benefits – OLHI – Free, impartial help with your life & health insurance complaints
OLHI OLHI – Free, impartial help with your life & health insurance complaints

Tag: benefits

Cancelling an insurance policy  – OLHI clears up a mistaken COI charge

Posted on:

Dale had a universal life insurance policy. 

When his insurance company told him they were going to charge him another premium for the policy, Dale decided to terminate it. 

To avoid a Cost of Insurance (COI) charge, the insurer told Dale to send a signed insurance cancellation letter to the same day he terminated his policy.

However, Dale’s insurer didn’t inform him that he needed to include his social insurance number (SIN) in the termination letter. Without the SIN, his policy termination got delayed and Dale was charged the COI. As a result, he received a lower refund than expected. 

After he received a final position letter from the insurer, Dale reached out to OLHI to review his complaint.

OLHI’s review confirmed that his insurance company did not tell Dale he had to include his SIN in the letter. 

OLHI’s review also found that even after Dale sent in the letter with his SIN, the company asked for it again. OLHI recommended that the insurer reconsider the COI charge for two reasons:

The company did not initially communicate that Dale needed to include his SIN in his termination letter. 

When the insurer said Dale needed to include the SIN, he did so, and sent the termination letter within the same day, so the company should have processed it effective as of the receipt date. 

Consequently, the insurer agreed and backdated the termination and refunded the COI charge.

Disclaimer: Names, places and facts have been modified in order to protect the privacy of the parties involved. This case study is for illustration purposes only. Each complaint OLHI reviews contains different facts and contract wording may vary. As a result, the application of the principles expressed here may lead to different results in different cases.

Taking Care of Dad – OLHI helps father and son with accident insurance complaint

Posted on:

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 pay for his medical expenses.

Fred’s insurer denied the claim. His son appealed, but the company upheld its final position.

When Fred’s son received the insurance company’s final position letter, he came to OLHI for help.

OLHI’s complaints team reviewed the complaint. We discovered that the original accident benefits claim did not have all of the available information about Fred’s injuries and hospital stays.

Based on hospital records, it was clear that both of Fred’s hospital stays were a result of his fall.

OLHI recommended that the insurer reconsider covering Fred’s hospital expenses.

The insurer paid the claim because of this new information.

Disclaimer: Names, places and facts have been modified in order to protect the privacy of the parties involved. This case study is for illustration purposes only. Each complaint OLHI reviews contains different facts and contract wording may vary. As a result, the application of the principles expressed here may lead to different results in different cases.

Resolving Conflicting Messages – OLHI helps mother and child with a refused health insurance claim

Posted on:

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 she could provide information proving they were medically required.

Lisa sent the company a letter from her son’s doctor justifying the treatments. The insurer still denied the claim in its final position letter.

Feeling lost and confused, Lisa came to OLHI for help. We reviewed her group health benefits policy. The policy’s definition of “eligible expense” had many conditions, used confusing wording, and didn’t clearly explain why Lisa’s claim was ineligible.

We contacted the insurer to learn more. They said the proposed treatments were not eligible because the policy only covered the cost of medical equipment, not the treatments themselves. Lisa was unaware of this condition until after she received the written follow-up.

Further review also found that the insurer took the position that the policy only covered medical equipment after it told Lisa it would pay for “medically reasonable” treatments.

We recommended that the insurer reconsider their position and cover the treatments for Lisa’s son because of the confusing communication with Lisa.

The insurer agreed, and Lisa’s son began his treatment.

Disclaimer: Names, places and facts have been modified in order to protect the privacy of the parties involved. This case study is for illustration purposes only. Each complaint OLHI reviews contains different facts and contract wording may vary. As a result, the application of the principles expressed here may lead to different results in different cases.

By continuing your navigation on this site, you accept the use of cookies.

These are designed to improve your user experience on our site by collecting traffic statistics and information on your behaviour.

More information on our Privacy Policy