Insurance agent approved my LTD claim BUT

so my insurance company approved my application after about 4 months of stalling.

this was only after I started requesting information to prove the timeline they were claiming.

during this a lot more stalling than out of the blue claim was approved.

what I asked for was proof of the check being issued and cashed by the Canadian government as I did not believe at this time they had actually done this or at least did it when they said.

then they claimed they could not release the funds to me until they heard back from Ontario works what amount they needed to pay to them. (fine I contacted Ontario works got the exact contact information and requested they also reach out to the insurance rep)

after confirming they received the necessary information they then claimed they needed to receive confirmation from Ontario works that the amount of money they requested was received and correct.

I called them out on this BS and requested the information I had previously requested to be proved as they had weekes now to obtain it, as well I wanted to see the proof with the date of the documents they were waiting on to approve the claim was “received”

after this, I was told they didn’t say what they said in their last email, and they are releasing the funds to me within the next few days now. as well only proved me the information on the date the check was issued for sending off to the government organization. as I suspected this was issued over a week after the day they claim they mailed the request.

this process pushed me to the edge of financial rune and they never paid interest on the money they had withheld for months as well refund me for the insurance I was required to pay during that time. not to mention halting and reversing my recovery as well causing me to question if I am just being paranoid or if they are in fact lying to me. (I have caught them in few so I know I was not being paranoid)

Conclusion:
For anyone dealing with insurance companies find creative ways to confirm timelines and request as much through email as possible so you have hard evidence and proof.

example of creative timeline discovery:
If 3rd party paperwork requires a fee to be paid on the other end ask when they mailed the request out then after some time ask when the check was issued.

note the time frame for Canada post to do national deliveries and request updates starting just before it should arrive till it does arrive to note how “fast” their mailroom is.

Main thing I’m looking for is Do you think I have a legal case?

thanks and best of luck to you all

If your plain includes a “waiver of premium” clause then they should reimburse you for the premiums you paid. Ask them about it.

thank you will do.

I was also wondering if there was still a case for damages and such related to the time they took and the proof of lies in there time line as actually sending requesting and using the paper work, as well blatant lie to tie funds up even more.

My understanding (from what my lawyer has told me) is basically as long as they continue to pay/reinstate benefits there are no legal grounds for a case. When they terminate benefits, there may be a case. He was honest and said that even before filing, he would write an appeal letter requesting to reinstatement my benefits (giving them one last chance), wait out the response and then move forward with filing.

Proof of lying is no matter at this point. It sucks and it’s very frustrating, but continue to what you can control: communicate in writing only so there is proof, follow their request for ongoing and regular treatment , submit paperwork and requests by deadlines and behave in a polite manner (your correspondence could be used in the legal case down the road) Keep your own notes of times and dates, but…let them dig their own hole LOL

Personally, I have taken to waiting before responding. I include prior written communication and screenshots in any responses (that need a response, not everything they say/do does) along with “Here is what you wrote to me on date, and here and here.”
This is a test of patience.

Thank you Marilyn for sharing your experience in this that is kind of what I needed to see.

I’ll make sure I have the shovel ready to hand them and keep offering more rope as they talk going forward, till I need to use it lol

I was recently terminated and they stated they had no medical information since August 2019. My doctor wrote a letter of appeal and called out the insurer that not only did they have their own IME report from after the date they quoted (it supports my diagnosis), my doctor sent in two reports and a psych evaluation after that date. She included the payment forms from the insurer themselves acknowledging they receiving those reports.
So they lied. And they put that lie in writing.

Works in my favour down the road.