, the CLHIA stats that there are three Canadian companies ranking among the top 15 largest life insurers in the world.
Of 133 total health insurance providers, the industry has backed itself more than three-times over the regulatory marker, which means dollars are going into well-founded accounts. Most of these are in bonds and mutual funds, with $6.6bn paid out to all levels of Canada in 2015.
Over 90% of the benefits paid out, totalling $84bn, went to living policyholders protecting over 28 million Canadians.


While these statistics are enormous, they do not represent the complaints or issues which consumers and claimants have had with insurance companies. Denied claims represent aggrivated consumers, or helpless individuals facing administrative pressure. While consumers resolve their complaints with insurance companies directly, the OmbudService for Life & Health Insurance (OLHI) may be used as a third-party complaint board for health insurance complaints. Their process involves answering questions about your complaint or insurance policy, reviewing the complaint, or helping you if 90 days have passed since you complained to your insurance company. In case of a denied insurance claim, we recommend talking to a lawyer or legal professional such as TSF Law.
In total, 700 Complaints were passed to the OHLI and 2,100 total were collected in Canada last year. The majority pertained to claims from health insurance companies. Still, we do not have an accurate representation of the total of denied claims from insurers in Canada. While Assuris has stated the insolvency of four insurance companies that have not paid claims to beneficiaries, the public is left to estimate what percentage of claims are actually denied.
Although the courts are dispute arbiters, there is a real need for an amalgamation of denied insurance claims in order for the public to understand just how many Canadians are denied their right to safe or assisted living.
Responses to claimants on behalf of insurance companies are usually full of legal jargon – in many ways, impossible for a layman to understand. The contract which is referred to between the insurance company and client are positioned such that the terms, in the eyes of the insurance company, disallow the complaint from reaching further resolution. Another point-of-view is required; your lawyer will be able to help interpret such a document.
Insurance companies usually have the upper hand; they have assets, knowledge, and advice at their disposal. Do not let them bully you into a settlement or denying your claim. You’ll be treated fairly at TSF Law; we’re always there for you. Contact us today by calling (905) 218-3668 for more information on your denied claim.