The basic duties and obligations when handling claim

I’ve been trying to find some kind of code of conduct, guidelines, duties or obligations on the part of insurance companies when it comes to handling claims, appeals, requests for information from the insured and haven’t been able to find anything.

Do these people just do whatever they want with no consequences?

There must at least be some guidelines established?

Also, anyone know where I can find an example of a narrative letter written from my doctor? Just trying to get an idea.

I’ve been advised by the agency regulating insurance matters in my province, to put together a comprehensive presentation of my claim, in order to file an official complaint through them. I need a good letter from my doctor, which I know I have to put together myself for her to add or remove what she needs. It’s a lot of work.


It’s a lot of work.
That’s what the insurance companies count on. You giving up so they don’t have to pay out a claim.
As for a narrative letter from your doctor, you’ll need to cite examples with dates and details. *i.e. Insurance company states in a letter dated February 1, 2020 that they have not received an update from my office since October 2019. *
*I have included four separate reports (with attached fax cover sheets) dated October 1, November 1, November 15, and December 1st, 2019. Also included is replies from the insurance company noting the acceptance of these reports.*In these reports, I have clearly noted the emotional and financial pressure patient is under from the expectations of the insurance company’s constant threat of termination of benefits.

Or something along those lines.