Denied claims and onus of proof


#1

Basically there are 4 ways your disability claim will be denied.

  1. A straight out denial before any benefit payments are made
  2. At change of definition to any occupation

In both of these situations the onus is on you to prove you meet the definition of disability. That is why so many claims are ended at the 2 year mark or change of definition to any occ.

  1. Denial due to breach in policy ( not under Doctor’s care, non compliance to rehab/treatment and such)
    In that case both you and the Insurer would have the onus of proof)

  2. Denial because of improvement to the point the person can gain employment-Insurer bears the burden of proof


#2

Studying law? :slightly_smiling_face:

“Onus” would be responsibility?

Where do you find the information on disability law?


#3

In 2004 my home was flooded in minus 42 weather due to a city fire hydrant exploding and shooting water at my home for 4 hours. There was major damage and I was the good claimant. My adjuster told us we needed to wait til the spring thaw before we could fully assess the damage.
Months later he showed up with two contractors. He started yelling at me why I was alone and was I always alone? (Prior he said the only time they could come was when my husband was at work)
He then asked me to show them whatever I would like to show them. I said what do you mean, the damages?
He said show us whatever you like and we’ll watch. It went on for over an hour. I was asked if I was stupid, did I know what I was talking about. Was I looking for some caulking. In the end he said nothing happened here and you will get what I tell you.
I did not eat for 3 days. I got a lawyer and a month later of more garbage from a new adjuster -they found out I had a lawyer. 6 years later I got almost 10 times the amount I had sued for.
That is why I say tape record-that day I didn’t. Now I record.

I sued the adjusters also-as that was coming up a new law I wanted my day in court.

I learned so much because of that experience-and I have been able to help over 40 people have a variety of claims paid .that were initially denied. I read from Canlii, blogs, peer reviews all on Insurance law. Its just a passion.


#4

Thanks for sharing.

Sorry to hear about the flooding.

Sometimes you learn it hard way.

Yeah, this is what they do sometimes. My STD case manager was like that.

You’re doing the right thing.