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What do you do if your insurance claim is denied?

Companies who offer long-term disability and care packages have made a decision to pay for your condition in case you are in an accident, fall ill, or need the services of a caregiver � whether in an alternate living environment, or your own home. Your health insurance claim has outlined such needs � and the objectivity of your state. Why has the company denied your claim?

Once your claim was submitted, your insurance company made an attempt to determine your state of health, whether or not your records are complete, questions were answered, or facts could be verified. Your insurer may have overlooked some details, or provided a reason why your denied insurance claim was justified. If your insurance company has not done so, this can be an illegal form of denial. You should reach out to the appropriate department. If they do not give you a reason as to why your health insurance claim is denied, consult a lawyer immediately. Your health insurance company can deny coverage for a variety of reasons, which you, legally, are able to dispute.

Health Insurance Claim: The Premiums

In some cases, denial of insurance claim will lead to an increase in your premium. You should be aware of this possibility � refer your contract with your health insurance company to ensure your education on the matter is sufficient enough to weigh your possible outcome. Note: Your lawyer may be able to remove the extra premium during and after the rejection of your insurance claim.

If your insurance company conducts an investigation after your claim and you, or a beneficiary, have not taken the appropriate measures to submit the appropriate information, you may find yourself in a situation whereby your denial of insurance claim will lead to a void contract between yourself and the company. You may lose out on your premiums as well.

If your Insurance Claim is Denied � and you feel your premiums may increase without good reason, contact [PW Lawyers]( "PW Lawyers") for a free consultation. We offer expert advice and professional, legal representation for you; our retainer is one of the best in the industry.

Making a Complaint after your Health Insurance Claim is Denied

Canadians have a variety of measures to take after their claim is denied. While hiring a lawyer is the most appropriate avenue towards resolution, you may:

  • Consult with your Insurance Agent and attempt to create an internal complaint
  • Formally compain to your insurer via writing
  • Contact your insurance Regulator
  • Contact OHLI, AMF, GIO, or FCAC and submit your complaint.

Filing a formal complaing requires facts, the reason for your belie of a problem, and the course of action you would like to have taken. It also requires copies of communication between yourself and your insurer � including your statements, contracts, medical records, etc. You should keep the originals. You should also keep records of who you talk to, including phone conversations and written discourse. You must also provide an internal letter from the insurer containing the reason for your denied insurance claim.

How much time do I have to file my claim?

Clients usually have a period of one year after expenses are incurred. Life insurance are encouraged to promptly pay out claims � since individuals may be in less-than-ideal situations. If your health insurance payments are cut off, you will need to consult with a Disability Insurance Lawyer. This can be a serious offence. If your application was denied, your benefits have been terminated or need legal advice on your long term disability claim, contact us today for your free consultation: (905) 940-5554.

How to fight a denied insurance claim

When a health insurance claim has been denied, people are often left to wonder what the next steps of action are. Sometimes insurance companies will not follow up with denied claims � leaving the options for the individual to a minimum. It is not in the best interest of an insurance company to recommend a lawyer to you. Insurers are looking to fly below the radar in this regard.

Whenever an insurer has sent you a letter stating your denial of insurance claim, you should consult with a laywer to weigh in on the next and appropriate steps of action. If your Insurance Claim is Denied, contact PW Lawyers for a free consultation.

Types of Disability Claims

There are many types of Disability Claims based on your insurance package, or lack of insurance package as a result of your employment terms. Here are a few.

Avoid disability claim internal appeals. You do not have to go through the insurance appeal process before you can contact a disability claim lawyer.

Typically there are three types of waiting periods that you encounter when filing a health insurance claim. Click here to learn more.


Paul Wilkins

Principal Partner

Paul is a member of the Ontario Trial Lawyer’s Association and the Advocates Society. Frequently involved in pursuing his clients’ claims, his areas of focus include statutory accident benefits, short term and long term disability benefits, disability claims and Canada Pension Plan disability benefits.

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