Request the Master Policy? Thoughts


#1

Some government, University and other employers post on the internet the Master policy or have a copy you can review through your HR.
I am in Manitoba and under our Insurance Act:
Copy of group insurance
151(5) In the case of a contract of group insurance, the insurer
(a) must, upon request, provide a group life insured or claimant under the contract with a copy of
(i) the group life insured’s application, and
(ii) any written statement or other record provided to the insurer as evidence of the insurability of the group life insured under the contract that is not part of the application; and
(b) must, upon request and reasonable notice,
(i) permit a group life insured or claimant under the contract to examine a copy of the group insurance policy, and
(ii) provide that person with a copy of the policy.

I would think this is standard across the Provinces-but not sure.

Also in my husbands group Master Policy there is a condition that the employer must provide a copy upon request.

We still do not have a complete copy-his Insurer has sent sections in a piecemeal fashion. So frustrating.
I would advise requesting a copy in writing.

Any one else’s thoughts? The benefit booklet (summary) leaves so much out.


#2

Not all provinces have a clause like 151. You are very fortunate to have this. If you have already made a formal request and they have not complied, then you should file a complaint with your provincial insurance regulator. Each province handles this differently but there will normally be an provincial Ombudsman’s office or complaints office.

Normally, the only policies you find online are those that related to public sector organizations or a very large private sector employer. Normally you can’t find the policy online.


#3

Hello David I have a similar question to allyoops in regards to group health insurance. Does Ontario have a 151 (5) clause. Also my initial insurer has now been bought by another company…so since I went on LTD before the new company bought, when requesting a full copy of the contract should it be my original company or the new company.
sorry about the lack of question marks, my computer sometimes switches things and I don’t know how to change it

Thanks for your input
Connie


#4

Ontario does:
Copy of application, policy, etc. — group insurance
(5) In the case of a contract of group insurance, an insurer,

(a) on request, shall furnish to a group person insured or claimant under the contract a copy of,

(i) the group person insured’s application, and

(ii) any written statement or other record, not otherwise part of the application, provided to the insurer as evidence of the insurability of the group person insured under the contract;

(b) on request and reasonable notice, shall permit a group person insured or claimant under the contract to examine, and shall furnish to that person, a copy of the policy of group insurance. 2012, c. 8, Sched. 23, s. 36.


#5

Conlou, I am sorry your application was delayed but hopefully it goes smooth forward.
You can request a copy of the Master Policy and they should give you the correct contract. The governing contract number should be in your benefit book.
Requesting the Master Policy is a personal choice. My husband is on his 3rd claim and we did not request until his Insurer started to stomp on his rights.
No need to cause waves.
If the Insurer starts off about rehabilitation, IME’s etc… or other Issues, then I feel it is a good time to ask for it.
Remember, stay humble, stay respectful and cooperative.
Let your Insurer be the only one to flex its ego.


#6

This is very interesting. My wife’s insurer very clearly told us they did not have to provide the master policy and that we could only get it from her employer. The employer did not provide the document, so she started her rehab without seeing the document - and signed the medical waiver. One more issue to look into.


#7

Steve …what province are you in? Did you make the request in writing? Have your wife not go alone, please. Next time she goes she can request a copy of her signed waivers, file and report from the treatment providers.
I didn’t think to ask for copies of the waivers in my husbands claim and it ended up being important.

Also read the posts on who owns your medical file/reports.


#8

Thanks Lori…it did get resolved…I just didn’t like that I had to discuss with lawyer to get them to act.


#9

only 22 months and finally my husbands employer is allowing a complete copy of the policy…


#10

My insurer did send me a copy of the master policy but only the pages pertaining to ltd. I’ll try to request the full copy but not sure if I really need the rest of the policy right now.

The master policy seems to have more clauses than the one I found online.

There is a change in the policy number this year. One for ltd has an old policy number (from the year of active employment) and one for health benefits has a new policy number (changed this year). Interestingly even if I request an old master policy that applies to ltd it won’t apply to the rest of the benefits like health, dental, life insurance. It means I have to request 2 totally different master policies to have a clear understanding of my current situation.


#11

We received first one section that only related to LTD. Then GWL used a clause regarding assessments, which we did not have so they then sent another portion with respect to claim rules and disclosures. We were asking his employer to review the policy as it is the employers obligation to allow a review of the policy. GWL was interfering and calling his employer not to provide.
Because we did not have the full policy GWL told my husband he had a contractual obligation to apply and appeal for CPP. They also pledged to continue paying him full benefits while awaiting to see if his CPP claim would be accepted.

There is no contractual obligation for him to apply for CPP and they have cut his benefits in half while we wait for a decision.
So because his employer refused him the right to review they have contributed to this mess. His union finally told him this Wed. he can pick up a copy of the complete policy. Good luck!


#12

The pages that they sent me were quite informative. I’m looking forward to read the rest of the policy.

It’s not nice of them to make you apply for cpp-d in good faith and then reduce the payments after. Well add it to “gwl bad faith folder”.

My policy clearly states that if I don’t apply for the benefits I’m eligible for then they can estimate and deduct. But there is nothing in those pages about signing the forms. So yes to cpp-d, no to forms.
Not sure if they can even deduct anything from the payments right now as the policy says “if you don’t apply then…” Well I applied. So there shouldn’t be “then” as a result.


#13

GWL has had some amazing case managers that have been fair and have provided excellent service. Overall I think GWL is better than most. It was their disability intervention services that really made a mess and acted in extreme bad faith.
What does your policy say with respect to rehabilitation? Also the Team leader for the case managers has a lot of ego and that is what has pushed us to sue.


#14

It says that the insurer may provide with a structured vocational plan to prepare employee for a return to any employment. An employee will continue to receive disability benefits while participating in the vocational plan. If employee doesn’t cooperate then he/she will no longer be entitled to disability benefits.


#15

Did they send you the claim provisions section?

The major part that GWL had withheld from us was the insuring agreement:
Great-West Life agrees to pay the benefits provided by this policy to the persons entitled to receive them. This agreement is made in consideration of the Group Policyholder’s payment of the required premiums.
:wink:


#16

No, only pages about ltd.


#17

I also only recieved part of the policy when I asked for the master policy.A laywer is retained.Probably take years .Seems.so unethical after you have worked so hard for so long and cannot work.


#18

It is unethical. It is their business model. I hope you have a good lawyer. It will be a super stressful time so try to make part of each day where you are not allowed to think or talk about the claim. I have been there and it is hard to do.


#19

Hi,

Any idea what reasonable notice means?

I’m getting the run around from both the insurer and employer. The employer told me that the insurer had to provide the master policy (after clearly not wanting to provide) then after a few months the insurer told me the employer had to provide it.

I’m in Ontario. It seems they either don’t know the insurance act requirement or they are acting in bad faith.

Thanks


#21

Reasonable notice would be within 30 days. Stay polite and calm when asking to review the full and complete contract.

I would send an email jointly to both your case manager and HR. Simply ask that either or provides you with a copy.
Go from there. It is ok to explain that each are saying the other has to provide.

If you paid the full premium for coverage I would mention. Be brief. To the point and stay humble.