My insurer refuses to tell me how to repay them back


#1

Hello

I seek feedback and insight wrt a weird situation with my insurance company: it has been four months since my insurance company has been made aware of the fact that I have been awarded a CPP lump sum, and they are not asking for overpayment/ lump sum refund despite my repeated requests.

I have been posting on this forum a few times this year, however, I will briefly restate my background: I have been on LTD for 9 years, and recently, in the March 2018 timeframe I have also qualified for CPP.

Below I will divide the rest of my post into RECENT BACKGROUND and QUESTIONS.

RECENT BACKGROUND

Upon receipt of the CPP award, I emailed the insurer wrt the LTD contract implying, (through specific phrasing), that only the NET CPP should be offset from my LTD income, instead of the GROSS CPP.

Not surprisingly, the reply I got was a standard one, meaning it was hazy and not to the point. (I have already posted on this occurrence).

After that dismissal of my questions, I decide to escalate, and I replied to the Insurer by also copying their Chief Financial Officer and the HR Lead of my employer.

In this email I pointed out once more the wording in the contract and asked to be communicated “what contract/ policy wording is used to make the determination for the calculation”.

Two things happened at that point:

  1. the insurance employee replied back, saying that they do offset the GROSS CPP as a matter of “procedure”, and that there is “no specific policy language to to point you indicating that we offset the gross”
  2. my two subsequent request for a breakdown of the lump sum I owe and for a modality of my repayment of the overpayment/ lump sum did not get any replies. (I asked once at the start of July, and once at the start of August, I think)

I should mention that they ARE offsetting the gross CPP from my monthly LTD.

QUESTIONS:

Why are they not asking for the lump sum?
Is there an event that has to occur on their side? On mine?
Are they trying to cause a specific action on my part?
Or, is it related to the admission that they have no basis for GROSS deduction?
What does it mean?

Any insights, or suggestions are appreciated.

My Regards


#2

Since you have requested a breakdown of the payback and have proof then you show a willingness to pay back you have protected yourself.

I would keep the lump sum in a separate account earning yourself some interest. That is what we did. It also would be proof for court that you had the funds set aside.

Since they are deducting the gross amount as an offset it is your position they are underpaying you as per the contract.

You could eventually take this to small claims court (to protect yourself from cost awards larger than small claims)

My spouse took the same position as you but not sure what happened as he can not tell me.
in fact his position was that the deduction of a gross offset was in breach of the contract and that the Insurer could not now rely on the contract to claim back any offset.

You have a strong argument in that they said it is “procedure” and there is no policy language. Which means no right in the contract. So they have admitted they have no contractual right to offset the gross amount.

Good luck!


#3

My policy says:

We subtract any income provided to you:

  • for the same or a subsequent disability under any government-
    sponsored plan, excluding dependent benefits, employment
    insurance benefits and automatic cost-of-living increases under
    any government-sponsored plan that occur after benefits begin.

As for the gross vs net.
Search the forum. :slight_smile:


#4

I expect they are waiting for an internal legal opinion on the net vs gross and it may have got lost in the weeds or overlooked. Make sure you set the full amount aside because they will come to collect at some point. keep contacting them about to protect yourself in case they send it to collections or something like that.

You will owe them the money even if they take forever to try and collect. They are not waiving their rights.


David Brannen

Disability Lawyer with Resolute Legal

The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.


#5

Hello David
Thanks for the reply.
I have question. First I present my status then I will ask my question.

STATUS:
-my LTD contract implies, that NET should be deducted/ offset from the LTD pension. (This is implied through a choice of words, Contra Proferentem wise)
-the insurer has admitted in writing that their ACTUAL offset of the gross is a procedure and not specified in the POLICY

QUESTION:
What TYPE of law practitioner would be able to explore my options at this stage?
Would it be correct to say that were I to seek to sever my relationship to my insurer the above two facts would prove a bargaining factor? Or am I overestimating the impact of these facts.

My regards.


#6

Hi David,

A new development has occurred, which may or not be related, as a result I will open a new thread.
However, I would still appreciate your feedback to my previous post in this thread regarding types of lawyer and likelihood of success.

Many thanks


#7

You would want to find a lawyer with experience in disability insurance law and contract law. You would want to pay for a legal opinion on this issue. To do so you would need to get the lawyer a copy of the insurance policy and all correspondence you have had to / from the insurer since beginning of claim. We offer this type of service at Resolute Legal and other law firms may as well. Contact us at the phone number below if you was to learn about our services.

You should not try to sever any relationships, because you need the contract to be enforced to receive benefits. It is ok to be in dispute about one part of a contract (net vs gross), while enforcing the rest of the contract (payment of LTD benefit).


David Brannen

Disability Lawyer with Resolute Legal

The response posted above is based on the limited factual information made available and is not intended as a full and complete response to the question. The only reliable manner to obtain complete and adequate legal advice is to consult with a lawyer, fully explain your situation, and allow the lawyer enough time to research the applicable law and facts required to give an adequate opinion. The basic information provided above is intended as a public service only, a full one-on-one discussion with a lawyer should be done before taking any any action. The information posted on this forum is available to the viewing public and is not intended to create a lawyer client relationship with any person. If you want one-on-one advice, please click here to request a free consultation or call toll free 1-877-282-5188 to speak with a member with our disability claim support team.