Requesting Claim File?

Disability Insurance
1

Hello,

I would like to get a copy of my claim file from my insurance company, for my records. What laws, if any, pertain to this?

Are they required to supply this information upon request? I have read on this forum several people saying that they requested and got their claim file.

Thanks

2

You have a right to a copy of your claim file. Send proof of your request via email or fax. They have 30 days under PIPEDA.

Just ask politely. ie. For my records I am requesting a full and complete copy of my claim file and all related documents or records.

Thank you in advance for your prompt handling of this request.

Include your claim number or employee file number and address :slight_smile:

TIP Read it carefully–you will likely note missing pages and need to re-ask for the pages that were removed

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Legislation related to PIPEDA

The Office of the Privacy Commissioner of Canada (OPC) is responsible for overseeing compliance with the Personal Information Protection and Electronic Documents Act (PIPEDA), which sets out the rules businesses subject to the Act must follow when collecting, using and disclosing personal information.

However, some provinces have privacy legislation that has been deemed “substantially similar” to PIPEDA, which means that it is applied instead of PIPEDA in some cases.

In addition, the introduction of new federal legislation or updates to existing acts can sometimes introduce changes to PIPEDA.

On this link you can find information about provincial laws and key federal laws that relate to PIPEDA.
https://www.priv.gc.ca/en/privacy-topics/privacy-laws-in-canada/the-personal-information-protection-and-electronic-documents-act-pipeda/legislation-related-to-pipeda/

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Thanks for the information. I have visited the website link you provided and found exactly what you are saying is correct. You are a wealth of information!!!

Regards

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5

Would they be able to hold back surveillance photos/videos using this clause in the law?

“The information was collected for purposes related to an investigation of a breach of an agreement or a contravention of the laws of Canada or a province, and it would be reasonable to expect that the individual’s knowledge of or consent for the collection would compromise the availability or accuracy of the information (paragraph 9(3)”

6

Only if it is in litigation they may claim privileged or if your claim has already been denied. Usually they would include or you would see a reference to it. My friend received her claim file from Manulife and they sent the surveillance notes. She was observed washing her clothes in a laundry mat and carrying what appeared to be a very heavy blanket.

Unfortunately her apt. block had bed bug scare–which is why she was at a laundromat. She was also there with a social worker who was helping her due to her disability. Of course the investigator notes said she was observed visiting with a friend. She was not cut off-or was any of this mentioned to her. It was just in her file.

It was a few days before she went for a functional capacity exam

7

Do a search on this forum for “master policy”.

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It seems like you need to change your insurance company, if they denied your request. I’ve never met denials with American Insurance, pay attention on this company, read more about them

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Can you specifically ask for all emails, notes from telephone calls, communication between employees, related to Claim file # … of …?

These would include communication from my employer/manager to/from insurer, communication between case manager and i.e. insurer psychologist or whomever looks over the file?

10

Absolutely! We had to request emails between employer and GWL because they were referenced but left out. Once we asked they did send. You are entitled to any and all information that references your person. If they refuse to release then they must give you a reason of why.

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