Case Studies

An elderly man named Fred fell and went to hospital with a head injury. He was discharged the next day. His son cared for him at home. Soon after, Fred had headaches and bouts of vomiting and returned to hospital. When he was discharged a month later, he moved into long-term care as he was unable to walk. Fred asked his son to submit an accident benefits claim on his behalf to […]

Mike W. worked in construction all his life until he hurt his back. Unable to work since his injury, he was declared “totally disabled” by the Régie des Rentes du Québec (“RRQ”). The credit insurance Mike purchased when he took out his mortgage covered his monthly payments. In the event of disability, it would pay […]

Lisa D.’s son has cerebral palsy, and his doctor recommended a treatment to help manage it. Lisa’s group health benefits provider verbally affirmed that the treatment was covered under her plan. But when the company followed up in writing, it informed her that the proposed treatments were ineligible for coverage unless […]

When Jim found out he had stage one prostate cancer, he submitted an insurance claim. His insurer denied the claim, saying stage one prostate cancer was not covered by his Critical Illness insurance policy. When Jim received his insurer’s final position letter, he came to OLHI. Our complaints team reviewed the case and learned that […]

Harold B. suffered a severe health problem related to his kidneys and had to have one removed. Worried about his clients, Harold returned to his job as soon as he felt able after the surgery. When Harold returned to work, he had to periodically reduce his work hours and was never able to work full-time again because of his health. Nearly two years later […]

Mrs. T. purchased medical travel insurance ahead of a trip abroad. On that holiday, she fell ill and had to be treated in hospital. Afterward, she submitted her claim. It was declined because the insurance plan did not cover anyone who had been treated for three specific medical conditions. In its final position letter, the […]

Mr. and Mrs. H. applied for life insurance and were approved. When her husband died several months later, Mrs. H. claimed the benefits under the policy. The insurance company denied the claim for failing to disclose information about Mr. H.’s health. Mrs. H. brought her final position letter to OLHI. She explained to our Dispute […]

Mrs. R. frequently traveled out of country. She purchased a travel health insurance plan that would cover her for 35 days every time she left Canada. She departed in February and in May, while still on her holiday, she suffered a major illness, was hospitalized and passed away two weeks later. While Mrs. R. was […]

Ms. C. worked as an office administrator, a predominantly sedentary role. She began to experience medical conditions that affected her back. Her employer’s group disability insurance plan covered her short-term disability claim. After several months, the insurance company denied Ms. C.’s coverage for long-term disability (LTD), stating that her illness did not prevent her from […]

Mrs. U. purchased life insurance in 2006. She explained to her agent that she only wanted a policy that would cover her for 10 years and that she planned to cancel when the term expired. She said she would not be able to afford the new premiums, which would rise dramatically after 10 years. Mrs. […]