Being held in the hospital due to sickness or disability is a stressful experience. It is not a time to worry about insurance coverage. However, this is a scenario millions of Canadian life and health insurance policy holders have gone through at some point in time.
According to a survey done by the National Association of Insurance Commissioners or NAIC, the top three complaints about insurance companies are about:
- Delay of processing and release of claim at 26%
- Denial of claims at 14%
- Insufficient financial releases at 14%
It should be noted that 48% of these complaints are for health-related insurance policies. If you have received a notification from the company that they won’t pay all or part of your claim, you’ll need to take the right course of action. Insurance claim lawyers are skilled professionals who can guide you through the process so you don’t have to worry about making a mistake.
Reasons Why Companies Deny Claims
There are a myriad of reasons why a company would declare your claim invalid. On the case of health and disability insurance, the most common reasons are misrepresentation of information and insufficient supporting documents.
If you have submitted your documents properly you should receive a formal response promptly from your company. If your company informs you after the deadline has passed, you may not have a case. In all circumstances, always make sure that you submit the necessary requirements and double check everything you write on paper. If you have proof of the information you put into the document, all the better.
Worst Insurance Companies for Paying Claims
Some of the worst disability insurance companies for paying claims have a poor rapport with Ontario’s Ombudsman. We recommend looking up some complaints filed on the Ombudsman’s website: investigations into insurance companies and health insurance providers can point you in the right direction.
Less Common Reasons:
- Your claim may not be covered by your insurance policy. This happens when insurance companies not paying claims interpret your request in context. It is unavoidable for some people to not be able to write clear answers on the forms and the companies use this to mislead the policy holder.
- The amount you are asking is too much and cannot be covered by your insurance. Instead of notifying you that this is the case, most companies just dismiss your claim to avoid additional clerical duties. Be sure to provide a reasonable amount and have receipts or medical requests ready to back up your claim.
- There are elements that disqualify your condition to be covered by the policy such as past undeclared illness, accidents due to your own negligence, and so on.
The most important thing to know is that numerous insurance companies prefer not to pay their policy holders money. Any kind of information can be exploited and you will be left questioning numerous accounts in your policy that actually support their conclusion. This is why you need disability insurance lawyers to give you a full heads up on what to expect from your policy.
Read and Understand Your Policy
Most people end up in unfavorable situations because they get insurance coverage – mindlessly – as a requirement for work or other purposes. Because of this, individuals may stay uninformed: when you need to take advantage of your paid premiums and your health insurance claim was denied, it becomes difficult to find out what to do.
For this reason, you need to fully understand what is written in your insurance contract with the company. If you are still about to get one, make sure to discuss all the stipulations with your insurance broker. It is essential that you agree to all these points before signing anything.
An insurance claim lawyer can walk you through your policy and explain the parts you don’t understand. Here at TSF Law, we offer a free consultation: call us today at (905) 218-3668. If your claim was denied and you want to pursue the company, we may help by taking on your case. You can freely discuss the terms with our team when the time comes.
How to Pursue a Denied Claim
The most effective way to pursue an insurance company is to get a skilled and experienced lawyer to represent you. This is essential especially if you have to stay back in the hospital for medication or therapy.
The first step is to contact your insurance company and see why the claim was denied. It can be just a simple error on your part or some lacking documents you can still submit to get a re-evaluation. Be persistent about getting your claim accepted. Check-in with the company on what else you can do to hasten the process.
If in any event the company still denies your disability claim even after all the collaboration you have done with your insurance company, it might be time to make an appeal. There is a fixed timeline a company is allotted to make a decision regarding your appeal. If they fail to respond in time or have given an unclear answer, you should get a lawyer to determine what the following steps to take.
The worst insurance companies for paying claims in Canada also hire the best lawyers for the job. You need to level the playing field by getting someone who is knowledgeable and experienced in pursuing disability and health insurance claims. This is the best way to ensure that you get what you paid premiums for.
We pride ourselves in providing personalized service, including extensive interviews and preparation for all clients and their witnesses. We believe that preparation is key to effectively, and successfully representing our clients.
Our experienced attorneys are available 24/7 to offer injury victims a free consultation. If you have been seriously injured and would like to speak to an attorney, we will make arrangements to travel to meet you. Call us today: (905) 218-3668
